THE RADIOLOGY CLINIC, LLC

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.

As part of your health care, The Radiology Clinic, LLC ("The Radiology Clinic") originates and maintains numerous medical, billing, and other related records containing private information about you. You provide personal information and medical information to The Radiology Clinic. Personal information includes your name, address, phone number, social security number, and driver's license number. Medical information includes your medical history, insurance coverage, or information from other doctors, nurses or medical providers. This notice describes how this information may be used and disclosed by The Radiology Clinic, as well as your rights and our duties with respect to such information. Our goal is to take appropriate steps to safeguard any medical or other personal information that you provide to us.

This notice also describes the practices of our employees when we provide services at:

• DCH Regional Medical Center

• Northport Medical Center

• Fayette Medical Center

• Pickens County Medical Center

• Bibb Medical Center

• Bryan W. Whitfield Memorial Hospital

Your Health Information Rights

Although all records relating to the treatment you receive at The Radiology Clinic are our property, you have the following rights with respect to your health information:

• You have the right to ask for restrictions on the ways in which we use and disclose your medical information beyond those required by law. We will consider your request, but we are not required to accept it.
• You have the right to obtain a copy of this notice in paper form upon request. You may ask us for a copy at any time from The Radiology Clinic's Privacy Officer at (205) 345-7000.
• Except under certain circumstances, you have the right to inspect and obtain a copy of your medical and billing records. If you ask for copies of this information, we may charge you a fee for copying and mailing.
• If you believe that information in your records is incorrect or incomplete, you have the right to ask us to correct the existing information or correct the missing information. Under certain circumstances, we may deny your request. We will notify you if we are unable to grant your request to amend your health record.
• You have the right to ask for a list of instances when we have disclosed your medical information for reasons other than your treatment, payment for services furnished to you, our health care operations, disclosures you give us authorization to make, and other limited circumstances. If you ask for this information more than once every twelve months, we may charge you a fee.
• You have the right to request that you receive communications containing your protected health information by alternative means or at alternative locations to protect your confidentiality. For example, you may ask to be contacted only at home or through the mail.

 

To exercise any of your rights, please contact us in writing at The Radiology Clinic, 208 McFarland Circle North, Tuscaloosa, AL 35406, Attention Leigh Wright, Privacy Officer.

Our Responsibilities

We are required by law to: (i) maintain the privacy of your health information; (ii) provide you with a notice as to the facility's legal duties and privacy practices with respect to your health information; and (iii) abide by the terms of this notice as it may be revised from time to time. THE RADIOLOGY CLINIC RESERVES THE RIGHT TO CHANGE THE TERMS OF THIS NOTICE AND TO MAKE ANY REVISIONS TO THE NOTICE EFFECTIVE FOR ALL YOUR PERSONAL HEALTH INFORMATION THAT WE MAINTAIN. Should we change the terms of this notice, we will post a copy of the revised notice at our office and on our website at www.tuscaloosaradiology.com. Additionally, you can request a copy of the revised notice at any time by contacting our office.

COMPLAINTS/COMMENTS/FOR MORE INFORMATION

If you have any complaints concerning our privacy practices under this Notice, you may contact us at The Radiology Clinic, PH# (205) 345-7000, 208 McFarland Circle North, Tuscaloosa, AL 35406, Attention Leigh Wright, or the Secretary of the Department of Health and Human Services. If you call, you will be required to put your complaint in writing. You will not be retaliated against for filing a complaint.

To obtain more information concerning this Notice of Privacy Practices, you may contact our Privacy Officer, Leigh Wright, PH# (205) 345-7000, The Radiology Clinic, 208 McFarland Circle North, Tuscaloosa, AL 35406.

Use and Disclosure of Your Health Information

The Radiology Clinic is permitted to use or disclose your personal health information ("PHI") in different ways. All of the ways in which we may use and disclose information will fall within one of the following categories, but not every use or disclosure in a category will be listed.

Treatment

We will use your PHI in the provision and coordination of your health care, in accordance with our policies and procedures. We may disclose all or any portion of your health information to your ordering physician, consulting physician or physicians, nurses, technicians, and other health care providers who have a legitimate need for such information in your care and continued treatment.

