GEM STATE RADIOLOGY
Doing business as
ADVANCED VEIN THERAPY
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.
We at Gem State Radiology, doing business as, ADVANCED VEIN THERAPY, understand that medical information about you and your health is personal. We are required by law to maintain the privacy of individually identifiable patient health information (this information is known as “protected health information” and is referred to in this document as “PHI”). We are required by law to provide patients with a copy of our notice of privacy practices regarding PHI. We are also required to post the information contained in this notice in a prominent place within our facility. A copy of this notice is also accessible on our website at www.aboutAVT.com. We will only use or disclose your PHI as is permitted under the terms of our Notice of Privacy Practices that may be currently in effect at any given time.
I. Persons Governed by this Notice
This notice applies to the delivery of health care by employees and staff of Advanced Vein Therapy as well as to the radiologists who provide services to our patients and interpret imaging studies performed at Advanced Vein Therapy. These radiologists belong to a group known as Gem State Radiology, LLP. Gem State Radiology and its radiologists; Advanced Vein Therapy and its employees and workforce; and SARMC (collectively referred to herein as “GSR” or “we”) have all agreed to be bound by the terms of this, or any subsequently applicable, Notice of Privacy Practices. This Notice of Privacy Practices will apply to PHI obtained by GSR in providing services to you at any GSR facility. In addition, all persons and entities participating in GSR, including Advanced Vein Therapy and Gem State Radiology and its radiologists may share your PHI with each other for the treatment, payment, or health care operations purposes and other purposes as described in this Notice.
II. How GSR May Use or Disclose Your PHI
GSR may use and disclose PHI about you in different ways. All of the ways which we may use or disclose information fall within one of the following described categories, however, not every potential use or disclosure within a category is listed in this Notice of Privacy Practices.
A. Uses and Disclosures Which do not Require Patient Authorization or Permission
The following uses and disclosures of information by GSR may be made without your permission or authorization and without notice to you:
i. For Treatment.
GSR may use your PHI to provide you with medical treatment, services, and supplies. For example, we may use your PHI, such as a history of heart disease, to assess your health and perform requested diagnostic services. In addition, we may disclose the findings of our treatment or diagnostic procedures to other health care providers, such as your referring physician, so that they may provide treatment to you, just as we may obtain PHI from other health care providers who have provided treatment to you, so that we may better provide treatment, services, or supplies to you.
- Appointment and Other Reminders. GSR may use and disclose PHI to contact you as a reminder that you have an appointment, that you need to schedule an appointment, or what steps you need to take to prepare for an appointment, such as whether and for how long you must abstain from food or drink prior to your appointment.
ii. For Payment.
GSR will use and disclose PHI about you to bill for our services and to collect payment from you and/or your insurance company. For example, we may give a payor information about your medical condition so that payor will make payment to us for the imaging or other services that we have furnished to you. We may also inform your payor of the tests you are going to receive, as well as other PHI about you, in order to obtain prior approval or to determine whether the services we are going to provide to you are covered by your insurance. We also may provide PHI to other health care providers, payors, or other persons, including those responsible to make payment for services provided to you, to help secure payment for our services, or for other health care providers to obtain payment for their services.
iii. For Health Care Operations.
We may use and disclose PHI about you for business, administrative and the general operations of GSR. For example, we may utilize PHI to arrange for accreditation, organization review, use by auditors or other business and legal consultants to review our practice, to evaluate our operations, and to assist us in improving the quality and delivery of our services.
iv. Business Associates.
GSR may use or disclose your PHI to other persons or entities with whom GSR, or any of its members, such as Advanced Vein Therapy and/or Gem State Radiology have an agreement or an arrangement by which such other person or entity uses or discloses PHI for obtaining payment, health care operations, and other permissible functions on behalf of GSR or its members. An example of a business associate would include billing and collection companies, or persons who might provide auditing or legal services. Any business associate of GSR or its agents and subcontractors will be required to guarantee that they will maintain the confidentiality of your PHI to the same extent GSR would if it were performing these tasks itself. Furthermore, business associate and their subcontractors are directly accountable for protecting your PHI and they are required to promptly inform GSR should your PHI be compromised.
v. Public Policy and Other Uses and Disclosures Permitted By Law.
