NEW ENGLAND PET IMAGING SYSTEM
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.
Understanding Your Health Record/Information
Each time you visit New England PET Imaging System, a record of your visit is made. Typically, this record contains your symptoms, examination, test results, diagnosis, and treatment plan. This information, often referred to as your health or medical record, can serve as a:
- Basis for planning your care and treatment
- Means of communication among the many health professionals who contribute to your care
- Legal document describing the care you received
- Means by which you or a third-party payer can verify that services billed were actually provided
- Tool with which we can assess and continually work to improve the services we render and the outcomes we achieve
- Understanding what is in your record and how your health information is used helps you to:
- Ensure its accuracy
- Better understand who, what, when, where, and why others may access your health information
- Make more informed decisions when authorizing disclosure to others
Your Health Information Rights
Although your health record is the physical property of New England PET Imaging System, the information belongs to you. You have the right to:
- Receive confidential communications of protected health information.
- Request a restriction on certain uses and disclosures of your information as provided by 45 CFR 164.522 by completing and submitting a Request of Restriction form to the New England PET Imaging System office. New England PET Imaging System is not required to agree to a restriction.
- Obtain a paper copy of the notice of information practices upon request.
- Inspect and obtain a copy of your health record as provided for in 45 CFR 164.524 by calling New England PET Imaging Systems Privacy Official at (978) 689-4738 to set up an appointment. We may charge reasonable fees, based on the cost of copying and postage and the preparation of a summary, if applicable, if you agree to the fees in advance. The Privacy Official will receive and process requests for access and determine if access can be granted.
- Request an addendum to your health record as provided in 45 CFR 164.528 by submitting a request in writing, providing a reason to support the requested addendum, and identifying the relevant parties with whom the addendum needs to be disclosed, if accepted. New England PET Imaging Systems Privacy Official will review the request and determine whether we may accept the requested addendum. New England PET Imaging System may deny your request under certain circumstances with a written denial. In response, you may file a statement in disagreement.
- Obtain an accounting of disclosures of your health information as provided in 45 CFR 164.528 by completing and submitting a Request for Accounting of Disclosures form to our office. New England PET Imaging Systems Privacy Official will then send the information to you as requested.
- Request communications of your health information by alternative means or at alternative locations by providing the request in writing, specifying an alternative location or method of contact and explaining how payment for services will be received.
- Revoke your authorization to use or disclose health information, except to the extent that action has already been taken, by submitting a written revocation to New England PET Imaging Systems Privacy Official.
As New England PET Imaging System is an indirect treatment provider, we are not required to provide patients with a Notice of Privacy Practices but we have a Notice available as a service to our patients.
New England PET Imaging System is required to:
- Maintain the privacy of your health information in accordance with applicable laws
- Abide by the terms of this notice
- Notify you if we are unable to agree to a requested restriction
- Accommodate reasonable requests you may have to communicate health information by alternative means or alternative locations
We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will change the notice posted in the office.
We will not use or disclose your health information without your authorization, except as described below in this notice.
For More Information or to Report a Problem
If you have questions and would like additional information or an additional copy of our privacy notice, you may contact New England PET Imaging Systems Privacy Official at (978) 689-4738.
If you believe your privacy rights have been violated, you can file a complaint with New England PET Imaging Systems Privacy Official or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.
Examples of Disclosures for Treatment, Payment and Health Operations
We will use your health information for treatment.
For example: Information obtained from your PET scan will be recorded in your record and used to determine the course of treatment that should work best for you. We will provide your physician or subsequent healthcare provider with copies of various reports that should assist him or her in treating you.
We will use your health information for payment.
For example: A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used. We may use your health information for accreditation purposes.
We will use your health information for regular health operations.
For example: Members of the medical staff, the risk or quality improvement manager, or members of the quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and service we provide. We may use your health information for accreditation purposes.
Other Permitted or Required Uses and Disclosures
Business associates: There are some services provided in our organization through contacts with business associates. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job weve asked them to do and bill you or your third- party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.
Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and general condition.
Communication with family: Health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that persons involvement in your care or payment related to your care.
Telephone policy: We will generally only disclose patient information to persons other than the patient if the patient has signed an authorization specifically authorizing the use or disclosure to the person(s).
Research: We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.
Organ procurement organizations: Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.
Patient Follow-up: We may contact you to provide appointment reminders.
Marketing: We may contact you to provide information about treatment alternatives or other health-related benefits and services that may be of interest to you.
Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.
Workers compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.
Public health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability or other public health activities.
Correctional institution: Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health and safety of other individuals.
Law enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.
Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.
Effective Date: April 14, 2003