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.

This notice will be followed by Advanced Radiology Services, P.C. physicians, all divisions of Advanced Radiology Services, P.C., Kalrad Company, LLC and any member of the Strategic Administrative and Reimbursement Services, LLC workforce including: all employees and temporary associates. Each entity and their locations will follow the terms of this notice.

If you have any questions about this notice, please contact our Privacy Officer at 1-800-781-7101.

Your medical information is personal. We are committed to protecting your medical information. Each time our Radiologists provide you with treatment a record of your treatment is made. Typically, this record can contain your name, address, payer information, signs and symptoms, examination, and the Radiologist’s impression of your exam.

The information, often referred to as your medical record, serves as a:

* Means of communication among the many health professionals who contribute to your care;
* Legal document describing the procedures you received;
* Means by which you or a third-party payer can verify that services billed were actually provided;
* A tool in educating heath professionals;
* A source of data for medical research; and
* A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve.

Understanding what is in your medical record and how your medical information is used, helps you to:

* Ensure its accuracy;
* Better understand who, what, when, where, and why others may access your medical information; and
* Make more informed decisions when authorizing disclosure to others.

This office is required by law to:

* Make sure that medical information that identifies you is kept private;
* Give you this notice of our legal duties and privacy practices with respect to your medical information; and
* Follow the terms of this notice.

Although your health record is the physical property of the healthcare practitioner or facility that compiled it, the information belongs to you.

How We May Use and Disclose Your Medical Information
The following describes the different ways that we may use or disclose your medical information. For clarification we have included some examples. Not every possible use or disclosure is specifically mentioned. However, all of the ways we are permitted to use and disclose your medical information will fit within one of these general categories.

Treatment: We will use medical information about you to provide you with medical treatment and services. We may disclose medical information about you to doctors, nurses, technicians and other office personnel who are involved in providing you medical treatment and services. For example, your medical information may be provided to the physician(s) who referred you to our Radiologists to ensure that the physician(s) has the necessary information to diagnose or treat you.

Payment: We may use and disclose your medical information so that the treatment and services you received 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 signs and symptoms, diagnosis, procedures and supplies used.

Healthcare Operations: We may use and disclose medical information about you for office operations. These uses and disclosures are necessary to run our office and make sure that all of our patients receive quality care. For example, we may use a sign-in sheet at the reception desk, we may call you by name in the waiting room and we may contact you to remind you of your appointment.

Other Permitted and Required Uses and Disclosures That May Be Made Without Your Authorization or Opportunity to Object

Health Care Operations of another health care provider or payer: We may disclose your medical information to another health care provider or payer for their own operations if we both have or have had a relationship with you. These disclosures will be limited to: quality assurance and improvement activities, population-based activities relating to improving health or reducing health care costs, case management, conducting training programs, accreditation, certification, licensing, or credentialing activities.

Business Associates: There are some services provided in our organization through contracts with business associates. Examples include: attorneys, accountants and accreditation agencies. When these services are contracted, we may disclose your medical information to our business associates so that they can perform the job we have asked them to do. To protect your medical information, we require the business associate to appropriately safeguard your information.

Quality Improvement: We will disclose medical information about you as a tool in assessing and continually working to improve the quality of care we give and outcomes we achieve.

Required by Law: We will disclose medical information about you when required to do so by federal, state or local laws. For example, disclosures may be made for Workers’ Compensation statutes, reporting of communicable diseases and for abuse or neglect.

Health Oversight: We may disclose medical information to a governmental or other oversight agency for activities authorized by law. For example, disclosures of your medical information may be made in connection with audits, investigations, inspections, and licensure renewals.

Law Enforcement: We may release medical information about you if required by law. For example, in response to a valid subpoena, a lawsuit, or medical emergency (not on the Practice’s premises) and it is likely that a crime has occurred.

Governmental: We will disclose medical information about you as a source of information to appropriate military command authorities to assure the proper execution of the military mission.

Communication with Family: Health Professionals, using their best judgment, may disclose to a family member, other relative, close personal friend you identify, medical information relevant to that person’s involvement in your care or payment related to your care.

