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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.
Why You Are Receiving This Notice
At Larchmont Medical Imaging (LMI), we are committed to treating and using protected health information about you in a responsible manner. We are required by federal and New Jersey law to treat your health information confidentially. It is your right to have us do so.
In meeting our commitment to you, we have developed a Privacy Compliance Program that is directed at protecting the privacy and confidentiality of your health information. This Notice of Privacy Practices describes the health information we collect, how and when we use or disclose that information, and your rights under our Privacy Compliance Program. LMI also participates in a health information exchange network called "the Virtua HIE", which gives authorized providers who participate in the Virtua HIE immediate electronic access to your pertinent health information for your care. This Notice describes how authorized health care providers, including radiologists associated with LMI, may use and disclose your health information electronically through the Virtua HIE. When you register, you will receive an informational brochure about the Virtua HIE, and you can get additional information about it by visiting www.virtua.org/hie.
Understanding Your Health Record Information
Each time you visit LMI, we create a record of your visit. Typically, this record contains your study films and reports. The medical record is a valuable tool that serves a number of purposes, such as:
Although the physical record that we create is the property of LMI, the information in it is about you, and it belongs to you. We want to help you make informed decisions about who has access to your health information.
Our Legal Duty
We are required by law to restrict the uses and disclosures of your health information. We are also required to give you this Notice about our privacy practices, our legal duties and your rights concerning your health information. If there is a security breach of your health information, we may be required by law to notify you and the Medicare program. We will follow the privacy practices that are in this Notice while it is in effect.
Uses and Disclosures of Your Health Information
Treatment, Payment and Health Care Operations Activities ("TPO")
We may use or disclose your health information for TPO purposes, without the need to get your written authorization. For example, those who are involved in your care and treatment will have access to your health information. In order for us to receive payment for the care we provide to you, we will need to tell your insurance company about that care. We may also use your health information for our own purposes, such as monitoring, planning and developing our care and services and educating our staff.
We may also disclose or release health information from your medical records to other health care providers involved in your care, such as to the physician who referred you to LMI.
In addition, unless you "opt-out" as described below under "Your Rights Regarding Your Health Information", any authorized health care provider who participates in the Virtua HIE can also electronically access and use your health information to provide treatment to you.
Other Uses and Disclosures Not Requiring Your Authorization
We may also use or disclose your health information to tell you about treatment options or alternatives or health-related benefits or services that we think may be of interest to you. We may use and disclose your health information to provide you with appointment reminders, such as voicemail messages. We may disclose your health information to business associates, which are individuals or organizations that perform certain key functions or processes for us. Before we disclose your health information to our business associates, we require them to give us written assurances that they will safeguard and protect the privacy of your health information.
We will disclose your health information when we are required to do so by law; for health oversightactivities conducted for or by governmental agencies; and for public health activities, such as toreport suspected child abuse, communicable diseases or certain types of injuries. We may use or disclose your health information for workers' compensation or similar programs as permitted or required by law.
If you are or were a member of the armed forces, we may release your health information to militarycommand authorities as required by law. We may use or disclose your health information in order toprevent or lessen a serious threat to your health and safety or the health and safety of someone else. If asked to do so, we may release your health information for law enforcement purposes, if we are permitted to do so by law. We may disclose your health information to authorized federal officials for purposes of national security.
We may disclose your health information if we are directed to do so by court order. In most circumstances, we may disclose your health information to a coroner or medical examiner, or to a funeral director. If you are an inmate, we may release your health information to the correctional institution where you are being housed, if required to do so by law.
Opportunity for You to Agree or Object
When possible, we will give you the option of restricting or limiting our use or disclosure of your health information for the involvement of your family or others in your care or payment for your care, or for disaster relief efforts.
Highly Confidential Health Information
Certain health information is specially protected under New Jersey law, including HIV-related information and information about tuberculosis. These protections apply to LMI when sharing specially protected information through the Virtua HIE.
AIDS or HIV Information
Records that contain identifying information about a person who has or is suspected of having AIDS or HIV infection can only be disclosed for certain purposes. New Jersey law permits us to release this information for management audits and financial audits. We may also release or disclose AIDS or HIV information to qualified personnel who are involved in your care and treatment, including for medical education purposes. We are permitted to release HIV or AIDS information to the New Jersey Department of Health and Senior Services, and to meet any obligation we may have to report communicable diseases for purposes of disease prevention and control. We are also permitted to release or disclose AIDS or HIV information if we are ordered by a court to do so AIDS or HIV information may also be released or disclosed in all other instances where authorized by New Jersey or Federal law.
If your health information indicates you have tuberculosis ("TB"), we usually must have your consent to release or disclose that information. However, we do not need your consent to release or disclose TB information about you for research purposes, when the New Jersey Commissioner of Health determines the disclosure is necessary to enforce public health laws or to protect the life or health of a specific person, or if we are ordered by a court to release it.
Other uses and disclosures of your health information not described in this Notice will be made only with your written permission. You can revoke that permission, in writing; but if you do, we are unable to take back any disclosures we already made with your permission.
Your Rights Regarding Your Health Information
You have the right to look at or get copies of your health information, with limited exceptions. You must submit your request in writing to the LMI File Room at the address on the back cover of this pamphlet. We may charge a fee to provide you with paper or electronic copies.
We may deny your request to look at or get a copy of your health information. If we do, we will explain why, and in most cases you may have the denial reviewed.
You have the right to request that we make corrections to your health information. Your request must be in writing, and it must explain the corrections to be made. We may deny your request under certain circumstances; and if we do, we will explain the reasons to you.
With certain exceptions, you have the right to know of the times (after April 14, 2003) when we have disclosed your health information without your authorization. We will provide you with a listing of those disclosures if you request it. If you request this listing more than once in a 12-month period, we may charge you a fee for the additional requests.
You have the right to request that we restrict or limit some of our uses or disclosures of your health information. We are not required to agree to those restrictions, unless the request involves health information to be disclosed for purposes of payment or health care operations and you have paid for the service you wish restricted "out of pocket" without submitting a claim to an insurer.
With regard to the Virtua HIE only, if you do not wish authorized providers involved in your care to share your health information through the Virtua HIE, you can submit a signed Opt-Out form either to us or to the Virtua HIE. The Opt-Out form can be obtained from any of your providers who participate in the Virtua HIE, you can download the form from www.virtua.org/hie, or you can call 1-888-847-8823.
You have the right to ask us to communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we contact you only at work or by mail. Your request must be in writing, and you must tell us where or how to contact you. We may require you to explain how payments will be handled before we grant your request.
If you received this Notice on our website or by electronic mail (e-mail), you have the right to receive this Notice in written form. You will receive a paper copy of this Notice at the time of your visit to LMI.
For More Information
If you have questions regarding your privacy rights or would like additional information, you may contact our privacy officer:
Larchmont Medical Imaging
1295 Route 38 West
Hainesport, NJ 08036
If you believe your privacy rights have been violated, you can file a complaint directly with LIA by contacting our privacy officer at the above address and phone number, or with the Secretary of the U.S. Department of Health and Human Services.
Effective Date; Revisions
The effective date of this Notice is April 14, 2003, as revised January 2012.
We reserve the right to change our privacy practices and the terms of our Notice at any time, as permitted by law. We reserve the right to make those changes effective for all health information that we maintain, even if we created or received it before we made the changes.
Our privacy practices, as described in this Notice, will remain in effect until we change this Notice. Whenever we make significant changes to our privacy practices, we will change this Notice and make the new Notice available upon request.