THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
THE PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO US.
PATIENT RIGHTS: Any requests to access, restrict, amend, or receive an accounting of disclosures should be directed to XRANM Administration.
ACCESS TO YOUR PHI: You may inspect and obtain a copy of your PHI for as long as we maintain those records. There may be a fee for copies. You may request electronic access to your finalized reports. If you request to inspect your records, we will act on your request within 30 days.
RESTRICTIONS: You may ask us not to use or disclose any part of your PHI for the purposes of treatment, payment, or healthcare operations. You may also request that any part of your PHI not be disclosed to family members or friends who may be involved in your care or for notification purposes. Your request must state the specific restriction requested and to whom you want the restriction applied. We are not required to agree to a restriction that you may request. If we believe that use and disclosure of your PHI is in your best interest, your PHI will not be restricted. If we agree to your restriction, your PHI will not be used in violation of that restriction unless it is needed to provide emergency treatment
CONFIDENTIAL COMMUNICATIONS BY ALTERNATIVE MEANS AND/OR LOCATIONS: We may ask you for information as to how payment will be handled or specification of an alternative address or other method of contact. You may request an alternative communication method by notifying XRANM Administration of your desire to do so. Requests will be reviewed within 5 business days.
AMENDMENTS: You may request an amendment of your PHI. In certain cases we may deny your request for an amendment, in which case you have the right to file a statement of disagreement with us. Requests will be reviewed within 60 days.
ACCOUNTING OF DISCLOSURES: You have the right to receive specific information regarding disclosures for purposes other than treatment, payment or health care operations that occurred after April 14, 2003. It excludes disclosures we have made to you, family members or friends directly involved in your care, or for allowed notification purposes. The right to receive this information is subject to certain exceptions, restrictions and limitations set forth in law. Requests will be reviewed within 60 days.
COMPLAINTS: If you believe your privacy rights have been violated, you may file a complaint with either the XRANM Privacy Officer or the Secretary of Health and Human Service:
X-Ray Associates of New Mexico
Attn: Privacy Officer
8020 Constitution Place NE, #202
Albuquerque NM 87110
(505) 998-3096.
We support your right to the privacy of your health information. We will not retaliate against you for filing a complaint. If you so desire, we will report to you on the review of your complaint and any action taken.
We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice at any time. Upon your request, we will provide you with a revised Notice of Privacy Practices.
NOTICE OF PRIVACY PRACTICES: We are required, by law, to maintain the Privacy of Protected Health Information (PHI) and provide you with legal notice of these duties. PHI is information about you, including demographic information that may identify you and relates to your past, present or future physical or mental health condition and related healthcare services. This notice describes how your PHI may be used and disclosed and how you can get access to this information. If you have any questions about this notice, contact X-Ray Associates Administration at (505) 998-3096.
USES AND DISCLOSURES OF HEALTH INFORMATION: We may use and disclose your health information for treatment, payment and healthcare operations. For example:
TREATMENT: We may use and disclose your PHI to provide, coordinate or manage your care and any related services. We may disclose PHI to other physicians or health care providers who become involved in your care.
PAYMENT: Your PHI may be used to obtain payment for your healthcare services. These activities include verifying eligibility, determining medical necessity, and undertaking utilization review activities.
HEALTHCARE OPERATIONS: We may use or disclose your PHI in order to support the business activities of your physicians and our practice. These activities include, but are not limited to, quality assessment activities, training of personnel, accreditation, licensing and compliance with laws and regulations. We may share your PHI with third party business associates that perform various activities for the practice. Whenever an arrangement between a business associate and XRANM involves the use or disclosure of PHI, we will have a written contract that protects the privacy of your PHI.
INFORMATION REQUIRING YOUR WRITTEN AUTHORIZATION: Aside from disclosures for treatment, payment or healthcare operations, other uses and disclosures of your PHI will be made only with your written authorization, unless otherwise permitted or required by law, as described below. You may revoke authorization, at any time, in writing.
OTHERS INVOLVED IN YOUR CARE: We may disclose to a family member, a close friend or other person you identify, your PHI that directly relates to that person’s involvement in your care. We may use or disclose PHI to notify a family member, personal representative or any other person responsible for your care, of your location, general condition or death. You have the opportunity to agree or object to the use or disclosure. If you are not present to agree or object to the use or disclosure, we may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the PHI that is relevant to your care will be disclosed
REQUIRED BY LAW: We may use or disclose your PHI to the extent that the use or disclosure is required by law. You will be notified of any such uses or disclosures. Examples of such disclosures include, but are not limited to, Public Health activities, Health Oversight Agencies, FDA, other government agencies, and law enforcement.
ABUSE OR NEGLECT: We may disclose your PHI if we believe that you have been the victim of abuse, neglect or domestic violence to the government entity or agency authorized to receive such information.
MILITARY ACTIVITY AND NATIONAL SECURITY: We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. We may disclose to authorized federal officials health information required for lawful intelligence, counterintelligence, and other national security activities.
LEGAL PROCEEDINGS: We may use or disclose your PHI in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent that such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful purpose.
CORONERS, FUNERAL DIRECTORS, AND ORGAN DONATION: We may disclose PHI to a coroner or medical examiner for identification purposes, determining cause of death or to perform other duties authorized by law. We may also disclose PHI to a funeral director in order to permit him/her to carry out their duties. We may disclose such information in reasonable expectation of death. PHI may be used and disclosed for organ tissue or eye donation purposes.
RESEARCH: We may disclose your PHI to researchers when an institutional review board has approved the research activity and ensures the privacy of your PHI.
