How we may use and disclose your Health Information:

The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures we will explain what we mean and for some categories we will give an example. We will not list every use or disclosure in a category, but all of the ways we are permitted to use and disclose information will fall within one of the categories.

For Treatment:

We may use medical information about you to provide you with medical treatment or imaging services. We may disclose medical information about you to doctors, nurses, technicians, students, or other medical offices or hospital personnel who are involved in your care. For example, a doctor treating you for diabetes may need to know that you have a fracture since diabetes may slow the healing process.

For Payment:

We may use and disclose medical information about you so that the service(s) and/or treatment(s) you receive at ICPC may be billed and payment may be collected from you, an insurance company or a third party.

Imaging Center, PC provides professional and technical services at its own facility. ICPC provides professional services and occasional technical services at the Governor Juan F. Luis Hospital. For example, we may need to give your health plan information about an imaging test that you received at ICPC and/or the Governor Juan F. Luis Hospital so your health plan will pay us or reimburse you for the interpretation and/or performance of one or more procedures. We may also tell your health plan about an examination or treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the service.

For Health Care Operations:

We may use and disclose medical information about you for regulatory operations that are necessary to run ICPC or make sure that our patients receive quality care. For example, we may use medical information to review our services and to evaluate the performance of our staff in caring for you. We may also disclose information to doctors, nurses, technicians, medical students and ICPC personnel for review and/or learning purposes.

Appointment Reminders:

We may use and disclose medical information to contact you as a reminder that you have an appointment for an examination or treatment at ICPC, Governor Juan F. Luis Hospital or some other medical facility.

Imaging and Treatment Alternatives:

We may use and disclose medical information to tell you about diagnostic imaging or treatment options that may be of interest to you.

Health-Related Benefits and Services:

We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.

Individuals Involved in Your Care or Payment for Your Care:

We will not disclose your personal information to family members, friends or spouses, unless you direct us to make exceptions to this policy. If you are a minor accompanied by your parent(s)and they are present in the examination room with you and/or are paying for your services, we may not withhold the visit related information from them.

Research:

Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of patients who received medical therapy to those who received surgical therapy, for the same condition. Your identifying information such as your name and office identification numbers will not be included in such research.

To Avert a Serious Threat to Health or Safety:

We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.

For special purposes:

We may disclose medical information about you for special purposes as permitted or required by law, including the following:

1. Community and public health activities and reports such as disease control, abuse or neglect, and health and vital statistics,
2. Administrative oversight for audits, investigations, licensure, or determining cause of death,
3. Court order or other legal processes related to law enforcement activities including custody of inmates, legal actions, or national security activities,
4. Military and veteran reporting on members of the armed forces of U.S. or foreign military as required by military command authorities,
5. Workers' compensation or other rehabilitative activity reporting as required by law,
6. Organ and tissue donation and transplant reports as required by regulatory organizations as necessary to facilitate organ or tissue donation and transplant,
7. Insurers to provide benefits for:

• work-related
• victim injuries, or
• illnesses.

8. Law enforcement if asked to do so by a law enforcement official:

• to identify or locate a suspect, fugitive, material witness, or missing person;
• to investigate the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement;
• to investigate a death, we believe may be the result of criminal conduct;
• in emergency circumstances to report a crime, its location or its victims; or the identity, description or location of the person who committed the crime.

Coroners, medical examiners and funeral directors:

We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about ICPC patients to funeral directors as necessary to carry out their duties.

National security and intelligence activities:

We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

Protective services for the President and others:

We may disclose medical information about you to authorized federal officials so they may provide protection to the President or other authorized persons or foreign heads of state.

Inmates:

If you are a correctional institution inmate or are under the custody of a law enforcement official, we may release your medical information to the correctional institution or law enforcement official. This release would be necessary for the:

1. institution to provide you with health care,
2. protection of health and safety of yourself or others, or
3. safety and security of the correctional institution.

Other Uses of Health Information:

Other uses and disclosures of medical information not covered by this Notice or the laws that apply to us will be made only with your written authorization. If you provide us an authorization to use or disclose medical information about you, you may revoke this authorization in writing at any time. If you revoke an authorization, we will no longer use or disclose your medical information for the reasons covered by new written authorization. You understand that we are unable to take back disclosures we already made with your authorization, and that we are required to retain our records of care that we provide to you.

Your Rights Regarding Health Information About You

Right to Inspect and Copy:

You have the right to inspect and copy medical information that may be used to make decisions about your care. If you request a copy of the information, we may charge a reasonable fee for copying your reports and/or diagnostic images (i.e., films), and we may charge you a reasonable fee for mailing any of these items to you. You must submit your written request to inspect and/or copy your medical information in our files that may be used to make decisions about your care. You must submit this request to us in writing.*

Right to Amend:

If you feel that medical information we have about you is incorrect or incomplete, you may ask us in writing* to amend the information and you must state the reason for your request. You have the right to add a statement to your records*. We may deny your request to amend your records in our files if the information that you seek to amend: 1. is accurate and complete, or 2. was not created by us, or 3. the person or entity that created the information is no longer available to make the amendment, or 4. the information is not part of the information which you are permitted to inspect and copy.

Right to an Accounting of Disclosures:

You have the right to request an accounting of disclosures. This is a list of certain disclosures we made of your medical information. To get an accounting of your medical disclosures from us, you must submit a written request to ICPC.* Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. The first list you request within a 12-month period will be free. For additional lists, we may charge you a reasonable fee for providing the list.

Right to Request Restriction:

You have the right to request a restriction on the medical information we use or disclose about you for treatment, payment or health care operations. Federal regulation does not require us to agree to your request. If we do agree, we will comply with your request unless the information is needed by an entity or a person to provide you with emergency treatment. To request restrictions, you must make a written request to ICPC.*

Right to Request Confidential Communications:

You have the right to request that we communicate with you about your medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request to us in writing.*

Right to Paper Copy of this Notice:

You have the right to receive a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time.

Changes to this Notice:

We reserve the right to change this Notice and to make the changed Notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice in the ICPC office. In addition, the next time you register at the ICPC for diagnostic imaging services or treatment, we will offer you a copy of our current Privacy Notice.

Complaints:

If you believe that we have violated any of your privacy rights, you may file a complaint with ICPC or with the Secretary of the Department of Health and Human Services. To file a complaint with ICPC, you must submit your complaint in writing. * If you wish to discuss your complaint, you may call the Privacy Officer at (340)778-5305 x 3. We will not penalize you for filing a complaint.