ZPRAD Privacy Agreement
YOUR RIGHTS REGARDING YOUR PHI
You have certain rights regarding your PHI, which are explained below. You may exercise these rights by submit- ting a request in writing to our Privacy Officer.
1. You have the right to request a restriction of your PHI. You have the right to request restrictions on our uses and disclo- sures of PHI for treatment, payment, and health care opera- tions. However, we are not required to agree to your request, except we must agree not to disclose your PHI to your health plan if the disclosure (1) is for payment or health care opera- tions and is not otherwise required by law, and (2) relates to a health care item or service which you paid for in full out of pocket. If we 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.
2. You have the right to request to receive confidential com- munications of PHI by alternative means or at alternative lo- cations. You have the right to request that we communicate with you in a certain way or at a certain 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.
3. You have the right to inspect and copy your PHI. You have the right to inspect and copy the PHI contained in your medical and billing records and in any other Zwanger-Pesiri Radiology Group records used by us to make decisions about you. If you request a copy of your PHI, we may charge you a fee for the costs of copying and mailing your records, as well as other costs associated with your request. There are situations where we may deny request for access to your PHI. Depending on the circumstances of the denial, you may have the right to have our denial reviewed.
4. You have the right to amend your PHI. You have the right to request an amendment to your PHI contained in your medical and billing records and in any other Zwanger-Pesiri Radiology Group records used by us to make decisions about you. There are situations where we may deny your request for amendment. If we deny your request, we will send you a written explanation and allow you to submit a written statement of disagreement.
5. You have the right to receive an accounting of certain disclosures that we have made of your PHI. Your request must state a specific time period for the accounting, which may not be longer than 6 years from the date of the request. You may request a shorter time frame. The first accounting you request within a twelve (12) month period will be free. For additional accountings, we may charge you for the cost of providing the list. We will notify you of the costs involved, and you may choose to withdraw or modify your request at that time before any costs are incurred.
6. You have the right to obtain a paper copy of this Notice from us.
7. You have the right to opt out of receiving fundraising communications from us. We may contact you for fundraising purposes. You have the right to opt out of receiving these communications.
8. You have the right to receive notice in the event of a breach of unsecured protected health information.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION THAT MAY BE MADE EITHER WITH YOUR AGREEMENT OR OPPORTUNITY TO OBJECT
Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, orally or in writing, your PHI that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose your PHI to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location or general condition.
USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION THAT REQUIRE YOUR WRITTEN AUTHORIZATION
Other uses and disclosures of PHI not covered by this Notice will be made only with your permission in a written authorization. The following uses and disclosures will be made only with your authorization: i. Uses and disclosures that constitute the sale of protected health information;
ii. Most uses and disclosures of psychotherapy notes (if the practice maintains psychotherapy notes); and
iii.Other uses and disclosures not described in this Notice.
You have the right to revoke that authorization at any time, provided that the revocation is in writing, except to the extent that we already have taken action in reliance on your authorization.
COMPLAINTS
If you believe that your privacy rights have been violated, you should immediately contact the Zwanger-Pesiri Radiology Group’s Privacy Officer at (631)225-7200, ext. 1090. We will not take action against you for filing a complaint. You also may file a complaint with the Secretary of Health and Human Services.
CONTACT PERSON
If you have any questions or would like further information about this Notice, please contact the Zwanger-Pesiri Radiology Group’s Privacy Officer at (631) 225-7200, ext. 1090.
HIPAA NOTICE OF PRIVACY PRACTICES
This Notice describes how medical information about you may be used and disclosed and how you can get access to the information. Please review it carefully. This Notice is effective as of November 1, 2017.
INTRODUCTION
The Zwanger-Pesiri Radiology Group understands that your medical information is private and confidential. We are required by law to maintain the privacy of health information that identifies you or could be used to identify you (known as “Protected Health Information” or “PHI”).
As required by law, this Notice provides you with information about your rights and our legal duties and privacy practices with respect to the privacy of PHI. This Notice also discusses the uses and disclosures we will make of your PHI. We must comply with the provisions of this Notice as currently in effect, although we reserve the right to change the terms of this Notice from time to time and to make the revised Notice effective for all PHI we maintain. You can always request a written copy of our most current privacy Notice from Zwanger-Pesiri Radiology Group’s Privacy Officer at (631) 225-7200, ext. 1090. You may also request a copy via our website at https://zwangerpesiri.com/.
