Privacy Policy

Radiology Response Notice of Privacy Practices

Medical Information Privacy Notice


Effective November 1, 2012

Our Policy Regarding Health Information Policy:

Radiology Response is committed to protecting your medical information. In order to provide you with quality care and to comply with our legal requirements, we create a record of the medical care and services you receive from Radiology Response. This notice applies to all records of your care provided by Radiology Response. Your personal doctor or any other physician included in your care may have different policies. You should refer to their privacy policy and/or notice to understand their respective privacy policies and/or notices.

This notice describes about how we may use and disclose medical information about you. We also describe your rights to medical information and obligations that we have regarding the use and disclosure of medical information.

Radiology Response is required by law to protect the privacy of your health information. We are also required to make this notice available to you, which explains how we may use information about you and when we can “disclose” or provide that information to others.

You have rights regarding your health information that are described in this notice. We are required by law to abide by the terms of this notice.

The terms “information” or ‘health information” in this notice include any information that we maintain can be used to: 1) identify you and 2) that relates to your physical health, mental health, the provision of health care to you, or the payment for such health care.

We have the right to change the terms of this notice and our privacy policy. We reserve the right to make any revised notice effective for information we already have and information that we receive in the future.

We will post the revised notice on The effective date will be posted on the first page of the notice.

How We Use or Disclose Information:

The following categories describe different ways that we use and disclose your medical information as defined in the introduction. The examples and situations provided for each category are not intended to be a complete list of use or disclosure in each category, but are intended to give you an idea about more specific situations in which a disclosure may be made.

Other disclosure or uses of medical information not covered by this notice or applicable laws will be made only with your written permission. You make revoke your permission for Radiology Response to use or disclose your medical information at any time in writing. After you revoke your permission in writing, we will no longer disclose or use medical information about you for the reasons covered in your prior permission or authorization. We are unable to take back any disclosures we previously made with your prior permission or authorization.

We may use medical information about you:

For Treatment:

We may use your medical information to provide you with medical treatment or services. We may disclose your personal medical information to doctors, nurses, medical students, technicians, or other affiliated personnel who are involved in your care. For example, a doctor reading your medical images may need to know if you have a history of prior surgery to interpret the images. This doctor may access your medical record to access this information. We may also provide information to individuals involved in your care outside of Radiology Response, including your personal or referring physician, other physicians involved in your care, or family members.

For Treatment Alternatives We may disclose and use medical information about you to inform you or other individuals involved in your care about medical treatment alternatives.

For Health-Related Services:

We may disclose and use information about you to inform you or other individuals involved in your care about health-related services that may be of interest or benefit to you.

For Individuals Involved In Your Care:

We may disclose information to individuals involved in your care, including friends, family members or any person named in a durable health care power of attorney or similar document. You can object to any release of information to individuals involved in your care. Your right to object to this disclosure and how to object to a disclosure is described under the section of this document entitled “Right to Request Restrictions.”

For Payment:

We may disclose and use medical information about you for the billing and payment of medical services. This information may be used for collection from an insurance company, a third party, or you. For example, we may need to provide your insurance provider with information about the medical services you received from Radiology Response so that they can reimburse you for the services you have paid for. We may also disclose information about you to another medical provider, such as the your personal physician who referred you to Radiology Response, for their payment activities. Information may also be given to individuals involved in the payment of your care.

For Healthcare Operations:

We may use or disclose information about you to ensure the safety and quality of operations of Radiology Response. For example, we may have medical personnel reviewing the work of other medical personnel at Radiology Response to ensure the quality of their services. In performing this reviewing role, they may access your medical information. Your medical information may be combined with internal or external medical information to compare
how we are doing. Use of your information in this way allows us to make improvements in the quality of care we provide. We may remove identifying information from your medical information to learn more about our services and improve our services without disclosing your identity. We may also use and disclose information about you for another hospital’s health care operations if you have received or are receiving care at that hospital.

For Workers Compensation Claims:

We may use and release information about you for the purposes of workers compensation claims. Workers compensation claims programs provide benefits for work-related injuries or illnesses. These disclosures may be made to your employer, the relevant insurance provider, or the relevant government agency. Additionally, they may be made to your legal representative, or the legal representative of your employer, the relevant insurance provider, or the relevant government agency.

For Lawsuits and Legal Disputes:

We may use and release information about you for the purposes of legal cases in which our services are rendered for the purposes of providing an expert opinion. In response to a court or administrative order, we may be required to disclose information about you. We may also disclose information about you in response to a subpoena, discovery request, or other lawful process by another party involved in a legal dispute.

