Notice
of Privacy Practices
Bay
Imaging Consultants Medical Group, Inc.
and
the
following Affiliated Covered Entities:
Alta
CT Services, Diablo Valley Radiology, John Muir MRI, Contra Costa Imaging Center,
Magnetic
Imaging Affiliates, Neuroscan, Alta Imaging Associates
This Notice of Privacy
Practices describes how we may use and disclose your Protected Health
Information to carry out treatment, payment or health care operations and for
other purposes that are permitted or required by law. It also describes your
rights to access and control your Protected Health Information. Protected Health Information
(PHI) is information about you, including demographic information that may
identify you and that relates to your past, present or future health or condition. You will be asked to acknowledge
receipt of this notice. This notice will be
effective for all protected health information that we maintain at this time.
This notice may be revised from time to time and you may obtain any revised Notice of Privacy Practices by
calling this office to request that a revised copy be sent to you or asking for
one at the time of your next appointment.
Uses and Disclosures of
Protected Health Information (PHI)
The
following are examples of the types of uses and disclosures that we and our
affiliated entities described above are permitted to make without your further consent to disclosure of your PHI. These examples are
not meant to be exhaustive, but to describe the types of uses and disclosures
that may be made.
Treatment: We will use and disclose
your PHI to provide, coordinate, or manage your health care and any related
services. This includes the coordination or management of your health care with
a third party that may also provide you with their Notice of Privacy Practices.
We will disclose your PHI to other physicians who may be treating you when we
have the necessary permission from you to disclose your PHI. For example, your PHI may be provided to a
physician to whom you have been referred to ensure that the physician has the
necessary information to diagnose or treat you. In addition, we may disclose
your PHI from time-to-time to another physician or health care provider (e.g.,
a specialist or laboratory) who, at the request of your physician, becomes
involved in your care by providing assistance with your health care diagnosis
or treatment to your physician.
Payment: Your PHI will be used, as
needed, to obtain payment for your health care services. This may include
certain activities that your health insurance plan may require before it
approves or pays for the health care services that have been requested by your
physician (e.g., making a determination of eligibility or coverage for
insurance benefits, reviewing services provided to you for medical necessity, and
undertaking utilization review activities).
HealthCare
Operations: We may use or disclose, as needed, your PHI in order to support the
business activities of our company and our affiliates. For example, we may use
a sign-in sheet at the registration desk where you will be asked to sign your
name and indicate the name of your physician. We may also call you by name in
the waiting room when we are ready for you. We may use or disclose your PHI, as
necessary, to contact you to remind you of your appointment. We will share your
PHI with third party “business associates” that perform various activities
(e.g., billing, transcription services, medical record storage duties) for us
and our affiliates. Whenever an arrangement between our company or affiliate and
a business associate involves the use or disclosure of your PHI, we will have a
written contract that contains terms that will protect the privacy of your PHI.
Other
uses and disclosures of your PHI will be made only with your written
authorization, unless permitted or required by law as described below. You may
revoke this authorization at any time, in writing. In the case of an emergency, or when there is a communication
barrier, we may use our professional judgement to determine if you would intend
to allow the use or disclosure under the circumstances. You have the
opportunity to agree or object to the use or disclosure of all or part of you
PHI. If you are not available or able to agree or object to the use or
disclosure of your PHI, we may, using professional judgement, determine whether
the disclosure is in your best interest, within the extent of the law.
Other Permitted and Required
Uses and Disclosures that may be made without your Authorization or Opportunity
to Object
We
may use or disclose your PHI in the following situations without your
authorization or opportunity to object:
Required by
Law: We
may use or disclose your PHI to the extent that the use or disclosure is
required by law. The use or disclosure will be made in compliance with the law
and will be limited to the relevant requirements of the law. You will be
notified, as required by law, of any such uses or disclosures.
Public
Health: We may disclose your PHI for public health activities and
purposes to a public health authority that is permitted by law to collect or receive the
information. The disclosure will be made for the purpose of controlling
disease, injury or disability. We may also disclose your PHI, if directed by
the public health authority, to a foreign government agency that is
collaborating with the public health authority.
Communicable
Diseases: We may disclose your PHI, if authorized by law, to a person
who may have been exposed to a communicable disease or may otherwise be at risk
of contracting or spreading the disease or condition.
Health
Oversight: We may disclose PHI to a health oversight agency for
activities authorized by law, such as audits, investigations, and inspections.
Oversight agencies seeking this information include government agencies that
oversee the health care system, government benefit programs, other government
regulatory programs and civil rights laws.
Abuse
or Neglect: We may disclose your PHI to a public health authority that
is authorized by law to receive reports of child or elder abuse or neglect. In
addition, we may disclose your PHI if we believe that you have been a victim of
abuse, neglect or domestic violence to the governmental entity or agency
authorized to receive such information. In this case, the disclosure will be
made consistent with the requirements of applicable federal and state laws.
Food and Drug
Administration: We may disclose
your PHI to a person or company required by the Food and Drug Administration to
report adverse events, product defects or problems, biologic product
deviations, track products; to enable recalls; or to make repairs or
replacements, as required.
Legal
Proceedings: We may disclose PHI in the course of any judicial or
administrative proceeding, in response to an order of a court or administrative
tribunal (to the extent such disclosure is expressly authorized), in certain
conditions in response to a subpoena, discovery request or other lawful
process.
Law
Enforcement: We may also
disclose PHI, so long as applicable legal requirements are met, for law
enforcement purposes. These law enforcement purposes include 1) legal
processes, 2) limited information
requests for identification and location purposes, 3) processes pertaining
to victims of a crime, 4) where a
suspicion that death or injury has occurred as a result of criminal
conduct, 5) in the event that a crime
occurs on the premises of our affiliated
offices, and 6) where there is a
medical emergency (not on these premises) and it is likely that a crime has
occurred.
