INVISION DIAGNOSTICS OF FLORIDA, LLC HIPAA NOTICE OF PRIVACY PRACTICES | Effective November 12, 2018
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PLEASE REVIEW THIS NOTICE CAREFULLY
This notice is provided to you pursuant to the Health Insurance Portability and Accessibility Act of 1996 and its implementation regulations (“HIPAA”). It is designed to tell you how we may, under federal law, use or disclose your Health Information.
I. Patient Rights. You have certain rights with respect to our 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 our restriction at any time by contacting our Privacy Officer. 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 intent to satisfy you 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 Officer. You have the right to receive your Health Information through confidential means and in a manner that is reasonably convenient for you and us. We may ask to reschedule your exam while we consider your request.
* Inspect and Copy: You may request access to inspect and copy you medical information maintained in our records, including medical and billing records. Your request must be in writing. We will act on your request for copies by the 15th business day after we get the request. We will act on your request to inspect within 30 days after we get it or within 60 days if the information is stored at another location. 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 is tis 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.
* Accounting of Disclosures: You may request a list of non-routine disclosures that we have made or 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 normal business operations as noted in the section on permitted uses and disclosures, or for those your 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.
* Self-payment: You have the right to request restrictions for disclosures related to self-payment. Our practice is required to comply with a request not to disclose health information to a health plan for treatment when the individual has paid in full out-of-pocket for a health care item or service and signed our “Do Not File Insurance Form”.
* Paper Copy of This Notice: You are entitled to receive a paper coot of our Notice of Privacy Practices by contracting our Privacy Officer.
* File a Complaint: If you believe that we have violated your privacy rights, you may file a complaint directly with our Privacy Officer using the contact information on the second page. You may also file a complaint with the Secretary of the Department of Health and Human Services. We will not penalize you for filing a complaint.
II. Permitted Uses and Disclosures. We may use and disclose your medical information in the ordinary course of our business.
* Treatment: We may use your medical information to provide you with medical services and supplies. We may also disclose your medical information to others who need that information to treat you, such as doctors, physician assistants, nurses, medical and nursing students, technicians, therapists, emergency service and medical transportation providers, and other healthcare professionals involved in your care. We may also use and disclose your medical information to contact you to remind you of an upcoming appointment, to inform you about possible treatment options or alternatives, to tell you about health-related services available to you, or to perform follow-up calls to monitor you care experience.
* 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 exam. Throughout this process, we may have to release details of your exam and medical condition if your health plan or 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.
III. 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, 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. We may use or disclose your health information to health oversight agencies during the course of audits, investigations, certification and other proceedings.
* 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 use or disclose your health information to a law enforcement official to comply with a court order or grand jury subpoena and other law enforcement purposes.
* Serious Threats to Health of 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.
* Sale or Merger of Business: In the event that our business is sold or merged with another organization, your health information/records will become the property of the new owner.
IV. For all other circumstances, we may only use or disclose your health information after you have signed an authorization. If you authorize us to use or disclose your health information for another purpose, you may revoke your authorization in writing any time.
* Breach: All patients will be informed if there is a breach, as defined by federal rules, of their unsecured protected health information as required by the HIPPA regulations.
V. Our Duties:
We are required by law to maintain the privacy of your health information and to provide you with a copy of this notice. We are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to amend this notice at any time in the future and to make the new notice provisions applicable to all your health information, even if it was created prior to the change in the notice. A copy of a revised notice will be available at any of our imaging center, or from our Privacy Officer by calling 919-606-2856 or by writing Invision Diagnostics of Florida, LLC at 1025 SW Martin Downs Blvd Ste 201 Palm City, FL 34990. You may also address questions regarding our privacy practices, your privacy rights, or requests for additional information regarding your privacy.
VI. Contact Information.
You may contact us about our privacy practices or to file a complaint by call our Privacy Officer at (919) 606-2856.
You may contact the DHHS at: The U.S. Department of Health and Human Services, 200 Independence Avenue S.W. Washington, D.C. 20201, Telephone: 202-619-0257, Toll Free: 1-877-696-6775.
We will review all complaints in a professional manner and keep you informed of your rights as our patient. We promise not to retaliate against you for any compliant you make about our privacy practices.