We learn about you as we care for your health. Some of what we learn becomes part of your health information. We work hard to protect the privacy of your health information and we have rules for our employees on how to manage this information. This Notice of Privacy Practices describes how your health information may be used and disclosed by our office and also how you may access and control your health information.
Our Health Information Duties:
• We have a legal duty to protect the privacy of your health information and to give you this Notice.
• We have a legal duty to abide by the Notice of Privacy Practices that is current.
• We may change the terms of this Notice and make the new terms effective for all health information we have. This includes health information we created or received before we made the changes.
• We will make any revised Notice available in hard copy, and by displaying it in our facilities and on our Web site. Also, you can request the revised Notice in-person or by mail.
“Health information” means information about your past or present health status, condition, diagnosis, treatment, prognosis, or payment for health care.
Patient Notice of Privacy Practices
Your Health Information may be used for the following purposes:
Treatment: We will use your information to provide, coordinate and manage care and treatment. For example we will release films and reports to another health provider who is involved in your care.
Payment: We will use information to receive payment for services we provide. For example we will disclose information in order to submit bills or claims to insurance companies and/or Medicare or State funded plans.When a patient neglects to make timely payments on balance due, we may use a collection agency.
Health Care Operations: We will use information for certain activities related to business functions of CRL and other covered components of CRL. For example, we may use or disclose information for quality assurance activities.
Appointment Reminders and Treatment Alternatives: At our imaging centers we may contact you to remind you of an appointment or we may need to reschedule your appointment. Your health information may be used to inform you about health care services that may be of interest to you.
Family Members or Individuals Involved in Your Care: You may agree to have verbal information about your treatment or diagnosis shared with a family member or designee. If you are unable to make health care decisions, we may disclose relevant health information to family members or other responsible individuals involved in your care. For example, you may give verbal consent for a radiologist to share with your designee information about your procedure.
Other Uses or Disclosures: We may disclose or use information in the following situations: for public health activities; as it relates to victims of abuse/neglect/ domestic violence; for health oversight activities; for judicial and administrative proceedings to the extent permitted by law; for law enforcement purposes, as permitted or required by law; to coroners/medical examiners/funeral directors, as permitted by law; for organ donation purposes; for research purposes under certain circumstances; to avert a serious threat to health or safety; for certain specialized government functions, such as military discharge, national security and intelligence; and for workers’ compensation purposes.
Your individual Privacy Right as a patient includes the following:
Inspection and Copy: You may make a request in writing to review or order a copy of your health record, with the exception of information protected by law. However, we ask that you obtain your report from your ordering physician before we will make a copy available to you. In our practice your health record is
limited to imaging studies, reports and billing information of imaging procedures you received from us.We have the right to ask you for this request in writing and we will respond within a reasonable time frame. There may also be a reasonable charge for copies.
Confidentiality: You have the right to make a request in writing to provide you with your health information. For example, if you request that we mail information to another address, we will agree to your request to the extent we are able to assure accuracy in doing so.
Restrict Use and Disclosure: You have the right to make a request in writing that we not use health information in certain ways or for certain purposes. You may also request that we not provide health information to certain individuals. However, we have the right to refuse your request, particularly when the law requires it.
Change Information or Amend Health Records: You have the right to request in writing that we correct information in your health record if we were the originator of such information. If your request is denied, you may write a statement of disagreement with the denial that we will keep with your health information.
Accounting of Disclosures: You have the right to make a request in writing for an accounting of disclosures of health information that was made without your signature. Requests for accountings will not include disclosures made after six years from the date of service.
Privacy Violations: If you feel your health information privacy rights have been violated, you may file a complaint with our contact person listed below or with the Secretary of Health and Humans Services. Filing a complaint will not affect the quality of the services you receive at our imaging facilities and you will not be retaliated against for filing a complaint.
We are glad to have you as a patient, and we will work hard to protect your health information.
CRL Privacy Officer
7505 Metro Blvd, Suite 400
Edina, MN 55439
952-285-3715 or email@example.com
U.S. Department of Health & Human Services Office for Civil Rights,Region V
233 N Michigan Avenue, Suite 240
Chicago, IL 60601
Phone: (312) 886-2359 Fax: (312) 886-1807
Organizations Covered by this Notice:
This Notice applies to the privacy practices of CRL clinic locations and other covered components of CRL listed below. We may share health information within the organization for treatment, payment or health care operations.
- CRL Imaging Southdale
- CRL Imaging Plymouth
- CRL Women’s Imaging
- LifeScan Minnesota
- Twin Cities Medical Imaging.
Effective August 25, 2015
Updated August 2016