Notice of Privacy Practice
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.
Victoria Radiology Associates (VRA) uses and discloses health information about you for treatment, to obtain payment for treatment, for administrative purposes, and to evaluate the quality of care that you receive.
This notice describes our privacy practices. You can request a copy of this notice at any time.
For more information about this notice or our privacy practices and policies, please contact the person listed below.
Disclosures of Treatment, Payment, and Health Care Operations Information
We are permitted to use and disclose your medical information to those involved in your treatment.
For example, in diagnostic radiology imaging when we provide services, we may request that your referring physician share your medical information with us.
Also, we may provide your referring physician information about your particular condition so that he or she can appropriately treat you for other medical conditions, if any.
We are permitted to use and disclose your medical information to bill and collect
payment for the services provided to you. For example, we may submit a claim form
to your insurer or managed care organization to obtain payment. The form will contain
medical information, such as a description of the medical services provided to you,
that your insurer or managed care organization needs to approve payment to us. We
must agree to restrict the disclosure of PHI (for payment or healthcare operations)
to a health plan when you pay for the service or item out of pocket in full. As
a provider it is mandatory for us to agree when this request is made.
Health Care Operations
We are permitted to use or disclose your medical information for the purposes of health care operations, which typically include business activities that support this practice and help us provide quality care.
For example, we may engage the services of a professional to aid this practice in its compliance programs.
They will review billing and medical files to determine that we maintain our compliance with regulations and the law.
Or, we may ask another physician to review this practice’s charts and medical records to evaluate our performance.
Other Disclosures That Can Be Made Without Your Authorization
There are situations in which we are permitted by law to disclose or use your medical information without your written authorization or an opportunity to object.
We may disclose medical information for management audit, financial audit, or program evaluation, but the personnel may not directly or indirectly identify you in any report of the audit or evaluation, or otherwise disclose your identity in any manner.
We may disclose your medical information for public health activities.
Public health activities are mandated by federal, state, or local government for the collection of information about disease, vital statistics (i.e. births and death), or injury by a public health authority.
We may disclose medical information, if authorized by law, to a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
We may disclose your medical information to report reactions to medications, problems with products, or to notify people of recalls of products they may be using.
Abuse or Neglect
We may, in accordance with the requirements of Texas and federal laws and regulations, also disclose medical information to a public agency authorized to receive reports of child abuse or neglect.
Texas law requires physicians to report child abuse or neglect.
Regulations also permit the disclosure of information to report abuse or neglect of elders or the disabled.
We may disclose your medical information to a health oversight agency for those activities authorized by law.
Health oversight agencies include public and private agencies authorized by law to oversee the health care system.
Examples of these activities are audits, investigators, licensure applications and inspections which are all government activities undertaken to monitor the health care delivery system and compliance with other laws, such as civil rights and criminal laws.
Legal Proceedings and Law Enforcement
We may disclose your medical information in the course of judicial or administrative proceedings in response to an order of the court (or the administrative decision-maker) or other appropriate legal process.
Certain requirements must be met before the information is disclosed.
If asked by a law enforcement official, we may disclose your medical information under limited circumstances, including, but not limited to information that:
- released pursuant to legal process, such as a warrant or court ordered subpoena;
- Pertains to a victim of crime and your are incapacitated;
- Pertains to a person who has died under circumstances that may be related to criminal conduct;
- Is about a victim of crime and we are unable to obtain our agreement;
- Is released because of a crime that has occurred on Victoria Radiology Associates’s premises; or
- Is released to locate a fugitive, missing person, or suspect.
To Avert a Serious Threat to Health or Safety
We may also release medical information about you to medical or law enforcement personnel if we believe the disclosure is necessary to prevent or lessen an imminent threat to your health and safety or the health and safety of another person.
We may disclose your medical information as required by the Texas workers’ compensation law.
If you are an inmate or under the custody of law enforcement, we may release your medical information to the correctional institution or law enforcement official.
This release is permitted to allow the institution to provide you with medical care.
Military, National Security and Intelligence Activities, Protection of the President
We may disclose your medical information for specialized governmental functions such as separation or discharge from military service, requests as necessary by appropriate military command officers (if you are in the military), authorized national security and intelligence activities, as well as authorized activities for the provision of protective services for the President of the United States, other authorized government officials, or foreign heads of state.
Under certain circumstances, we may use and disclose medical information about you for research purposes.
All research projects, however, are subject to a special approval process.
Prior to using or disclosing any medical information, the project must be approved through this research approval process.
We will ask for your specific permission if the researcher will have access to your name, address, or other information that reveals who you are, or who will be involved in your care.
Organ Donation, Coroners, Medical Examiners, and Funeral Directors
We may release medical information to organ procurement organizations for the purpose of facilitating organ, eye, or tissue donation if you are a donor.
Also, we may release your medical information to a coroner or medical examiner to identify a deceased person or a cause of death.
Further, we may release your medical information to a funeral director where such a disclosure is necessary for the director to carry out his duties.
Required by Law
We may release your medical information where the disclosure is required by law.
Sale of Practice
We may use and disclose medical information about you to another physician or healthcare facility in the sale, transfer, merger, or consolidation of Victoria Radiology Associates’s practice.
In other situations we will ask for your written authorization before using or disclosing any identifiable health information about you.
