THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW
We are required by law to maintain the privacy of your medical
information and to provide you with notice of our legal duties and
privacy practices. We are required to abide by the terms of the Notice
of Privacy Practices currently in effect. We reserve the right to change
those terms and any changes made will be effective for all medical
information we maintain. A copy of a revised notice will be available
from our Privacy Coordinator by calling 610-280-6103, or by writing to
Exton MRI, c/o Privacy Coordinator, 495 Thomas Jones Way, Suite 104,
Exton, PA, 19341. You may also address questions regarding our privacy
practices, your privacy rights, or requests for additional information
regarding your privacy to this person.
Permitted Uses and Disclosures
We may use and disclose your medical information in the ordinary course
of our business. We have described some of these uses and disclosures in
the following paragraphs:
Treatment: We will provide your doctor or other health
care provider with the results of the diagnostic imaging exams we
perform. We may contact you before the exam to remind you of your
appointment or to talk with you about preparing for the exam. We
normally call you at the contact number you provide us. If you are not
available or your voice mail answers, we will leave a brief message
reminding you of the place and time of your appointment. If applicable,
we will ask you to call us regarding your exam preparations.
Payment: We will bill your insurance company, you
directly, or another person that may be responsible for payment of your
account. We may need to contact your health plan to see if they will pay
for the exams your doctor has ordered. Throughout this process, we may
have to release details of your exam and medical condition, if your
health plan or other payor requires this information to make payment.
Health Care Operations: We often have to use specific
patient information to conduct our normal business operations. For
example, we routinely review past exams performed to maintain quality
assurance goals. One type of review we may conduct includes selecting
images for review by another radiologist. Another is to select your
billing information for review by our internal compliance team or by
external auditors. In addition, we may use specific patient information
to demonstrate our skills to an accreditation body. Accreditation is
important to our patients and us because the process causes us to
demonstrate some degree of proficiency in conducting examinations and
maintaining the quality of our equipment.
Disclosures without Authorization
We may use and disclose medical information about you, without your
specific authorization, as follows:
Disclosures Required by Law: We may be required by
federal, state, or local law to disclose your medical information.
Public Health Activities: We may disclose your medical
information to a public agency, such as the Food and Drug Administration
(FDA), if you experience an adverse effect from any of the drugs,
supplies, or equipment we use.
Victims of Abuse, Neglect, or Domestic Violence: We may be required to
disclose your medical information if we feel that you have been abused
Health Oversight Activities: We may be required to
disclose your medical information to Medicare or a related agency if
they select your case for a medical review.
Judicial and Administrative Proceedings: We may have to
disclose your medical information if we receive a subpoena from a judge
or administrative tribunal.
Law Enforcement: We may have to disclose your medical
information in conjunction with a criminal investigation by a federal or
state law enforcement agency.
Serious Threats to Health or Safety: We may be required
to disclose your medical information if, in our opinion, doing so will
help avert a serious threat to the public.
Military Personnel: We may disclose your medical
information to the appropriate command authorities.
Worker's Compensation: We may disclose your medical information to
comply with laws regarding worker's compensation.
You have certain rights with respect to your medical information.
Requesting Restrictions: You may ask us to limit our
use or disclosure of your protected health information. We are not
required to agree to your request, but if we agree to it, we will abide
by your request except as required by law, in emergencies, or when the
information is necessary to treat you. Your request must: 1) be in
writing, 2) describe the information that you want restricted, 3) state
if the restriction is to limit our use or disclosure, and 4) state to
whom the restriction applies. You may revoke your restriction at any
time by contacting our Privacy Coordinator as noted on the first page.
We may ask to reschedule your exam while we consider your request.
Confidential Communications: You may ask that we
communicate with you in a particular way, or at a certain location, to
maintain your confidentiality. Your request must be in writing, tell us
how you intend to satisfy your financial responsibility, and specify an
alternate way that we can contact you confidentially. You do not have to
give a reason for your request. In certain circumstances, we may require
payment in full at the time you have your exam. You may revoke your
request at any time by contacting our Privacy Coordinator as noted on
the first page. We may ask to reschedule your exam while we consider
Inspect and Copy: You may request access to inspect and
copy your medical information maintained in our records, including
medical and billing records. Your request must be in writing. We will
act on your request within 30 days after we get it or within 60 days if
the information is stored at another location. If we must deny your
request, we will send you a written denial. If this happens, you may
request a review of the denial. We may charge you a fee for providing
copies. If that is the case, we will advise you of the cost of those
copies at the time that we arrange for you to pick them up or have them
delivered to you. We will compute these fees using state guidelines. You
may also have to pay for the cost of postage or shipping, depending on
how you ask that we get these copies to you.
Amendment: You may ask us to amend your health
information if you believe that it is incorrect or incomplete. Your
request must be in writing and must include a reason to support the
amendment. Your request may be denied if we believe that the information
is complete and accurate, if the information is not part of the medical
information that you would be permitted to inspect or copy, or if we did
not create the information.
Accounting of Disclosures: You may request a list of
non-routine disclosures that we have made of your medical information
over the previous six (6) years. This does not include disclosures we
make for your treatment, to seek payment for our services, or for our
normal business operations as noted in the section on permitted uses and
disclosures, or for those you authorize in writing. You may not request
an accounting for dates of service prior to April 14, 2003. Your first
request within a 12-month period is free, but we may charge for
additional lists within the same 12-month period.
Paper Copy of This Notice: You are entitled to receive
a paper copy of our Notice of Privacy Practices by contacting our
Privacy Coordinator using the contact information on the first page.
File a Complaint: If you believe that we have violated
your privacy rights, you may file a complaint directly with our Privacy
Coordinator using the contact information on the first page. You may
also file a complaint with the Secretary of the Department of Health and
Human Services. We will not penalize you for complaining.
Patient Authorizations for Certain Disclosures
We will request your written authorization for uses and disclosures of
your medical information that we did not identify in this notice or for
those not otherwise permitted by law. These disclosures include your
requests to provide exam results to your attorney, for exams related to
life insurance or disability insurance applications, or for
pre-employment physicals, among others. You may revoke your
authorization in writing at any time by contacting our Privacy
Coordinator using the contact information on the first page.
Effective Date: March 31, 2003
Connect with MLH
New Appointments 1.866.CALL.MLH or 484-580-1000
Health Center: Exton
491 John Young Way
Baxter Building I at Oaklands Corporate Center
Exton, PA 19341
495 Thomas Jones Way
Baxter Building II
Exton, PA 19341
For more information, call 1.866.CALL.MLH.