LARCHMONT IMAGING ASSOCIATES,
L.L.C. - NOTICE OF PRIVACY PRACTICES
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 Imaging Associates (LIA), 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.
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. 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 LIA.
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 oversight activities conducted for
or by governmental agencies; and for public health activities,
such as to report 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 military command authorities as required
by law. We may use or disclose your health information in order
to prevent 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.
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.
Understanding Your Health Record Information
Each time you visit LIA, 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:
• Planning your care and treatment
• Communicating with those who provide you with care or
services;
• Allowing your insurer to verify that services billed were
actually provided;
• Educating healthcare professionals;
• Assessing our own performance so that we can continue
to improve our care and services.
Although the physical record that we create is the property
of LIA, 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.
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.
Tuberculosis Information
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 Heath 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. However, the physician who ordered your
test can best explain the test results. It is our preference and
recommendation that you obtain test results and reports from your
ordering physician. If you are still interested in obtaining copies
of your health information after you have reviewed your test results
with your ordering physician, you may submit a request in writing
to our administrative offices at the address on the back cover
of this pamphlet.
We may also 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.
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 LIA.
If you believe your privacy rights have been violated, you can
file a complaint directly with LIA by contacting our privacy officer
at the address and phone number below, 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. 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.
Privacy Officer
1295 Route 38 West
Hainesport, NJ 08036
609-261-1493
