333 N. Commercial Street, Suite 100
Neenah, WI 54956
Radiology Associates of the Fox Valley
NOTICE OF PRIVACY PRACTICES
This page describes the use and disclosure of your medical information. It also explains how you (individual) can have access to this information. Please review this information carefully.
RADIOLOGY ASSOCIATES OF THE FOX VALLEY (RAFV) STATEMENT OF PURPOSE
OUR DUTY TO SAFEGUARD YOUR PROTECTED HEALTH INFORMATION
Information that is individually identifiable to your past, present, or future health care needs is your “Protected Health Information” (PHI). RAFV is required to extend certain protections to your PHI and give you Notice about our privacy practices that explains how, when and why we may use or disclose your PHI. Except in otherwise specified circumstances, we will use or disclose only the minimum PHI necessary for accomplishing the purpose of the use or disclosure request.
We are required to follow the privacy practices outlined in this Notice. However, we reserve the right to change our privacy practices and the terms of this Notice at any time.
You may request a copy of the new Notice from RAFV or view it online.
HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION
We use and disclose PHI for a variety of reasons. We have a limited right to use and/or disclose your PHI for purposes of treatment, payment and our healthcare operations. For uses beyond these, we must have your written authorization unless the law permits or requires us to make the use or disclosure without your authorization. If we disclose your PHI to an outside entity in order for that entity to perform a function on our behalf, we must have an agreement from (the outside entity) in place extending the same level of privacy protection to your information that we must apply to your PHI. However, the law provides for us to make some uses/disclosures without your consent or authorization. The following describes and offers examples of our potential uses/disclosures of your PHI.
Treatment: We may disclose your PHI to doctors, nurses, and other healthcare personnel who are involved in providing your health care. In other words, we will share your PHI with the members of your healthcare team.
Payment: We may use/disclose your PHI in order to bill and collect payment for your healthcare services. We may contact your employer to verify employment status, and/or private insurer to receive payment for the services we provided. We may release information to collection agencies for purposes of receiving payment.
Healthcare Operations: We may use/disclose your PHI in the course of managing our business. We may use your PHI in evaluating the quality of our services or disclose your PHI to our accountant or attorney for audit purposes.
Appointment Reminders: Unless you provide us with alternative instructions, we may send appointment reminders and other similar materials to you at your home.
DISCLOSURE OF PHI
RAFV does not disclose an individual’s health information to any organization or individual, except for the purpose of treatment, payment or healthcare operations. For example:
We will contact the individual to provide appointment reminders or information about treatment, treatment alternatives or other health-related benefits and services that may be of interest to the individual.
We will disclose the individual’s PHI to their referring physician or physician group for continuity of care purposes.
We will disclose the individual’s PHI to a group health plan, HMO, an insurance issuer for payment and collection purposes.
USES AND DISCLOSURES OF PHI REQUIRING AUTHORIZATION
For uses and disclosures that go beyond treatment, payment and operations, we are required to have your written authorization unless the use or disclosure falls within one of the exception clauses described below. You can revoke your authorization at any time to stop future uses/disclosures except to the extent that we may have already undertaken an action in reliance upon your current and/or previous authorization.
The law provides that we may use/disclose information from your PHI records without consent or authorization in the following circumstances:
When Required by Law: We may disclose PHI when a law requires that we report information about suspected abuse, neglect or domestic violence, in relationship to a suspected criminal activity, or in response to a court order. We must also disclose PHI to authorities that monitor compliance with these privacy requirements.
Public Health Activities: We may disclose PHI when we are required to collect information about disease or injury, or to report vital statistics to the public health authority. Health Oversight Activities: We may disclose PHI to our corporate office, the protection and advocacy agency, or other agencies responsible for monitoring the healthcare system for such purposes as reporting or investigation of unusual incidents and in monitoring the Medicaid program.
Relating to Decedents: In cases of a death, we may disclose PHI to coroners, medical examiners or funeral directors. When appropriate we may disclose PHI to organ procurement organizations for purposes of organ, eye, or tissue donations and/or transplants.
Avert Threat to Health or Safety: In order to avoid a serious threat to health or safety, we may disclose PHI as necessary to law enforcement or other persons who can reasonably prevent or lessen the threat of harm.
Specific Government Functions: In certain situations, we may disclose PHI of military personnel and veterans, correctional facilities, government benefit programs that relate to eligibility and enrollment, and for national security reasons such as protection of the President.
The only exceptions of disclosure are those sanctioned under the HIPAA regulations that include but not limited to:
An individual’s personal representative for example, a minor’s parent or guardian.
As required by the Food and Drug Administration (FDA) or specialized government functions such as national security and intelligence, or law enforcement custodial duties.
To judicial and law enforcement officials such as court orders or subpoena, locating or identifying suspected criminals and reporting relevant information about victims of a crime.
If RAFV reasonably believes the individual is a victim of abuse, neglect or domestic violence, we will disclose PHI to the appropriate government authorities.
For a deceased individual disclosure to the executor of the individual’s estate, an administrator or other person authorized to act on the deceased’s behalf or to a coroner or medical examiner for the purposes of identification or determining the individual’s cause of death.
These exceptions do not require RAFV to obtain the individual’s authorization. However, RAFV verifies each case