“I have been coming to DRA for years. Excellent facility in all aspects. Always a pleasant experience.”

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 read it carefully.

Our goal is to take appropriate steps to attempt to safeguard any medical or other personal information that is provided to us. We are required to: (1) maintain the privacy of medical information provided to us; (2) provide notice of our legal duties and privacy practices; and (3) abide by the terms of our Notice of Privacy Practices currently in effect.

WHO WILL FOLLOW THIS NOTICE:

DRA Imaging PC and Hudson Valley Radiologists PC, and all of their employees and staff, will follow the privacy practices set forth in this notice. These entities have designated themselves as affiliated entities, and may share medical information with each other for the treatment, payment or healthcare operations purposes described in this notice.

INFORMATION COLLECTED ABOUT YOU:

In the ordinary course of receiving treatment and health care services from us, you will be providing us with personal information such as:

In addition, we may gather additional medical information about you and will create a record of the care provided to you. Some information also may be provided to us by other individuals or organizations that are part of your “circle of care” – such as the referring physician, other physicians, health plan, and close friends or family members.

HOW WE MAY USE AND DISCLOSE INFORMATION ABOUT YOU:

We may use and disclose personal and identifiable health information about you in different ways. All of the ways we may use and disclose information will fall within one of the following categories, but not every use or disclosure in a category will be listed.

For Treatment: We will use health information about you to perform your procedure, in accordance with our policies and procedures. For example, we will use your medical history, such as any presence or absence of disease, to assess your health and perform the requested diagnostic procedure.

For Payment: We will use and disclose health information about you to bill for our services and to collect payment from you or your insurance company. For example, we may need to give a payer information about your current medical condition so that it will pay us for your procedure. We may also need to inform your payer prior to the procedure in order to obtain prior approval or to determine whether your procedure is covered.

For Healthcare Operations: We may use or disclose information about you for the general operation of our business. For example, we sometimes arrange for accreditation organizations, auditors or other consultants to review our practice, evaluate our operations, and suggest how to improve our services to you.

Public Policy Uses and Disclosures: There are several public policy reasons why we may disclose information about you.

We may disclose health information about you when we are required by state, federal or local law.

We may disclose protected health information about you in connection with certain public health reporting activities. For instance, we may disclose such information to a public health authority authorized to collect or receive protected health information for the purpose of preventing or controlling disease, injury or disability, or at the direction of a public health authority. Public health authorities include but are not limited to New York State Health Department, Center for Disease Control, the Food and Drug Administration (FDA), the Occupational Safety and Health Administration (OSHA), and the Environmental Protection Agency (EPA).

We are also permitted to disclose protected health information to a public health or other government authority authorized by law to receive reports of domestic, elder or child abuse or neglect. Additionally we may disclose protected health information to a person subject to the FDA’s power for the following activities: to report adverse events, product defects or problems, or biological product deviations, to track products, to enable product recalls, repairs or replacements.

We may disclose your protected health information in response to a judicial subpoena, or a court or administrative order, and in connection with certain government investigations and law enforcement activities. We may also disclose your protected health information in response to a subpoena, discovery request or other lawful process by someone else involved in the dispute, but only if efforts have been made to notify you about the request or to obtain an order protecting the information requested.

We may disclose health information in connection with health oversight activities of licensing and other agencies. Health oversight activities include audit, investigation, inspection, licensure or disciplinary actions, and civil, criminal, administrative proceeding(s), actions or other activities necessary for the oversight of 1) the healthcare system, 2) government benefit programs for which health information is relevant to determining beneficiary eligibility, 3) entities subject to governmental regulatory programs for which health information is necessary to determine compliance with program standards, or 4) entities subject to civil right laws for which health information is necessary for determining compliance.

We may release personal health information to a coroner or medical examiner to identify a deceased person or determine the cause of death.

We may release your personal health information to workers’ compensation or similar programs.

We may use or disclose certain personal health information about your condition and treatment for research purposes where an Institutional Review Board or a similar body referred to as a Privacy Board determines that your privacy interests will be adequately protected in the study. We may also use and disclose your protected health information to prepare or analyze a research protocol and for other research purposes.

Information about you also will be disclosed when necessary to prevent a serious threat to your health and safety or the health and safety of others.

If you are a member of the Armed Forces, domestic or foreign, we may release personal health information about you as required by military command authorities.

If you are an inmate, we may release protected health information about you to a correctional institution where you are incarcerated or to law enforcement officials.

Finally, we may disclose protected health information for national security and intelligence activities and for the provision of protective services to the President of the United States and other officials or foreign heads of state.

Our Business Associates: We sometimes work with outside businesses and individuals who assist us in operating our business successfully. We may disclose your health information to these business associates so that they can perform the tasks that we hire them to do. Our business associates must guarantee to us that they will respect the confidentiality of your personal and Identifiable health information.

Individual Involved in Your Care or Payment for Your Care: We may disclose information to individuals involved in your care or in the payment for your care, but we will obtain your agreement before doing so. This includes people and organizations that are part of your “circle of care” – such as your spouse, your other physicians, or an aide who may be providing services to you. Although we must be able to speak with your other physicians or health care providers, you can let us know if we should not speak with other individuals, such as your spouse or family.

Appointment Reminders: We may use and disclose medical information to contact you as a reminder that you have an appointment or that you should schedule an appointment.

Treatment Alternatives: We may use and disclose your personal health information in order to tell you about or recommend possible treatment options, alternatives or health-related services that may be of interest to you.

Other Uses and Disclosures of Personal Information: We are required to obtain written authorization from you for any uses and disclosures of medical information other than those described above. If you provide us with such permission you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose information about you for the reasons covered by your written authorization. We will be unable to take back any disclosures already made based upon your original permission.

INDIVIDUAL RIGHTS:

You have the right to ask for restrictions on the ways in which we use and disclose your medical information beyond those imposed by law. Our policy is to not agree to such requests.

You have the right to request that you receive communications containing your protected health information from us in a certain way or at a certain location. For example, you may ask that we only contact you at home or by mail.

Except under certain circumstances, you have the right to inspect and copy medical and billing records about you. If you request copies, we may charge you a fee for copying and mailing.

If you believe that information in your records is incorrect or incomplete, you have the right to ask us to correct the existing information or correct the missing information. Under certain circumstances, we may deny your request.

You have a right to ask for a list of instances when we have used or disclosed your medical information for reasons other than treatment, payment for services, our healthcare operations, or disclosures you gave us authorization to make. If you ask for this more that once in a 12-month period, we may charge you a fee.

You have a right to a copy of this notice.

To exercise any of your rights, please contact us in writing at:

CHANGES TO THIS NOTICE:

We reserve the right to make changes to this notice at any time. We reserve the right to make the revised notice effective for personal health information we have about you as well as any information we receive in the future. In the event there is a material change to this notice, the revised notice will be posted in the office and updated on our web site.

COMMENTS/SUGGESTIONS:

You may contact Joe Chiseri, at DRA Imaging, P.C. (845) 454-4700.

If you have any complaints concerning our Privacy Policy, you may contact the Secretary of the Department of Health & Human Services, at 200 Independence Ave. S.W., Room 509F, HHH Building, Washington, D.C. 20201 (email:ocrmail@hhs.gov)

To obtain more information concerning this Notice of Privacy Practices, you may contact our Privacy Officer, Mark Newton, at (845) 454-4700.