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.
If you have any questions about this Notice, please contact our Privacy Official who is identified at the end of the Notice.
We are required by law to maintain the privacy of your Protected Health Information (“PHI”), and are required to notify you of our legal duties and privacy practices with respect to your PHI. This Notice of Privacy Practices describes how we may use and disclose your PHI to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your PHI. “Protected Health Information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.
We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice, at any time. The new notice will be effective for all PHI that we maintain at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices by calling the office and requesting that a revised copy be sent to you in the mail. A copy of this notice will also be posted on our website at www.stmri.com.
USES AND DISCLOSURES OF PHI
1. Permitted Uses and Disclosures of PHI for Treatment, Payment and Healthcare Operations
Southern Tier Imaging (STI) may use or disclose your PHI for purposes of treatment, payment and healthcare operations, without your prior authorization. Below, we describe these purposes in greater detail and provide some examples. These examples are provided to help you understand uses and disclosures of PHI for treatment, payment and healthcare operations, but we do not attempt to describe all of the possible examples of such purposes.
Treatment: Your PHI may be used and disclosed by STI’s physicians and office staff to other health care providers outside of our office for purposes of your care and treatment. We will use and disclose your PHI to provide, coordinate, or manage your health care and any related services. For example, we may disclose your PHI, as necessary, to a home health agency that provides care to you. In addition, your PHI may be provided to a physician to whom you have been referred, or to a physician who has referred you to us for diagnostic imaging, to ensure that the physician has the necessary information to diagnose or treat you.
Payment: We may use and disclose your PHI to obtain payment of your health care bills. For example, we may disclose your PHI in submitting a claim to your health insurer.
Healthcare Operations: We may use or disclose, as needed, your PHI in order to support the business activities of STI. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, and conducting or arranging for other business activities. We will share your PHI with third party “business associates” that perform various activities in support of our operations (for example, billing services or record storage). Whenever an arrangement between our office and a business associate involves the use or disclosure of your PHI, we will have a written contract that contains terms that will protect the privacy of your PHI.
2. Other Permitted or Required Uses and Disclosures That May Be Made Without Your Authorization or Opportunity to Object
In addition to treatment, payment and healthcare operations, we may use and disclose your PHI for the following reasons, without your consent or authorization:
As required by law. We may make disclosures that we are required by federal, state or local law to make.
As required by judicial or administrative proceedings. For example, we make disclosures as required by court order.
As required for law enforcement purposes. For example, we make disclosures as required by grand jury subpoena or court-ordered warrant.
For public health activities. For example, we may report information about diseases to government officials in charge of collecting such information.
In response to health oversight activities. For example, we will provide information to assist the government when it conducts an investigation or inspection of a health care provider or organization.
For research purposes. Under certain conditions, we may provide PHI in order to conduct medical research.
About victims of abuse, neglect or domestic violence. We may disclose information regarding victims, if permitted or required by New York State law.
For specialized government functions. For example, we may disclose PHI of military personnel for military purposes.
For workers’ compensation purposes. We may provide PHI in order to comply with the Workers’ Compensation Law.
When contacting you. We may use PHI to provide appointment reminders or give you information about treatment alternatives, or other healthcare services we offer.
Other required uses and disclosures. Under the law, we must disclose your PHI to you upon your request, as described below. In addition, we must disclose PHI when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with federal medical privacy laws.
3. Other Uses and Disclosures that May Be Made upon Your Authorization or Where You Do Not Object
Unless you object in whole or in part, we may provide your PHI to a family member, friend or other person that you indicate is involved in your care or in the payment for your healthcare. In addition, we may use and disclose your PHI to assist in disaster relief efforts.
4.Uses and Disclosures of PHI Based upon Your Written Authorization
Other uses and disclosures of your PHI will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke this authorization, at any time, in writing, except to the extent that STI has already taken an action in reliance on your authorization.
5.Other Applicable Limitations on Disclosure
New York State law applies other restrictions on the disclosure of certain PHI. For instance, to the extent we have records containing such information, we may not disclose information about HIV or AIDS conditions or testing, mental health information, drug or alcohol abuse diagnosis or treatment information and certain kinds of information regarding pregnancy and family planning, without specific authorization from you, or in other limited circumstances provided by law.
The following is a statement of your rights with respect to your PHI and a brief description of how you may exercise these rights.
1. You have the right to inspect and copy your PHI. This means you may inspect and obtain a copy of PHI about you that is contained in a designated record set for as long as we maintain the PHI. A “designated record set” contains medical and billing records and any other records that STI uses for making decisions about you. However, we may deny your request in certain circumstances, as permitted or required by applicable law. For instance, we may deny access to information compiled by us in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding. In certain circumstances, you may have the right to have a denial reviewed. Please contact the Privacy Official identified at the end of this notice if you have questions about access to your medical record.
2. You have the right to request a restriction of your PHI. This means you may ask us, in writing, not to use or disclose any part of your PHI for the purposes of treatment, payment or healthcare operations. You may also request that any part of your PHI not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.
STI is not required to agree to a restriction that you may request. If STI does 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. With this in mind, please discuss any restriction you wish to request with your physician. Please direct any written request to the Privacy Official identified below.
3. You have the right to request to receive confidential communications from us by alternative means or at an alternative 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. We will not request an explanation from you as to the basis for the request. Please make this request in writing to our Privacy Official, identified below.
4. You may have the right to request that STI amend your PHI. This means you may request, in writing, that we amend any PHI about you in a designated record set for as long as we maintain this information. If we approve your request we will make the change to your PHI, tell you that we have done it, and tell others that need to know about the change to your PHI.We may deny your request for an amendment if: the PHI is not created by us; the PHI is not part of the health information kept by or for us; the PHI is not part of the information which you would be permitted to inspect and copy; or the PHI is accurate and complete. If we deny your request for amendment, you have the right to file a written statement of disagreement with us. If you do not file one, you have the right to request that your request and our denial be attached to all future disclosures of your PHI. Please contact our Privacy Official to determine if you have questions about amending your medical record.
5. You have the right to receive a list of certain disclosures we have made, if any, of your PHI. This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you, made to family members or friends involved in your care or for notification purposes. The list will include a statement of when, to whom, and why we released health information about you, along with a description of the PHI released. You have the right to receive a list of disclosures that occurred in the last six years, excluding disclosures made prior to April 14, 2003. You may request a shorter time frame. The right to receive this information is subject to certain exceptions, restrictions and limitations. Please contact our Privacy Official if you have questions.
6. You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically.
You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. We will not retaliate against you for filing a complaint.
You may contact our Privacy Official, Edwin J. Lis, by telephone at (607)729-1999, or in writing at 32 – 36 Harrison Street, Johnson City, NY 13790 for further information or to make a complaint.
This notice is effective as of Sept 4, 2013.