St. Petersburg Independent Diagnostic Radiology,
Inc.
Notice of
Privacy Practices
Effective:
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.
How ST.
PETERSBURG INDEPENDENT DIAGNOSTIC RADIOLOGY, INC. May Use or Disclose Your
Health Information
For Treatment. St. Petersburg Independent Diagnostic Radiology, Inc. may use your health information to provide you with medical treatment or services. For example, information obtained by a health care provider, such as a physician, nurse, or other person providing health services to you, will record information in your record that is related to your treatment. This information is necessary for health care providers to determine what treatment you should receive. Health care providers will also record actions taken by them in the course of your treatment and note how you respond to the actions.
For Payment. St. Petersburg Independent Diagnostic Radiology, Inc. may use and disclose your health information to others for purposes of receiving payment for treatment and services that you receive. For example, a bill may be sent to you or a third-party payor, such as an insurance company or health plan. The information on the bill may contain information that identifies you, your diagnosis, and treatment or supplies used in the course of treatment.
For Health Care Operations. St. Petersburg Independent Diagnostic Radiology, Inc. may use and disclose health information about you for operational purposes, for example, your health information may be disclosed to members of the medical staff, risk or quality improvement personnel, and others to:
Facility Directory.
Unless you notify us in writing that you object, we will include certain
limited information about you in the facility directory while you are a patient
at St.
Petersburg Independent Diagnostic Radiology, Inc. This information may include your name,
location in the facility, your general condition (e.g., fair, stable, etc.) and
your religious affiliation. The
directory information, except for your religious affiliation, may also be
released to people who ask for you by name.
Your religious affiliation may be given to a member of the clergy, such
as a priest or rabbi, even if they don’t ask for you by name. This is so your family, friends and clergy
can visit you or generally know how you are doing.
Appointments. St. Petersburg Independent Diagnostic
Radiology, Inc. may use your information to provide appointment
reminders or information about treatment alternatives or other health-related
benefits and services that may be of interest to the individual.
Required By Law. St. Petersburg Independent Diagnostic
Radiology, Inc. may use and disclose information about you as required
by law. For example, St. Petersburg Independent Diagnostic
Radiology, Inc. may disclose information for the following purposes:
·
For
judicial and administrative proceedings pursuant to legal authority;
Public Health.
Your health information may be used or disclosed for public health activities
such as assisting public health authorities or other legal authorities to
prevent or control disease, injury, or disability, or for other health
oversight activities.
Decedents.
Health information may be disclosed to funeral directors or coroners to
enable them to carry out their lawful duties.
Organ/Tissue Donation.
Your health information may be disclosed to avert a serious threat to
the health and safety of you or any other person pursuant to applicable law.
Research. St. Petersburg Independent Diagnostic
Radiology, Inc. may use your health information for research purposes
when an institutional review board or privacy board that has reviewed the
research proposal and established protocols to ensure the privacy of your
health information has approved the research.
Patient Education. St.
Petersburg Independent Diagnostic Radiology, Inc. may use your
information to contact you about treatment options and other health related
topics. These include disease-management
programs.
Health and Safety.
Your health information may be disclosed to avert a serious threat to
the health and safety of you or any other person pursuant to applicable law.
Fundraising Efforts.
We may use or disclose your name, address, and dates that you received
treatment for St. Petersburg
Independent Diagnostic Radiology, Inc.. supported fundraising efforts.
Letters addressed to you will note what to do so as not to receive future
communications.
Government Functions.
Your health information may be disclosed to specialized governmental
functions such as protection of public officials or reporting to various
branches of the armed services that may require use or disclosure of your
health information.
Workers Compensation.
Your health information may be used or disclosed in order to comply with
laws and regulation related to Workers Compensation.
Your Health Information Rights
You have the right to:
·
Request
a restriction on certain uses and disclosures or your information as provided
by 45 CFR §164.522; however, St.
Petersburg Independent Diagnostic Radiology, Inc. is not required to
agree to a requested restriction;
·
Obtain
a paper copy of the Notice of Privacy Practices upon request;
·
Inspect
and obtain a copy of your health record as provided for in 45 CFR §164.524;
·
Amend
your health record as provided for in 45 CFR §164.526;
·
Request
communications of your health information by alternative means or at
alternative locations;
·
Revoke
your authorization to use or disclose health information except to the extent
that action has already been taken; and
·
Receive
an accounting of disclosures made of your health information as provided by 45
CFR §164.528.
St. Petersburg Independent Diagnostic
Radiology, Inc. will
not require you to waive your above mentioned rights in order to provide treatment
to you. If you feel your rights have
been violated, see the Complaint Section that follows.
Obligations of
St. Petersburg
Independent Diagnostic Radiology, Inc. is required to:
·
Maintain
the privacy of protected health information;
·
Provide
you with this notice of its legal duties and privacy practices with respect to
your health information;
·
Abide
by the terms of this notice;
·
Notify
you if we are unable to agree to a requested restriction on how your
information is used or disclosed;
·
Accommodate
reasonable requests you may make to communicate health information by
alternative means or at alternative locations; and
·
Obtain
your written authorization to use or disclose your health information for
reasons other than those listed above and permitted under law.
St. Petersburg Independent Diagnostic
Radiology, Inc.
reserves the right to change its information practices and to make the new
provisions effective for all protected health information it maintains. Revised notices will be made available to you
upon request and will be available on the St.
Petersburg Independent Diagnostic Radiology, Inc. website, www.spin-dr.com.
Complaints
You
may complain to St. Petersburg
Independent Diagnostic Radiology, Inc and to the Department of Health and Human
Services if you believe your privacy rights have been violated. You will not be retaliated against for filing
a complaint. To file a complaint with St. Petersburg Independent Diagnostic
Radiology, Inc, contact Cheryl Castano, our Privacy Officer at (727) 327-5006. To file a complaint by mail, send it to the
following address:
St. Petersburg Independent Diagnostic
Radiology, Inc
You
may also file an anonymous complaint by contacting St. Petersburg Independent Diagnostic Radiology, Inc by
telephone at (727) 327-5006 or by fax at (727) 327-3077.