All Care Sleep Center Inc.
Effective Date: April 14, 2003
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
We are required by law to maintain the privacy of your medical information and to provide you with notice of our legal duties and privacy practices. We are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change those terms and any changes made will be effective for all medical information we maintain. A copy of a revised notice will be available by calling (877) 922-5111. You may also address questions regarding our privacy practices, your privacy rights, or requests for additional information regarding your privacy to this person.
Permitted Uses and Disclosures
We may use and disclose your medical information in the ordinary course of our business. We have described some of these uses and disclosures in the following paragraphs:
Treatment: We will provide your doctor or other health care provider with the results of the diagnostic imaging exams we perform. We may contact you before the exam to remind you of your appointment or to talk with you about preparing for the exam. We normally call you at the contact number you provide us. If you are not available or your voice mail answers, we will leave a brief message reminding you of the place and time of your appointment. If applicable, we will ask you to call us regarding your exam preparations.
Payment: We will bill your insurance company, you directly, or another person that may be responsible for payment of your account. We may need to contact your health plan to see if they will pay for the exams your doctor has ordered. Throughout this process, we may have to release details of your exam and medical condition, if your health plan or other payor requires this information to make payment.
Health Care Operations: We often have to use specific patient information to conduct our normal business operations. For example, we routinely review past exams performed to maintain quality assurance goals. One type of review we may conduct includes selecting images for review by another radiologist. Another is to select your billing information for review by our internal compliance team or by external auditors. In addition, we may use specific patient information to demonstrate our skills to an accreditation body. Accreditation is important to our patients and us because the process causes us to demonstrate some degree of proficiency in conducting examinations and maintaining the quality of our equipment.
Disclosures without Authorization
We may use and disclose medical information about you, without your specific authorization, as follows:
Disclosures Required by Law: We may be required by federal, state, or local law to disclose your medical information.
Public Health Activities: We may disclose your medical information to a public agency, such as the Food and Drug Administration (FDA), if you experience an adverse effect from any of the drugs, supplies, or equipment we use.
Victims of Abuse, Neglect, or Domestic Violence: We may be required to disclose your medical information if we feel that you have been abused or neglected.
Health Oversight Activities: We may be required to disclose your medical information to Medicare or a related agency if they select your case for a medical review.
Judicial and Administrative Proceedings: We may have to disclose your medical information if we receive a subpoena from a judge or administrative tribunal.
Law Enforcement: We may have to disclose your medical information in conjunction with a criminal investigation by a federal or state law enforcement agency.
Serious Threats to Health or Safety: We may be required to disclose your medical information if, in our opinion, doing so will help avert a serious threat to the public.
Military Personnel: We may disclose your medical information to the appropriate command authorities.
Worker’s Compensation: We may disclose your medical information to comply with laws regarding worker’s compensation.
You have certain rights with respect to your medical information.
Requesting Restrictions: You may ask us to limit our use or disclosure of your protected health information. We are not required to agree to your request, but if we agree to it, we will abide by your request except as required by law, in emergencies, or when the information is necessary to treat you. Your request must: 1) be in writing, 2) describe the information that you want restricted, 3) state if the restriction is to limit our use or disclosure, and 4) state to whom the restriction applies. You may revoke your restriction at any time by contacting our Privacy Coordinator as noted on the first page. We may ask to reschedule your exam while we consider your request.
Confidential Communications: You may ask that we communicate with you in a particular way, or at a certain location, to maintain your confidentiality. Your request must be in writing, tell us how you intend to satisfy your financial responsibility, and specify an alternate way that we can contact you confidentially. You do not have to give a reason for your request. In certain circumstances, we may require payment in full at the time you have your exam. You may revoke your request at any time by contacting our Privacy Coordinator at (877 922-5111. We may ask to reschedule your exam while we consider your request.
Inspect and Copy: You may request access to inspect and copy your medical information maintained in our records, including medical and billing records. Your request must be in writing. We will act on your request within 21 working days after we get the request. If we must deny your request, we will send you a written denial. If this happens, you may request a review of the denial. We may charge you a fee for providing copies. If that is the case, we will advise you of the cost of those copies at the time that we arrange for you to pick them up or have them delivered to you. We will compute these fees based on state guidelines. You may also have to pay for the cost of postage or shipping, depending on how you ask that we get these copies to you.
Amendment: You may ask us to amend your health information if you believe that it is incorrect or incomplete. Your request must be in writing and must include a reason to support the amendment. Your request may be denied if we believe that the information is complete and accurate, if the information is not part of the medical information that you would be permitted to inspect or copy, or if we did not create the information. If we amend the records, we will automatically provide notice of a change in your records to any entity with which we shared the record in the past 6 months or to anyone designated by you.
Accounting of Disclosures: You may request a list of non-routine disclosures that we have made of your medical information over the previous six (6) years. This does not include disclosures we make for your treatment, to seek payment for our services, or for our normal business operations as noted in the section on permitted uses and disclosures, or for those you authorize in writing. Your first request within a 12-month period is free, but we may charge for additional lists within the same 12-month period.
Paper Copy of This Notice: You are entitled to receive a paper copy of our Notice of Privacy Practices by contacting our Privacy Coordinator using the contact information on the web page.
File a Complaint: If you believe that we have violated your privacy rights, you may file a complaint directly with our Privacy Coordinator using the contact information on the first page. You may also file a complaint with the Secretary of the Department of Health and Human Services. We will not penalize you for complaining.
Patient Authorizations for Certain Disclosures
We will request your written authorization for uses and disclosures of your medical information that we did not identify in this notice or for those not otherwise permitted by law. These disclosures include your requests to provide exam results to your attorney, for exams related to life insurance or disability insurance applications, or for pre-employment physicals, among others. Your authorization is valid for one year after you grant it, unless you specify a shorter time. You may revoke your authorization in writing at any time by contacting our Privacy Coordinator using the contact information on the first page.