Coroners,
Funeral Directors, and Organ Donation: We may disclose PHI to a coroner or medical examiner for
identification purposes, determining cause of death or for the coroner or
medical examiner to perform other duties authorized by law. We may also
disclose PHI to a funeral director, as authorized by law, in order to permit
the funeral director to carry out their duties. We may disclose such information
in reasonable anticipation of death. PHI may be used and disclosed for organ,
eye or tissue donation purposes.
Research:
We may disclose your PHI to researchers when their research has been approved
by an institutional review board that has reviewed the research proposal and
established protocols to ensure the privacy of your PHI.
Criminal
Activity: Consistent with applicable federal and state laws, we may
disclose your PHI, if we believe that the use or disclosure is necessary to
prevent or lessen a serious and imminent threat to the health and safety of a
person or the public. We may also disclose PHI if it is necessary for law
enforcement authorities to identify or apprehend an individual.
Military
Activity and National Security: When the appropriate conditions apply,
we may use or disclose PHI of individuals who are Armed Forces personnel 1) for activities deemed necessary by
appropriate military command authorities;
2) for the purpose of a determination by the Department of Veterans Affairs
of your eligibility for benefits; or 3)
to foreign military authority if you are a member of that foreign military
services. We may also disclose your PHI to authorized federal officials for
conducting national security and intelligence activities, including for the
provision of protective services to the President or others legally
authorized.
Workers’
Compensation: Your PHI may be disclosed by us as authorized to comply
with workers’ compensation laws and other similar legally-established benefit
programs.
Inmates:
We may use or disclose your PHI if you are an inmate of a correctional
facility and your physician created or received your PHI in the course of
providing care to you.
Required
Uses and Disclosures: Under the law, we must make disclosures to you and for any instances required by the Health
and Human Services Department for investigation to determine our compliance
with the requirements of Section 164.500 et.seq.
Your Rights
Following
is a statement of your rights with respect to your PHI and a brief description
of how you may exercise these rights.
You
have the right to inspect and copy your PHI: This means you may inspect
and obtain a copy of PHI about you that is contained in a designated record set
for as long as we maintain the PHI. A “designated record set” contains medical
and billing records and any other records that your physician and we use for
making decisions about you. Under federal law, however, you may not inspect or
copy the following records; psychotherapy notes; information compiled in
reasonable anticipation of, or use in, a civil, criminal, or administrative
actions or proceeding, and PHI that is subject to law that prohibits access to
PHI. Depending on the circumstances, a decision to deny access may be reviewable.
In some circumstances, you may have a right to have this decision reviewed. A
form is available at this facility to request an inspection or copy of your
PHI.
Please
asked our staff to contact the person who handles privacy concerns for our
facility if you have questions or concerns.
You
have the right to request a restriction of your PHI: This means you may ask us not to use or
disclose any part of your PHI for the purposes of treatment, payment or
healthcare operations. You may also request that any part of your PHI not be
disclosed to family members or friends who may be involved in your care or for
notification purposes as described in this Notice of Privacy Practices. Your
request must state the specific restriction requested and to whom you want the
restriction to apply. We ARE NOT REQUIRED
to agree to a restriction that you may request. If we believe it is in your
best interest to permit use and disclosure of your PHI, your PHI will not be
restricted. If we do agree to the requested restriction, we may not use or
disclose your PHI in violation of that restriction unless it is needed to
provide emergency treatment. A form is available at this facility to request a
restriction of your PHI. Please asked our staff to contact the person who
handles privacy concerns for our facility if you have questions or concerns.
You
have the right to request to receive confidential communications from us by
alternative means or at an alternative location: We will accommodate
reasonable requests. We may also condition this accommodation by asking you for
information as to how payment will be handled or specification of an
alternative address or other method of contact. We will not request an
explanation from you as to the basis for the request. A form is available at
this facility to request alternative means or locations to receive confidential
communications. Please asked our staff to contact the person who handles
privacy concerns for our facility if you have questions or concerns.
You may have the right to have us amend your PHI. This means you may request that your PHI be amended in a specified
way for as long as we maintain this information. In certain cases, we may DENY your request for an amendment. If
we deny your request for amendment, you have the right to file a statement of
disagreement with us and we may prepare a rebuttal to your statement and will
provide you with a copy of any such rebuttal. A form is available at this
facility to request amendments to your PHI. Please asked our staff to contact the
person who handles privacy concerns for our facility if you have questions or
concerns.
You have the right to receive an accounting of
certain disclosures we have made, if any, of your PHI. This right applies to
disclosures for purposes other than treatment, payment or healthcare operations
as described in this Notice of Privacy Practices. It excludes disclosures we
may have made to you, to family members or friends involved in your care, or
for notification purposes. You have the right to receive specific information
regarding these disclosures that occurred after April 14, 2003. The right to
receive this information is subject to certain exceptions, restrictions and
limitations. A form is available at this facility to request an accounting of
your PHI disclosures we have made. Please asked our staff to contact the person
who handles privacy concerns for our facility if you have questions or
concerns.
You
have the right to obtain a paper copy of this notice, upon request,
even if you have agreed to accept this notice electronically.
Complaints
You
may complain to us or to the Secretary of Health and Human Services if you
believe your privacy rights have been violated by us. You may file a complaint
with us by contacting our Privacy Officer through our Patient Confidentiality
Voice Mail Box at (925)296-7199, Ext. 888
or email address complianceofficer@bmmi.net.
This
notice was published and becomes effective on April 1, 2003.
This notice was prepared from
a draft provided by the American Medical Association and reproduction and use
by physicians and their staff is permitted.