If you chose to sign an authorization to disclose information, you can later revoke that authorization, in writing, to stop future uses and disclosures.
However, any revocation will not apply to disclosures or uses already made or taken in reliance on that authorization.
Your Rights Under Federal Privacy Regulations
The United States Department of Health and Human Services created regulations intended to protect patient privacy as required by the Health Insurance Portability and Accountability Act (HIPAA).
Those regulations create several privileges that patients may exercise.
We will not retaliate against a patient that exercises his/her HIPAA rights.
Your rights include:
You may request that we restrict or limit how your protected health information is used or disclosed for treatment, payment, or healthcare operations.
We do NOT have to agree to this restriction, but if we agree, we will comply with your request except under emergency circumstances.
To request a restriction, submit the following in writing:
- the information to be restricted;
- what kind of restriction you are requesting (i.e. on the use of information, disclosure of information or both); and
- to whom the limits apply.
Please send the request to the address and person listed below.
We will notify you if we are unable to agree to a requested restriction.
You may also request that we limit disclosure to family members, other relatives, or close friends that may or may not be involved in your care.
If you request that we limit disclosure to the person responsible for payment for services provided to you, you must make alternative payment arrangements with us.
Receiving Confidential Communications by Alternative Means
You may request that we send communications of protected health information by alternative means or to an alternative location.
This request must be made in writing to the person listed below.
We are required to accommodate only reasonable requests.
Please specify in your correspondence exactly how you want us to communicate with you and, if you are directing us to send it to a particular place, the contract/address information.
Right to Inspect and Copy
You have the right to inspect and copy medical information that may be used to make decisions about your care.
Usually, this includes medical and billing records.
We can refuse to allow you to inspect and copy information:
- that includes the identity of a person who provided information if it was obtained under a promise of confidentiality;
- that is subject to the Clinical Laboratory Improvements Amendments of 1998; or
- that has been compiled in anticipation of litigation.
If you are denied access to medical information, you may request the denial be reviewed.
Another licensed health care professional chosen by our practice will review your request and denial.
The person conducting the review will not be the person who denied your request.
We will comply with the outcome of the review.
With your permission, Texas law allows us to provide you a summary within 15 days of your request.
We will inform you of when the records are ready or if we believe access should be limited.
If we deny access, we will inform you in writing.
HIPAA permits us to charge a reasonable cost--based fee.
We will comply with the Texas State Board of Medical Examiners’ (TSBME) set fees for copies of medical records.
Amendment of Medical Information
If you feel that medical information we maintain about you is incorrect or incomplete you may request an amendment of your medical information in Victoria Radiology Associate’s designated record set.
Any such request must be made in writing to the person listed below.
You must provide a reason that supports your request.
We will respond within 60 days of your request.
We may refuse to allow an amendment if the information:
- was not created by this practice or the physicians here in this practice, unless the person or entity that created the information is no longer available to make the amendment;
- is not part of our Designated Record Set;
- not part of the information which you would be permitted to inspect and copy; or
- if the information is accurate and complete.
Even if we refuse to allow an amendment you are permitted to include a patient statement about the information at issue in your medical record.
If we refuse to allow an amendment we will inform you in writing.
If we approve the amendment, we will inform you in writing, allow the amendment to be made and make a reasonable effort to let others know the amended information.
It is your right to be notified when a breach of your unsecured PHI has occured.
We will notify individuals that are affected by the breach.
Accounting of Certain Disclosures
The HIPAA privacy regulations permit you to request, and us to provide, an accounting of disclosures that are other than for treatment, payment, healthcare operations, or made via an authorization signed by you or your representative.
Please submit any request for an accounting to the person listed below.
Your first accounting of disclosures (within a 12 month period) will be free.
For additional requests within that period we are permitted to charge for the cost of providing the list.
We will notify you and you may choose to withdraw or modify your request before any costs are incurred.
If you are concerned that your privacy rights have been violated, you may contact our Privacy Officer at the address or telephone number listed below.
You may also send a written complaint to the United States Department of Human Services.
We will not retaliate against you for filing a complaint with the government or us.
The contact information for the United States Department of Health and Human Services is:
U.S. Department of Health and Human Services
|Office of Civil Rights
||Region VI, Office for Civil Rights
|200 Independence Avenue, S.W.
||U.S. Department of Health and Human Services
|Room 509F, HHH Building
||1301 Young Street, Suite 1169
|Washington, D.C. 20201
||Dallas, Texas 75202
Your complaint must be filed within 180 days of when you knew or should have known that the violation occurred.
Our Promise to You
We are required by law and regulation to make every effort to protect the privacy of your medical information, to provide you with this notice of our privacy practices with respect to protected health information, and to abide by the terms of the notice of privacy practices in effect.
Questions and Contact Person for Requests
If you have any questions or want to make a request pursuant to the rights described above or to file a complaint, please contact our Privacy Officer at:
|Victoria Radiology Associates
|Victoria, Texas 77903
|(361) 578-0317, fax (361) 578-8142
This notice is effective on the following date: March 22, 2011.
Changes to This Notice
We may change our policies and this notice at any time and have those revised policies apply to all the protected health information we maintain.
If or when we made a material change to our notice, we will post the new notice in the office where it can be seen.
You may request that a copy be provided to you by contacting our Privacy Officer at the address or telephone number above.