NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

PLEASE REVIEW IT CAREFULLY.

(Click for Print Version)

Breast Imaging of Oklahoma creates a record of the services you receive. Your medical records and billing information are created and retained on a computer system. The system is accessible to billing personnel and Breast Imaging of Oklahoma’s (BIO) staff. Proper safeguards are in place to discourage improper use or access. We are required by law to protect your privacy and the confidentiality of your personal and protected health information and records. This notice describes your rights and our legal duties regarding your Protected Health Information (PHI).

Definitions: You, at times may see or hear new terms in relation to this notice. Some of the terms you may hear and their definitions are:

  1. Protected Health Information or PHI is your personal and protected health information that we use to render care to you and bill for services provided.
     

  2. Privacy Officer is the individual who has responsibility for developing and implementing all policies and procedures concerning our PHI and receiving and investigating any complains you may have about the use and disclosure of your PHI.
     

  3. Business Associate is an individual or business outside BIO that works with the facility to help provide you with services.
     

  4. Authorization, we will obtain authorization from you giving us permission to use or disclose your protected health information for purposes other than for our treatment, to obtain payment of your bills and for health care operations.
     

  5. Organized Health Care Arrangement, this facility and the independent health care professionals who practice with the facility are part of a clinically integrated care setting in which your PHI will be shared for purposes of treatment, payment, and health care operations.

Breast Imaging of Oklahoma may use and disclose your protected health information for the following:

  1. Treatment. We may use PHI about you to provide you with medical treatment or services. We may disclose protected health information about you to doctors, nurses, technicians, laboratory assistances, medical students or other personnel who are involved in taking care of you.
     

  2. Payment. We may use and disclose PHI about you so that the treatment and services you receive at BIO may be billed to and payment may be collected from you, an insurance company or a third party. For example, we may need to give your health plan information about a procedure so your health plan will reimburse for the service rendered. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the recommended treatment.
     

  3. Business Associate. We may disclose your PHI to Business Associates outside the facility with whom we contract to provide services on our behalf. However, we will only make these disclosures if we have received satisfactory assurance that the Business Associate will properly safeguard your privacy and the confidentiality of your protected health information. For example, we have a contract with a company outside of this facility to provide billing services.
     

  4. Appointment Reminders. We may use and disclose your PHI to contact you as a reminder that you have an appointment for routine exams, including a mammogram, ultrasound, or MRI.
     

  5. Health Related Benefits and Services. We may use and disclose your PHI to tell you about health-related benefits or services or recommended possible treatment options or alternative that may be of interest to you. For example we may use a mailing for new breast care recommendations.
     

  6. Research. Under certain circumstances, we may use and disclose PHI about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one extra diagnostic exam to those who did not for the same risk factors. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of protected health information, trying to balance the research needs with the patients’ need for privacy of their protected health information. Before we use or disclose medical information for research, the project will have been approved through this research approval process.
     

  7. As Required by Law. We will disclose PHI about you when required to do so by federal, state or local law.
     

  8. Workers compensation. We may release PHI about you for workers’ compensation or similar programs as authorized by state laws. These programs provide benefits for work-related injuries or illness.
     

  9. Public Health Risks. We may disclose PHI about you for public health activities, for example:

  • Prevent or control disease, injury or disability

  • Report reactions to medications or problems with products

  • Notify people of recalls of products they may be using or were used in their treatment

  • Notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence, when required by law

  • 10. Health Oversight Activities. We may disclose PHI to a health

  1. oversight agency for activities necessary for the government to monitor the health care system, government programs, and compliance with applicable laws. These oversight activities include, for example; audits, investigations, inspections, medical device reporting and licensure.

  2. Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose PHI about you in response to a court or administrative order.

  3. Law Enforcement. We may release PHI if asked to do so by a law enforcement official:

  • In response to a court order, subpoena, warrant, summons, or similar process

  • To identify or locate a suspect, fugitive material witness, or missing person

YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION ABOUT YOU.
You have the following rights regarding PHI we maintain about you:

  1. Right to Inspect and Copy. You have the right to inspect and request a copy of your protected health information, except as prohibited by law.

    To inspect and/or request a copy of your PHI that may be used to make decisions about you, you must submit your request in writing. If you request a copy of the information, we may charge a fee of 35 cents a page to offset the costs associate with the request.
     

  2. Right to Amend. If you feel that PHI we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for Breast Imaging of Oklahoma. To request an amendment your request must be made in writing that states the reason for the request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request to amend information that:

  • Was not created by us, unless the person or entity that created the information is no longer available to make the amendment

  • Is not part of the protected health information kept by or for Breast Imaging of Oklahoma

  • Is not part of the information which you would be permitted to inspect or copy

  • Is accurate and complete

  1. Right to Accounting Disclosures. You have the right to request a free accounting every twelve (12) months of the disclosures we made of protected health information about you. To request this list, you must submit your request in writing. Your request must state a time period which may not be longer than six (6) years and may not include dates before February 10, 2003. Your request should indicate in what form you want the list (for example, on paper or electronically). For additional lists, we may charge you for the cost of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request.
     

  2. Right to Restrictions. You have the right to request a restriction or limitation on the protected health information we use or disclose about you for treatment, payment or health care operation. You also have the right to request a limit on the PHI we disclose about you to someone who is involved in your care, like a family member or friend. For example, you could ask that we not use or disclose information about a procedure you had.

    We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide your emergency treatment.

    To request a restriction, you must make your request in writing. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit your use, disclosure or both; and (3) to whom you want the limits to apply.
     

  3. Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain locations. For example, you can ask that we only contact you at work or by mail.

    To request confidential communication, you must make your request in writing. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

    You may obtain a copy of this notice at our web site: www.breastimagingofoklahoma.com

CHANGES TO THIS NOTICE.

We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for PHI 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 facility. The notice will contain on the first page, at the top, the effective date. In addition, each time you register, we will make available to you a copy of the current notice in effect.

AUTHORIZATION FOR OTHER USES OF PROTECTED HEALTH INFORAMTION.

Other uses and disclosure of protected health 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 authorization, to use or disclose PHI about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will not longer use or disclose protected health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your authorization, and that we are required to retain our records of the care that we provided to you.

COMPLAINTS.

If you believe your privacy rights have been violated, you may file a written complaint with the facility or with the Secretary of the Department of Health and Human Services.

To file a complaint with the facility, write:

Kathy Tucker, Privacy Officer
Breast Imaging of Oklahoma
2601 Kelley Pointe Parkway, Suite 101
Edmond, Oklahoma 73013
Fax: 405-844-2601
E-mail complaints: ktucker@breastok.com

To file a complaint with the Secretary of Department of Health and Human Services, write:
Office of Civil Rights, Region VI
U.S. Department of Health and Human Services
1301 Young Street, Suite 1169
Dallas, Texas 75202
Fax: 214-767-4056
E-mail complaints: OCRComplaint@hhs.gov
 

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       E-mail: Info@breastimagingofoklahoma.com
         Phone: (405) 844-2601