Notice of Privacy
Practices
Kearney Imaging Center
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.
Our goal is to protect the
privacy of your personal health information.
We call this information “protected health information,” or PHI for
short. We are legally required to:
-
Maintain the privacy of
PHI provided to us;
-
Provide you with this
notice of our legal duties and privacy practices; and
-
Follow the terms of our
Notice of Privacy Practices described in this notice. With some
exceptions, we may not use or disclose any more of your PHI than is
necessary.
Who Will Follow this
Notice
This notice describes the
practices of Kearney Imaging Center and Great Plains Radiology employees
and staff. These entities may share medical information with each other
for the treatment, payment, or health care operations described in this
notice.
Information Collected
about You
While receiving treatment
and health care services at Kearney Imaging Center, you will be
providing us with personal information such as your name, address, and
phone number, medical history, and insurance information.
We will create a record of
the medical care you receive at Kearney Imaging Center. Some
information will be given to us by you or others who are part of your
“circle of care,” such as referring and consulting doctors, other
healthcare facilities, your insurance or health plan, and family
members.
How We May
Use or Disclose Information about You
We may use and disclose your
PHI for different reasons:
For Treatment.
We will use your PHI to furnish services and supplies to you. For
example, we may use your medical history, such as past allergic
reactions to contrast (“dye”), when deciding the safety of using
contrast when performing a CT scan.
For Payment. We will use and disclose
PHI to bill for our services and to collect payment. For example, we
will give the insurance company information about your diagnosis so
that it will pay for exams we furnished. We may inform your payer of
tests you are going to receive in order to obtain prior approval or to
determine whether the service is covered.
For Health Care Operations. We may use
and disclose information about you for the general operation of our
business. For example, we may arrange for auditors to review our
practice, evaluate our operations, and tell us how to improve our
services.
Public Policy Uses and Disclosures.
There are a number of public policy reasons why we may disclose
information about you.
We may disclose your
health information when required by federal, state, or local law. For
example, we may disclose PHI to public health or law enforcement
officials about various diseases, or to prevent a serious threat to
the health and safety of you or others.
We may disclose PHI to the
Food and Drug Administration when reporting adverse events, product
defects, or to enable product recalls.
We may use and disclose
PHI for health oversight activities. For example, we will provide
information for a government inspection of a health care provider.
We may disclose your PHI
in response to the lawful request of a court in connection with a
government investigation, law enforcement activities, and legal or
administrative proceedings that involve you.
If you are an inmate, your
PHI may be released to a correctional institution where you are
incarcerated or to law enforcement officials.
We may release PHI to a
coroner or medical examiner to identify a deceased person or determine
a cause of death.
If you are a member of the
U.S. Armed Forces or foreign military, we may release your PHI as
required by your country’s military authorities.
Our Business Associates. We sometimes
work with outside individuals and businesses that help us operate our
business successfully. We may disclose your PHI to these business
associates so they can provide us with their services. They must sign
an agreement that they will respect the confidentiality of your PHI.
Individuals
Involved in Your Care or Payment for Your Care.
This includes people and organizations that are part of your “circle
of care”—such as your spouse, other doctors, or an aide caring for
you. Although we must speak to your physicians and health care
providers, you can inform us of individuals with whom you do not want
PHI shared. We may deny your request.
Other Uses and
Disclosure of Personal Information
We are required to obtain
your written authorization for any other uses and disclosures other than
those listed above. If you give us such permission, you may revoke that
permission in writing at any time. If you revoke your permission, we
will no longer disclose personal information about you for the reasons
covered by your written authorization. We will be unable to take back
any disclosures already made based upon your original permission.
Individual Rights
You have the right to ask
for restrictions to our use of your PHI beyond those the law requires.
We will consider your request, but we are not required to accept it.
You have the right to
inspect and copy your medical and billing records except in certain
circumstances. We may charge you a fee for copying and mailing.
You have the right to
request that any communications containing PHI be sent to you by
alternative means or to alternative locations. For example, you may ask
that we only contact you at home or by e-mail.
If you believe that
information in your records is incorrect or incomplete, you have the
right to ask us to correct the existing or missing information. Under
certain circumstances, we may deny your request.
You have a right to ask for
a list of disclosures we have made for reasons other than treatment,
payment, health care operations, or disclosures you authorized. If you
ask us for this information more than once a year, we may charge a fee.
You have the right to a copy
of this Notice in paper form at any time.
To exercise any of your
rights, please contact us in writing:
Linda Mercer, RN, Compliance
Officer
Kearney Imaging Center
3219 Central Ave. #109
Kearney, NE 68847
You may call the Compliance
Officer for instructions at: 308-865-2217.
Changes
to this Notice
We reserve the right to make
changes to this notice at any time, and to make the revised notice
effective for current and future PHI we have or will have about you. If
we change this Notice, the revised Notice will be posted. You may
request a copy of the revised Notice at any time.
Complaints/Comments
If you have any comments
concerning our Privacy Policy, you may contact our Privacy Officer at
308-865-2217 or the Secretary of the Department of Health and Human
Services in Washington,
D.C.
April 14, 2003
