WHO WILL FOLLOW THIS NOTICE
The Notice of Privacy Practices describes Radiology and Imaging Specialists’ practices and that of (a) any health care professional authorized to enter information into your medical record, (b) all departments and units of Radiology and Imaging Specialists (c) all contracted services, and (d) all members of Radiology and Imaging Specialists’ workforce, follow this notice.

YOUR PROTECTION OF MEDICAL INFORMATION
We understand that information about you and your health is personal. We are committed to protecting that medical information. We create a record of the care and services you receive to provide you with quality care and to comply with certain legal requirements. This notice applies to all the records of your care generated by Radiology and Imaging Specialists. Your personal physician may have different policies regarding his/her use and disclosure of medical information created in his/her office or clinic. This notice tells you about the ways in which we may use and disclose information about you. It also describes your rights and certain obligations we have regarding the use and disclosure of medical information. We are required by law to (1) make sure health related information that identifies you is kept private (2) give you this notice of our legal duties and privacy practices with respect to medical information about you, and (3) follow the terms of the notice that is currently in effect.

THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED

To Provide Treatment: Radiology and Imaging Specialists may use your health information to coordinate care within Radiology and Imaging Specialists and with others involved in your care, such as your attending or consulting physician. For example, technologists involved in your care will need information about your symptoms in order to ensure that you do not have reactions to certain contrast materials. Radiology and Imaging Specialists also may disclose your health care information to individuals outside of Radiology and Imaging Specialists involved in your care including family members whom you have designated.

To Obtain Payment: Radiology and Imaging Specialists may include your health information in invoices to collect payment from third parties for the care you may receive from Radiology and Imaging Specialists. For example, Radiology and Imaging Specialists may be required by your health insurer to provide information regarding your health care status so that the insurer will reimburse you or Radiology and Imaging Specialists. Radiology and Imaging Specialists also may need to obtain prior approval from your insurer and may need to explain to the insurer your need for Radiology and Imaging Specialists care and the services that will be provided to you.

To Conduct Health Care Operations: Radiology and Imaging Specialists may use and disclose health care information for its own operations in order to facilitate the function of Radiology and Imaging Specialists and as necessary to provide quality care to all Radiology and Imaging Specialists’ patients. Health care operations include such activities as:

Use your health information to contact you as a reminder regarding a visit to Radiology and Imaging Specialists.

Federal privacy rules allow Radiology and Imaging Specialists to use or disclose your health information without your consent or authorization for a number of reasons, such as:

1. When Legally Required. Radiology and Imaging Specialists will disclose your health information when it is required to do so by any Federal, State or local law.

2. When There Are Risks to Public Health. Radiology and Imaging Specialists may disclose your health information for public activities and purposes in order to:

• Prevent or control disease, injury or disability, report disease, injury, vital events such as birth or death and the conduct of health surveillance, investigations and interventions.
• To report adverse events, product defects, to track products or enable product recalls, repairs and replacements and to conduct post-marketing surveillance and compliance with requirements of the Food and Drug Administration.
• To notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease.
• To an employer about an individual who is a member of the workforce as legally required.

3. To Report Abuse, Neglect or Domestic Violence. Radiology and Imaging Specialists is allowed to notify government authorities if Radiology and Imaging Specialists believes a patient is the victim or abuse, neglect or domestic violence. RIS will make the disclosure only when specifically required or authorized by law or when the patient agrees to the disclosure.

4. To Conduct Health Oversight Activities. Radiology and Imaging Specialists may disclose your health information to a health oversight agent for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action. Radiology and Imaging Specialists, however, may not disclose your health information, if you are the subject of an investigation and your health information is not directly related to your receipt of health care or public benefits.

5. Lawsuits and Disputes. Radiology and Imaging Specialists may disclose your health information in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order or in response to a subpoena, discovery request or other lawful process, but only when Radiology and Imaging Specialists makes reasonable efforts to either notify you about the request or to obtain an order protecting your health information.

6. For Law Enforcement Purposes. Radiology and Imaging Specialists may release information if asked to do so by a law enforcement official (a) in response to a court order, subpoena, warrant, summons or similar process; (b) to identify or locate a suspect, fugitive, material witness, or missing person; (c) about the victim of a crime if, under certain limited circumstances, Radiology and Imaging Specialists is unable to obtain patient agreement; (d) about a death we believe my be the result of a criminal conduct, (e) about criminal conduct at Radiology and Imaging Specialists; and (f) in emergency circumstances to report a crime, the location of the crime or victims, or the identify, description or location of the person who committed the crime.

7. To Coroners and Medical Examiners. Radiology and Imaging Specialists may disclose your health information to coroners and medical examiners for purposes of determining your cause of death or for other duties, as authorized by law.

8. For Research Purposes. Radiology and Imaging Specialists may, under very select circumstances, use your health information for research. Before Radiology and Imaging Specialists discloses any of your health information for such research purposes, the project will be subject to an extensive approval process. Radiology and Imaging Specialists will ask your permission if any researcher will be granted access to your individually identifiable health information.

9. In The Event Of A Serious Threat to Health or Safety. Radiology and Imaging Specialists may, consistent with applicable law and ethical standards of conduct, disclose your health information if Radiology and Imaging Specialists, in good faith, believes that such disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or to the health and safety of the public.

10. For Specified Government Functions. In certain circumstances, the Federal regulations authorized Radiology and Imaging Specialists to use or disclose your health information to facilitate specified government functions relating to military and veterans, national security and intelligence activities, protective services for the President and others, medical suitability determinations and inmates and law enforcement custody.