Payment

We may release PHI about you for the purposes of determining coverage, billing, claims management, medical data processing, and reimbursement. Your health information may be released to an insurance company, third party payer, person, or other entity or their authorized representatives involved in the payment of your medical bill. The information may include copies or excerpts of your medical record which are necessary for payment of your account. For example, a bill sent to a third party payer may include information that identifies you, your diagnosis, and the services and supplies provided to you. We may also need to inform your payer of the tests that you are going to receive in order to obtain prior approval or to determine whether the service is covered.

Routine Health Care Operations

We may use and disclose your health information during routine health care operations, including but not limited to, quality assurance, utilization review, medical review, internal auditing, accreditation, certification, licensing or credentialing activities.

Family and Friends Involved in Your Care

We may release health information about you to a friend or a family member who is involved in your medical care, but we may obtain your agreement before doing so. We may also give information to someone who helps pay for your care. Although we must be able to speak with your physicians or health care providers, you can let us know if we should not speak with other individuals, such as your spouse or family.

Business Associates

We may disclose certain health information about you to our business associates. A business associate is an individual or entity under contract with us to perform or assist us in a function or activity which necessitates our disclosure of health information. Our business associates must guarantee to us that they will respect the confidentiality of your personal and identifiable health information. Examples of business associates, include, but are not limited to, consultants, accountants, lawyers, medical equipment vendors and collection agencies.

Law Enforcement/Litigation

We may disclose your health information for law enforcement purposes as required by law or in some response to a valid subpoena or court order.

Public Health

As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury or disability. Public health authorities include state health departments, the Center for Disease Control, The Food and Drug Administration, the Occupational Safety and Health Administration and The Environmental Protection Agency, to name a few.

Workers' Compensation

We may release PHI about you for workers' compensation or similar programs. These programs provide benefits for work related injuries or illnesses.

Required By Law

We may disclose PHI about you when required to do so by law, in response to a warrant, subpoena, or other order of a court or administrative hearing body, and in connection with certain government investigations and law enforcement activities. We may also release PHI in the absence of such an order and in response to a discovery or other lawful request, if efforts have been made to notify you or secure a protective order.
 

Coroner, Medical Examiner, Funeral Directors

We may release your PHI to a coroner or medical examiner. This may be necessary for example, to determine the cause of death or identify a deceased person. We may also release your PHI to funeral directors as necessary to carry out their duties.

Organ Procurement Organizations

Consistent with applicable law, we may disclose your PHI to an organ procurement organization or entity engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.

Research

We may disclose your PHI to researchers when the research has been approved by an institutional review board that has reviewed the research purpose and established protocols to ensure the privacy of your health information. Before disclosing any of your PHI, we will verify that the researchers have obtained your consent to participate in the study.

Appointments, Reminders and Treatment Alternatives

We may contact you to provide appointment reminders or information about treatment alternatives or other health related benefits and services that may be of interest to you.

Food and Drug Administration

We may disclose to the FDA health information relative to adverse events with respect to food supplements, products, and product defects or post marketing surveillance to enable product recalls, repairs, or replacement.

Abuse/ Neglect

We are permitted to disclose PHI to a public health authority or other government authorized by law to receive reports of child abuse or neglect. We may also disclose your PHI in situations of domestic or elder abuse.

Health Oversight Activities

We may disclose PHI in connection with certain health oversight activities of licensing and other agencies. Health oversight activities include audit, investigation, inspection, licensure or disciplinary actions, and civil, criminal, or administrative proceedings or actions or any other activity necessary for the oversight of 1) the health care system, 2) governmental benefit programs for which PHI is relevant to determining beneficiary eligibility, 3) entities subject to governmental regulatory programs for which PHI is necessary for determining compliance with program standards, or 4) entities subject to civil laws for which PHI is necessary for determining compliance.

Injury/ Threat to Your Health and Others

Your PHI may be disclosed when necessary to prevent a serious threat to your health and safety or the health and safety of others.

Armed Forces

If you are a member of the Armed Forces, we may release your PHI as required by military command authorities. We may also release PHI about foreign military personnel to the appropriate foreign military authority.

Inmates

If you are an inmate, we may release PHI about you to a correctional institution where you are incarcerated or to law enforcement officials.

National Security

We may disclose PHI for national security and intelligence activities and for the provision of protective services to the President of the United States and other officials or foreign heads of state.

Other Uses

Any other use or disclosure of your health information will be made only with your written authorization. If you provide us with your authorization, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose PHI about you for the reason covered by your written authorization. We will be unable to take back any disclosures already made based upon your original authorization.

EFFECTIVE DATE 

The effective date of this notice is April 14, 2003.