This Policy shares how medical information about you may be disclosed or used, as well as how you may access this information.
Effective Date January 1st, 2017. Please Read It Carefully.
Bellevue Medical Imaging’s strives to take appropriate steps to safeguard all medical or other personal information that is provided to us. We are required to: (1) maintain the privacy of medical information provided to us; (2) provide notice of our legal duties and privacy practices;(3) abide by the terms of our Notice of Privacy Practices (“Notice”) currently in effect; and (4) notify affected individuals following a breach of unsecured protected health information.
Persons required to abide by this Notice:
This Notice describes the practices of our staff as well as all employees and affiliates of Bellevue Medical Imaging, PLLC., all of whom will follow the terms of this Notice. These individuals, and affiliates, may share protected health information with each other solely for the purpose of payment, treatment, or health care operations as described in this Policy.
Information Obtained About You:
In the ordinary course of receiving treatment and health care services from us, you will be providing us with personal information such as:
- Your name, address, and phone number.
- Information relating to your medical history.
- Your insurance information and coverage.
- Information concerning your doctor, nurse or other medical providers.
- Information pertaining to required diagnostic and imaging procedures.
Some additional information may be provided to us by other individuals or organizations such as the referring physician, your other doctors, your health plan, and close friends or family members.
The Usage And Disclosing of Your Information:
There are various ways we may use and disclose personal and identifiable health information.
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.
For Treatment. We may use protected health information to provide services and supplies to you for treatment purposes in accordance with our policies and procedures. An example is if our doctor is treating you for a particular condition, we may need to obtain and use information from your health plan about prior treatment of similar or different condition.
For Payment. To bill for our services and to collect payment from you or your insurance company, we may use and disclose protected health information about you. For example, we may need to give a payer information about your current medical condition so that the payor will pay us for the reading of an examination or other services that we have provided 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.
For Health Care Operations. Sometimes we arrange for accreditation organizations, auditors or other consultants to review our practice, to evaluate our operations, and to tell us how to improve our services.
We may use and disclose protected health information about you for the general operation of our business.
Public Policy Uses and Disclosures. There are a number of public policy reasons why we may disclose protected health information. If required to do so by federal, state, or local law, we may disclose protected health information. We may disclose protected health information about you in connection with certain public health reporting activities. For instance, we may disclose such information to a public health authority authorized to collect or to receive protected health information for the purpose of preventing or controlling disease, injury or disability, or at the direction of a public health authority, to an official of a foreign government agency that is acting in collaboration with a public health authority.
Information about you also will be disclosed when necessary to prevent a serious threat to your health and safety or the health and safety of others.
We are permitted to disclose protected health information to a public health authority or to other government authorities authorized by law to receive reports of child abuse or neglect.
In situations of domestic abuse or elder abuse, we may disclose your protected health information.
We may disclose protected health information 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 the health care system governmental benefit programs for which protected health information is relevant to:
- determining beneficiary eligibility entities subject to governmental regulatory programs for which protected health information is necessary for determining compliance with program standards;
- entities subject to civil rights laws for which protected health information is necessary for determining compliance.
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 disclose information. We may release protected health information to a coroner or to a medical examiner to identify a deceased person or to determine the cause of death.
We also may release protected health information to organ procurement organizations, transplant centers, and eye or tissue banks.
We may release your protected health information to workers compensation or similar programs.
If you are a member of the Armed Forces, we may release protected health information about you as required by military command authorities. We also may release protected health information about foreign military personnel to the appropriate foreign military authority. We may disclose your protected health information for legal or administrative proceedings that involve you. We may release such information upon order of a court or administrative tribunal. We may also release protected health information 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 to secure a protective order.
If you are an inmate, we may release protected health information about you to a correctional institution where you are incarcerated or to law enforcement officials.
Finally, we may disclose protected health information 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.
Our Business Associates. We sometimes work with outside individuals and businesses that help us to operate our business successfully. Our business associates must guarantee to us that they will respect the confidentiality of your personal and identifiable health information. We may disclose your protected health information to these business associates so that they can perform the tasks that we hire them to do.
Individuals Involved in Your Care or Payment for Your Care. Although we must be able to speak with your other physicians or health care providers, you can let us know if we should not speak with other individuals, such as your spouse or family. We may disclose information to your personal representative involved in your care or in the payment for your care.
Treatment Alternatives. We may use and disclose your protected health information in order to tell you about or recommend possible treatment options, alternatives or health-related services that may be of interest to you.
Other Uses and Disclosures of Personal Information. We are required to obtain written authorization from you for any other uses and disclosures of protected health information other than those described above, including, but not limited to: uses and disclosures of any protected health information for marketing purposes (except in certain circumstances) and disclosures that constitute the sale of protected health information. If you provide us with such permission, you may revoke that permission, at anytime however it must be in writing. If you revoke your permission, we will no longer use or disclose protected health 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 request restrictions on the ways in which we use and disclose your protected health information beyond those imposed by law. We are not required to accept it unless the request is to restrict disclosures of protected health information about you to a health plan if the disclosure is for the purpose of carrying out payment or health care operations and not otherwise required by law, and the protected health information pertains solely to a health care item or service for which you, or a person other than the health plan on your behalf, have paid in full. You have the right to request that you receive communications containing your protected health information from us by alternative means or at alternative locations. For example, you may ask that we only contact you at home or by mail. You have the right to inspect and copy medical and billing records about you (except under certain circumstances). If you ask for copies of this information, we may charge you a fee for copying and mailing.
You have the right to ask us to correct the existing information, correct the missing information, or otherwise amend the protected health information if you believe that information in your records is incorrect or incomplete. We may deny your request under certain circumstances,
You have a right to ask for a list of instances when we have used or disclosed your protected health information for reasons other than your treatment, payment for services provided to you, our health care operations, or disclosures you have given us authorization to make.
- You have the right to a copy of this Notice in paper form.
- You may ask us for a copy at any time.
- You may also obtain a copy of this form on our website: www.BMIRAD.com