Minors: There are certain circumstances when Michigan State Law may not recognize the parent as the personal representative of a minor. Examples are: when the minor seeks medical treatment for alcohol or drug abuse, sexually transmitted diseases, and psychological care. When a minor seeks medical care for pregnancy or related problems the medical care provider may release information to the parents but is not obligated to do so when considering the medical need and the best interest of the minor.

Treatment Alternatives: In certain situations we may use and disclose medical information to educate you on possible treatment options or alternatives that may be of interest to you.

Research: We may use and disclose your medical information when performing exams requested by a provider who is conducting research.

Deceased Patient: Medical information on a deceased patient remains confidential and in most cases can only be released by the personal representative of the decedent’s estate.

Funeral Directors and Medical Examiners: We may disclose medical information to a coroner, medical examiner and funeral directors consistent with applicable laws to carry out their duties.

In any other situation not covered by this Notice, we will ask for your written authorization before using or disclosing your medical information. You may revoke your authorization for any subsequent uses and disclosures by notifying us in writing to our Privacy Officer.

Right to Request Restrictions

* Your Medical information Rights You have the right to request a restriction on certain uses and disclosures of your information; and
* To request restriction, you must make your request in writing to the Privacy Officer.

* Our Responsibilities This organization is required to notify you if we are unable to agree to a requested restriction; and
* We will accommodate reasonable requests you have to communicate medical information by alternative means unless the information is needed to provide you with emergency treatment.

Right to Inspect and Copy

* Your Medical information Rights You have the right to inspect and copy your medical information;
* To inspect and copy your medical information, you must submit your request in writing to the Privacy Officer;
* If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or supplies associated with your request; and
* If your request is denied you may have a right to have this decision reviewed. For information regarding such a review contact the Privacy Officer.

* Our Responsibilities This organization is required to provide you with access to inspect and/or a copy of your medical record when requested; and
* We may deny your request to inspect and copy your medical records in certain very limited circumstances.

Right to Amend

* Your Medical information Rights If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information;
* To request an amendment, your request must be made in writing, with a reason that supports the request and submitted to the Privacy Officer; and
* If we deny your request you have the right to file a statement of disagreement with us that will become a part of your records. For information regarding such a disagreement contact the Privacy Officer.

* Our Responsibilities We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
a. Was not created by us;
b. Is not part of the medical information kept by this office;
c. Is not part of the information which you would be permitted to inspect; or
d. Is accurate and complete.
* If we deny your request this organization is required to provide you with a written explanation that includes your additional options; and
* If we deny your request and you file a statement of disagreement we may prepare a rebuttal to your statement and will provide you with a copy.

Right to an Accounting of Disclosures

* Your Medical information Rights You have the right to request an “accounting of disclosures”;
* This is a list of the disclosures this office has made of your medical information for purposes other than treatment, payment or health care operations;
* To request this accounting of disclosures, you must submit your request in writing to the Privacy Officer; and
* Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003.

* Our Responsibilities This organization is required to document disclosures that are made of your medical information for purposes other than treatment, payment, health care operations, or when your authorization is required.

Right to Request Confidential Communications

* Your Medical information Rights You have the right to request that we communicate with you only in a certain manner. For example, you can ask that we only contact you at work or by mail; and
* To request confidential communications, you must make your request in writing to the Privacy Officer.

* Our Responsibilities This organization is required to accommodate all reasonable requests; and
* We may deny your request unless you provide information as to how payment will be handled.

Changes to this Notice
We reserve the right to make changes to this Notice at any time. Before we make significant changes in our policies and procedures effective, we will change our Notice and post the new Notice in waiting areas. You can receive a copy of the current Notice at any time in the waiting areas or by calling the Privacy Officer. The effective date for this Notice is listed on the top left of all pages except the first page.

Complaints
If you believe your privacy rights have been violated, you may file a complaint with this office or with the Secretary of the Department of Health and Human Services. For information on how to file a complaint with this office, contact the Privacy Officer at 1-800-781-7101. All complaints must be submitted in writing. THIS OFFICE WILL NOT PENALIZE YOU IN ANY WAY FOR FILING A COMPLAINT.

 


Corporate Office: 616.363.7272, 3264 North Evergreen Drive, Grand Rapids, MI 49525