11. For Worker’s Compensation. Radiology and Imaging Specialists may release your health information for worker’s compensation or similar programs.

12. For Patient Satisfaction Surveys. Radiology and Imaging Specialists participates in the Patient Satisfaction/Loyalty Survey. Randomly select a small percent of our patients and do a phone survey to determine satisfaction levels. We hope you will participate if they call. Our objectives are to improve our services to our patients.

13. Appointment Reminders. Radiology and Imaging Specialists may use and disclose information to contact you as a reminder that you have an appointment or treatment.

14. Follow-Up Phone Calls. As part of your treatment plan, there may be times that you will be contracted by Radiology and Imaging Specialists’ staff via telephone after you have had service at one of its facilities. Examples include (1) a phone call to address patient satisfaction issues, or (2) a phone call to provide additional education or guidance to the patient on a particular topic. Such phone calls will be limited in number and are meant to ensure optimum service, patient satisfaction and education.

15. Marketing. It is the policy of Radiology and Imaging Specialists not to use patient records to market facilities or services.

16. Military and Veterans. If you are a member of the armed forces, Radiology and Imaging Specialists may release information about you as required by military authorities. We may also release information about foreign military personnel to the appropriate foreign military authority.

17. Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, Radiology and Imaging Specialists may release information about you to the correctional institution or law enforcement official to provide you with health care, to protect your and others’ health and safety, or for the safety and security of the correctional institution.

AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION
Other than stated above, Radiology and Imaging Specialists will not disclose your health information other than with your written authorization. If you or your representative authorizes Radiology and Imaging Specialists to use or disclose your health information, you may revoke that authorization in writing at any time.

YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION
You have the following rights regarding your health information that Radiology and Imaging Specialists maintains:

Right to request restrictions. You may request restrictions on certain uses and disclosures of your health information. You have the right to request a limit on Radiology and Imaging Specialists’ disclosure of your health information to someone who is involved in your care or the payment of your care. However, Radiology and Imaging Specialists is not required to agree to your request. If you wish to make a request for restrictions, please contract the Privacy Officer.

Right to receive confidential communications. You have the right to request that Radiology and Imaging Specialists communicate with you in a certain way. For example, you may ask that Radiology and Imaging Specialists only conduct communications pertaining to your health information with you privately, with no other family members present. If you wish to receive confidential communications, please contract the Privacy Officer. Radiology and Imaging Specialists will not request that you provide any reasons for your request and will attempt to honor your reasonable requests for confidential communications.

Right to inspect and copy your health information. You have the right to inspect and copy your health information, including billing records. A request to inspect and copy records containing your health information may be made to the Film Record Storage and Retention Department. If you request a copy of your health information, Radiology and Imaging Specialists may charge a reasonable fee for copying and assembling costs associated with your request.

To amend health care information. If you or your representative believes that your health information records are incorrect or incomplete, you may request that Radiology and Imaging Specialists amend the records. That request may be made as long as the information is maintained by Radiology and Imaging Specialists. A request for an amendment of records must be made in writing to the Privacy Officer. Radiology and Imaging Specialists may deny the request if it is not in writing or does not include reason for the amendment. The request also may be denied if your health information records were not created by Radiology and Imaging Specialists, if the records you are requesting are not part of Radiology and Imaging Specialists’ records, if the health information you wish to amend is not part of the health information you or your representative are permitted to inspect and copy, or if, in the opinion of Radiology and Imaging Specialists, the records containing your health information are accurate and complete.

Right to an accounting. You or your representative have the right to request an accounting or disclosures of your health information made by Radiology and Imaging Specialists for any reason other than for treatment, payment or health operations. The request for an accounting must be made in writing to the Film Record Storage and Retention Department. The request should specify the time period for the accounting starting on April 14, 2003. Accounting requests may not be made for periods of time in excess of six years. Radiology and Imaging Specialists would provide the first accounting your request during any 12-month period without charge. Subsequent accounting requests may be subject to reasonable cost-based fee.

Right to a paper copy of this notice. You or your representative has a right to a separate paper copy of this. Notice at any time even if you or your representative has received this Notice previously. To obtain a paper copy, please contact Radiology and Imaging Specialists’ office.

DUTIES OF RADIOLOGY AND IMAGING SPECIALISTS
Radiology and Imaging Specialists is required by law to maintain the privacy of your health information and to provide to you and your representative this Notice of its duties and privacy practices. Radiology and Imaging Specialists is required to abide by terms of this Notice and may be amended from time-to-time. Radiology and Imaging Specialists reserves the right to change the terms of its Notice and to make the new Notice provisions effective for all health information that it maintains. If Radiology and Imaging Specialists changes its Notice, Radiology and Imaging Specialists will provide a copy of the revised Notice to you or your appointed representative. You or your personal representative has the right to express complaints to Radiology and Imaging Specialists and to the Secretary of Health and Human Services if you or your representative believes that your privacy rights have been violated. Any complaints to Radiology and Imaging Specialists should be made in writing addressed to the Privacy Officer. If you have any questions, call (863) 688-2334. Radiology and Imaging Specialists encourages you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way for filing a complaint.

CONTACT PERSON (Privacy Office)
Radiology and Imaging Specialists’ contact person for all issues regarding patient privacy and your rights under the Federal privacy standards is the Assistant Executive Director (863) 688-2334.

EFFECTIVE DATE
This Notice is effective April 14, 2003.