NOTICE OF PRIVACY PRACTICES

Effective Date: April 14, 2003.

THIS NOTICE DESCRIBES HOW PERSONAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
We respect patient confidentiality and will only release your personal health information in accordance with NY State and Federal laws. This notice describes our policies related to the use of your personal health information records generated by Radiology Associates Of New Hartford.

Privacy Contact: If you have any questions about this policy or your rights, contact our Privacy Compliance Coordinator at 315-793-8806.

USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION

In order to effectively provide care, there are instances in which we need to share your Personal Health Information (PHI) with others beyond Radiology Associates Of New Hartford. With your permission, we may use or disclose PHI about you. These instances may include:

Treatment We may disclose your personal health information(PHI) to provide, coordinate, or manage your care or any related services, including sharing information with others outside Radiology Associates Of New Hartford with whom we are consulting or referring.

Payment We may disclose your PHI to obtain payment for the treatment and services provided. This may include contacting your health insurance company for prior approval of planned treatment or for billing purposes.

Healthcare Operations We may disclose your PHI to coordinate healthcare operations. This may include setting up appointments, reviewing your care and training staff.

INFORMATION DISCLOSED WITHOUT YOUR CONSENT: Under State and Federal law, your PHI may be disclosed without your consent in the following circumstances:

Medical Emergencies Sufficient information may be shared to address an immediate emergency situation that you may encounter.

Follow Up Appointments/Care We may contact you regarding appointment changes or other health-related instances that may arise in your care with us.

As Required by Law This includes situations which require disclosure of your PHI for a subpoena, court order, or a mandate to provide public health information, such as communicable diseases or suspected abuse and neglect such as child abuse, elder abuse, or institutional abuse.

Coroners, Funeral Directors We may disclose PHI to a coroner or personal health examiner and funeral directors for the purposes of carrying out their duties.

Governmental Requirements We may disclose information to government agencies for activities authorized by law, such as audits, investigations, inspections and national security issues. There may be a need to share your information with the Food and Drug Administration in relation to adverse events or product defects. We are also required to share information, if requested, with the Department of Health and Human Services to determine our compliance with Federal laws related to health care.

Criminal Activity or Danger to Others Information about you may also be disclosed when necessary to prevent a serious threat to your health and safety or the health and safety of others.

PATIENT RIGHTS: You have the following rights under NY State and Federal law:

Copy of Records You are entitled to inspect the personal health record Radiology Associates Of New Hartford has generated about you. We may charge you a reasonable fee for copying and mailing your record.

Release of Records You may consent in writing to the release of your records to others, for any purpose you choose. This may include your attorneys, employers, or others who you wish to have knowledge of your care. You may revoke this consent at any time, but only to the extent no action has been taken in reliance on your prior authorization. Any revocation must be in writing.

Restriction on Record You may ask us not to use or disclose all or part of your PHI. This request must specify any and all restrictions in writing. Radiology Associates of New Hartford is not required to agree to your request if we believe it is in your best interest to permit use and disclosure of the information. The request should be given to the HIPAA Coordinator who will consult with the staff involved in your care to determine if the request can be granted.

Patient Contact You may request that we send information to an alternative address or by alternative means. You may also request limits on disclosure of information to those involved with your care. Limitation requests must be specified in writing. We have the right to verify that the payment information you provide us is correct. It is our policy not to provide information by email.

Amending Record If you believe that something in your record is incorrect or incomplete, you may request that it be amended. To amend your record, contact the HIPAA Coordinator and ask for a Request to Amend Health Information form. In certain instances, we may deny this request. If we deny your request for an amendment, you have a right to file a statement that you disagree with us. We will then file our response and your statement and our response will be added to your record.

Accounting for Disclosures You may request a listing of any disclosures we have made related to your PHI. Exceptions to this disclosure policy include information used in your treatment, payment information and our health care operations. Information shared with you or your family, or information that you have given specific consent to release falls into this exceptions category. It also excludes information required for release to government or law enforcement agencies. To receive information regarding disclosure made for a specific time period no longer than six years and after April 14, 2003, please submit your request in writing to our Privacy Coordinator. We will notify you of the cost involved in preparing this list.

Questions and Complaints If you have questions or have complaints, you may contact our Privacy Coordinator, in writing, at 185 Genesee Street, Suite 600, Utica, NY 13501. You also may contact the Secretary of Health and Human Services if you believe Radiology Associates Of New Hartford has violated your privacy rights. You will not be subject to negative actions should you decide to file a complaint.

Changes in Policy Radiology Associates Of New Hartford reserves the right to change its Privacy Policy based on the needs of this practice and changes in state and federal law.