PERMITTED USES and DISCLOSURES OF PROTECTED HEALTH INFORMATION
We can use or disclose your PHI for purposes of treatment, payment, and health care operations without your authorization. For each of these categories of uses and disclosures, we have provided a description and an example below. However, not every particular use or disclosure in every category will be listed.
Treatment
We will use and disclose your PHI to provide, coordinate or manage your treatment. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In addition, the doctor may need to contact a physical therapist to create the exercise regimen appropriate for your care.
Payment
We will use and disclose your PHI to obtain payment for the health care provided to you. For example, prior to providing health care services, we may need to provide information to your health plan about your medical condition to determine whether the proposed course of treatment will be covered. We can also provide the health plan with information regarding your care if necessary to obtain payment. Federal or State law may require us to obtain a written release from you prior to disclosing certain specially protected health information for payment purposes, and we will ask you to sign a release when necessary under applicable law.
Health Care Operations
We will use and disclose your PHI in order to support our business activities. For example, we may use your PHI to decide what additional services we should offer, what services are not needed, and whether certain new treatments are effective.
OTHER PERMITTED USES and DISCLOSURES OF PROTECTED HEALTH INFORMATION
In addition to using and disclosing your PHI for treatment, payment, and health care operations, we may use and disclose your PHI in the following ways without your authorization: Required by the Secretary of Health and Human Services We may be required to disclose your PHI to the Secretary of Health and Human Services to investigate or determine our compliance with the requirements of the final rule on Standards for Privacy of Individually Identifiable Health Information. Required by Law We may use or disclose your PHI to the extent that the use or disclosure is otherwise required by federal, state or local law.
Research
Under certain circumstances, we may disclose your PHI to researchers when their research has been approved by an institutional review board that has reviewed the re- search proposal and established protocols to ensure the privacy of your PHI.
Organ and Tissue Donation
If you are an organ donor, we may disclose your PHI to organizations that handle organ procurement or organ, eye or tissue transplantation, or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
Military and Veterans
If you are a member of the Armed Forces, we may dis- close your PHI as required by military command authori- ties. We may also disclose PHI about foreign military per- sonnel to the appropriate foreign military authority.
Workers’ Compensation
We may disclose your PHI for programs that provide benefits for work-related injuries or illnesses.
Public Health Activities
We may disclose your PHI for public health activities, such as disclosures to a public health authority or other government agency that is permitted by law to collect or receive the information (e.g., the Food and Drug Administration).
Abuse or Neglect
We may disclose your PHI to the appropriate government authority if we believe you have been the victim of abuse, neglect, or domestic violence. We may also disclose your PHI to a public health authority that is authorized by law to receive reports of child abuse or neglect.
Health Oversight Activities
We may disclose health information to Federal or State agencies that oversee our activities. These activities are necessary for the government to monitor the health care system, government benefit programs, and compliance with civil rights laws or regulatory program standards.
Lawsuits and Disputes
We may disclose your PHI in response to a court or administrative order. In certain conditions, we may also disclose your PHI in response to a subpoena, discovery request, or other lawful process.
Law Enforcement
So long as applicable legal requirements are met, we may disclose your PHI if asked to do so by a law enforcement official, such as providing information about the victim of a crime.
Coroners, Medical Examiners, and Funeral Directors
We may disclose your PHI to a coroner, medical examiner or funeral director if it is needed to perform their legally authorized duties, such as to identify a deceased person or determine the cause of death.
National Security and Intelligence Activities
We may release your PHI to authorized Federal officials for intelligence, counterintelligence, or other national security activities authorized by law. Protective Services for the President and Others We may disclose your PHI to authorized Federal officials so they may provide protection to the President or other authorized persons or foreign heads of state or conduct special investigations.
Inmates
If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose your PHI to the correctional institution or law enforcement official.
Serious Threats
We may disclose your PHI if we, in good faith, believe it is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public or is necessary for law enforcement authorities to identify or apprehend an individual.
Business Associates
We may disclose your PHI to persons who perform functions, activities or services to us or on our behalf that require the use or disclosure of PHI. To protect your health information, we require the business associate to appropriately safeguard your information.
Note: HIV-related information, genetic information, alcohol and/or substance abuse records, mental health records and other specially protected health information may enjoy certain special confidentiality protections under applicable State and Federal law. Any disclosures of these types of records will be subject to these special protections.
