Prescott Medical Imaging - Privacy Notice

Prescott Medical Imaging (PMI) understands that your medical information is personal to you. PMI will act reasonably to protect your personal information. To provide quality medical services to you, PMI is required to create a record of the care and services you receive and to comply with applicable laws regarding your medical information.

This notice applies to all of the records of your care that PMI maintains, which includes records created by PMI staff or Radiologists.

Applicable law requires that PMI:

Excercise Reasonable efforts to keep your medical information about you private.
Provide to you an explanation of our legal duties and privacy procedures with respect to your medical information, as set forth in this notice.
Follow the terms of this Privacy Notice, as may be in effect from time to time.

REASONABLE USE AND DISCLOSURE OF MEDICAL INFORMATION

1. PMI may use your protected health information for purposes of providing treatment, obtaining payment for treatment, and conducting health care operations.

2. PMI, in the course of treatment, may contact you for appointment reminders or to verify insurance information and medical history.

3. PMI may use and disclose medical information about you for:

a) Reasonable treatment (for example, sharing your medical information with your healthcare provider or specialist as part of a referral;)
b) to obtain or facilitate payment for treatment (for example, sending billing information to your insurance company or Medicare); and
c) to facilitate PMI’s healthcare operations including such activities as quality assessment and improvement activities, employee review activities, training programs, accreditation/certification/credentialing activities, compliance reviews, medical reviews, legal services, and business management and general administrative activities.

4. In addition, PMI is permitted and may use or disclose medical information about you without your prior authorization for:

a) emergencies;
b) Workman’s Compensation purposes;
c) public health purposes;
d) abuse or neglect reporting;
e) health oversight audits or inspections;
f) instances as required by coroners and funeral directors;
g) instances when required by law;
h) instances when required by military command authorities;
i) instances when necessary for your health and safety or the public’s health and safety.

5. If asked to do so by a law enforcement official, PMI may release medical information for:

a) in response to a court order;
b) to identify or locate a suspect, fugitive, material witness or missing person;
c) about the victim of a crime;
d) about a death that may be the result of a criminal conduct under certain limited circumstances;
e) about criminal conduct at PMI;
f) to report a crime.

YOUR RIGHTS

A. You have the right to receive and review a copy of your medical information in the possession of PMI used to make decisions about your care. You must submit the request in writing. PMI may charge a fee for out-of pocket cost to accommodate your request. If PMI denies your request to review or obtain a copy, you may request a review of that action by the Administrator. You must submit the request in writing.

B. You have the right to request that your medical information be communicated to you in a confidential manner. For example, you may request that we send mail to an address other than your home. You must notify PMI, in writing, of the specific way or location for PMI to use to communicate with you if you prefer some alternate location where you can be contacted.

C. You have the right to request that we correct your medical records if the information in your record is incorrect or incomplete. You must submit the request in writing. Please provide your reason for requesting the correction. PMI may deny the request to correct the record if; 1) the information was not created by PMI; 2) it is not information maintained by PMI; or 3). PMI determines the record is accurate. If you disagree with the decision of PMI, you may request a review of that decision through the Administrator. The request must be in writing.

D. You have the right to an accounting of disclosure of your medical information other than disclosures for treatment, payment, or healthcare operations, or when you have specifically authorized a disclosure. You must submit the request in writing. Your request must state the time-period desired for the accounting. Your request must be for a period of 6 years or less. The first accounting provided to you in a twelve month period is at no-charge. Thereafter, PMI may charge you for the cost of producing the list and you will be informed in advance of the costs so that you may choose to withdraw or modify your request before any costs are incurred.

E. You have the right to request that PMI not use or disclose medical information about you for treatment, payment, or health care operations or that PMI not use or disclose your medical information to persons involved in your care, except where specifically authorized by you, when required by law or in an emergency. You must submit the request in writing. In the request you must state: 1) what information you want to limit; 2) if you want to limit our use or only the disclosure of the information, or both; and 3) to whom you want the limitation to apply. Your request will be given reasonable consideration. However, PMI is not legally required to accept your request. You will be notified of PMI’s decision.

F. You have the right to a copy of this Privacy Notice. This notice shall be available at the front desk of PMI, through PMI Medical Records, and at our website at http://www.pmixray.com.

REQUESTS, APPEALS OR COMPLAINTS

You have the right to express complaints to PMI and to the Secretary of Health and Human Services if you disagree with a decision made by PMI about your medical information or records, or if you believe that your privacy rights may have been violated. PMI assures you that you will not be penalized or retaliated against for filing a request for review, appeal or complaint. You may address written complaints to:

Prescott Medical Imaging
Administrative Director
810 Whipple Street
Prescott, AZ 86301
Phone: 928 771-7577

OR

U.S. Department of Heath and Human Services
Office of Civil Rights

CHANGES TO THIS NOTICE

PMI reserves the right to change this notice as to any information we already have about you as well as any information we receive in the future. PMI will post a copy of the current Privacy Notice; each time you register we will offer you a copy of the current notice in effect.