For Public Health Activities:

We may use and release information about you for public health activites, some of which may be required by law. For example, we may release information to prevent or control a disease outbreak or to report problems associated with a medication or device. We may use and disclose information to notify a person who may have been exposed to a disease. We will only make these disclosure if you agree to the disclosure or when required or authorized by law.

When Required By Law:

We will release medical information when it is required by the relevant federal, state, or local law. This may include the following scenarios:
• If we believe a patient has been the victim of abuse, neglect, or domestic violence.
• Attempts to locate a suspect, fugitive, material witness, or missing person.
• Inquiries about a death or injury believed to be the result of criminal conduct or criminal conduct in the provision of medical services.
• In response to a court order, subpoena, warrant, summons, or similar process.

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 the health and safety of you, another person, or the general public.

Military, National Security, Intelligence, and Veterans:

We will release information about you as required by the relevant military, national security, or intelligence command authorities if you are a member of the armed forces, national security or intelligence services of the United States or another country. We may use and disclose to the Department of Veterans Affairs information regarding eligibility for benefits.


We may release information to the appropriate correctional institution or law enforcement official if you are an inmate of a correctional institution.

National Security:

We may release medical information about you to authorized agents for intelligence, counter-intelligence, special investigations. We may release medical information about you to authorized officials so they may provide protection to the President, other heads of state, or other individuals.

Coroners and Medical Examiners:

We will release information about you as required by coroners and medical examiners. This disclosure may be necessary for determining the cause of death or the identity of a deceased person.

We are obligated to use and disclose your health information to provide that information:

• To you or someone who has the legal right to act for you (your representative) in order to administer your rights as described in this notice; and
• To the Secretary of the Department of Health and Human Services, if necessary to make sure that your privacy is protected.

You have the following rights regarding your health information:

To Inspect and Copy Medical Information:

You have the right to inspect and copy medical information that may be used to make decisions about your care, including medical and billing records. To
inspect and copy medical information, you must submit your request to Radiology Response in writing. Radiology Response may charge a fee for the costs of copying, electronically processing, mailing, or other supplies associated with your request. We may provide you with a summary or explanation of the information instead of providing you with access to it, if you agree. We will obtain your agreement to pay the fees for preparing a summary or explanation. In very limited circumstances, we may deny access to your medical records, such as if the referring physician determines accessing the medical record is not advisable for medical reasons. If such a denial occurs, another physician will review this denial. We will follow the guidance of the physician who conducts this review.

Right to Request Restrictions:

You have the right to request that specific restrictions be made on the use or disclosure of your medical information, including the disclosure of medical information to individuals involved in your care or the payment of your care. You must submit the request to the Hospital’s Privacy Officer and inform us (1) the type of information you want to restrict access to; (2) whether the limitation applies to use, disclosure, or both (3) who the limitations apply to, for example, disclosures to your employer or your spouse.

We are not required to comply with your request. If we do agree with your request, we will only disclose information we agreed not to disclose if needed for emergency treatment.

Right to Amend:

You may request an amendment to your medical information if you believe that the medical information is incorrect or incomplete. You can make this request as long as the information is kept by or for Radiology Response. Your request must be made in writing and submitted to Radiology Response’s Privacy Officer along with a reason for the request. If the request does not include a reason for the request or is not in writing, it will be denied. We will deny amendments if the information was not created by Radiology Response unless the person who created the information is not available to amend it themselves. We will deny amendments to medical records if they are accurate and complete. We will deny amendments to medical records if they concern part of the medical record not kept by Radiology Response.

Right to Accounting of Disclosures:

You have a right to request a list of some of the disclosures we made of medical information about you that we re not specifically authorized by you in advance. This is called an “accounting of disclosures”. To request this “accounting
of disclosures”, you are required to submit your request in writing to Radiology Response. Your request must include a time period that may not be longer than six years, and may not include dates before November 1, 2012. Your request must include whether you want the list provided electronically or on paper. You will be charged for the cost of creating the list- we will notify you of the cost involved so you can modify or withdraw your request prior to being charged.

Right to Confidential Communications:

You have a right to request to receive communications in a confidential basis form us. For example you can request that we contact you by a specific address or only contact you at work. If reasonable, we must accommodate your request. You must contact the Privacy Officer if you would like confidential communications. You are not required to provide a reason for the request.

Right to a Paper Copy of This Notice:

You have the right to a paper copy of this notice, which you may request at any time, even if you have agreed to receive this notice electronically. Please submit a request to the Privacy Officer in writing to obtain a paper copy of this notice.

Right to Submit A Complaint of Privacy Violation:

If you believe that your privacy rights have been violated, you may file a complaint with Radiology Response or with the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint. To file a complaint, contact the Radiology Response Privacy Officer. All complaints must be submitted in writing.

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