There are a number of reasons why we may disclose PHI about you pursuant to federal or state law, or applicable public policy. We may disclose PHI about you when we are allowed or required to do so by federal, state, or local law. Types of such use and disclosure of your PHI include the following:
(1) Public Health Reporting. We may disclose PHI about you in connection with public health reporting activities. For example, we may disclose PHI to a public health authority authorized to collect or receive PHI for the purpose of preventing or controlling disease, injury, or disability. Also, we may disclose PHI about you at the direction of a public health authority or to an official of a foreign government agency that is acting in collaboration with a public health authority. A public health authority may include state health departments, the Center for Disease Control, the Food and Drug Administration, the Occupational Safety and Health Administration, and the Environmental Protection Agency, to name but a few.
(2) Abuse and Neglect Reports and Patient Safety. We are also permitted to disclose PHI about you to a governmental agency or other entity authorized by law to receive reports of child abuse or neglect, or neglect or abuse of vulnerable adults. PHI about you may also be used or disclosed as necessary to prevent a serious threat to your health and safety or to the health and safety of others.
(3) Food and Drug Reports. We may disclose PHI to a person subject to the Food and Drug Administration’s oversight, including, for example, 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, or to conduct post marketing surveillance.
(4) Health Oversight Activities. We may disclose PHI concerning you in connection with certain health oversight activities of licensing and other agencies. For example, health oversight activities include audit, investigation, inspection, licensure or discipline activities and actions, and civil, criminal, or administrative proceedings or actions or any other activity necessary for the oversight of the health care system; governmental benefit programs for which health information is relevant to determining beneficiary eligibility; entities subject to governmental regulatory programs for which health information is necessary to determine compliance with program standards, or subject to civil rights for which health information is necessary for determining compliance.
(5) Law Enforcement and Legal Proceedings. We may disclose PHI in response to a warrant, subpoena, or other order of a court or administrative hearing body, and in connection with certain government investigations and law enforcement activities, including identifying a criminal suspect or a missing person; or providing certain information about crime victims or criminal conduct, including to report a crime that we suspect occurred on our premises. We may also disclose your PHI in connection to legal administrative proceedings that involve you. We may release such information upon an order of a court or administrative tribunal. We may release such PHI also in the absence of such an order and in response to discovery or other lawful requests, if efforts have been made to notify you or secure a protective order limiting or preventing the disclosure of PHI.
(6) Coroners and Transplant Procurement. We may also release PHI to a coroner or medical examiner to identify a deceased person or determine the cause of death. We may release PHI to organ procurement organizations, transplant centers, and eye or tissue banks.
(7) Workplace Injury or Illness. GSR may use or disclose your PHI to comply with workplace illness and injury laws, including obligations for workplace medical surveillance and worker’s compensation laws.
(8) Military, Government and National Security. If you are a member of the armed forces, we may release or use your PHI as required by military command authorities. We may also release PHI about foreign military personnel to the appropriate foreign military authority. Likewise, we may disclose PHI for national security intelligence activities, and for the provision of protective services of the President of the United States and other officials or foreign heads of state.
(9) Disclosure Regarding Inmates. If you are an inmate, we may release PHI about you to a correctional institution where you are incarcerated or to law enforcement officials who may have custody of you.
(10) Certain Research Uses. We may use or disclose PHI about your condition and treatment for research purposes where an institutional review board or similar body referred to as a privacy board, determines that your privacy interests will be adequately protected in this setting by the limited use of PHI. We may also use and disclose your PHI to prepare or analyze a research protocol. Researchers will be required to safeguard the PHI they receive.
III. Permitted Use or Disclosure with the Opportunity for You to Agree or Object
GSR and its members may use or disclose your PHI in certain circumstances without your authorization, but you have the opportunity to ask that such uses or disclosures not occur. These uses and disclosures include the following:
GSR may disclose PHI about you to a friend or family member who is involved in your medical care. GSR will also give information to someone who helps you pay for your care. In addition, GSR will disclose PHI about you to an agency assisting in a disaster relief effort so that your family can be notified about your condition, status, or location. You have a right to request that your PHI NOT be shared with some or all of your family, friends, or otherwise as described above.
B. Promotional Communications
GSR does not share or sell your PHI to companies that market health care products or services directly to customers for use by those companies to contact you, such as drug companies. GSR may maintain a database of individuals for communications concerning disease management or detection, health promotion, and regarding products that GSR believes may be of benefit to you and your health condition. Individuals in this database under certain circumstances may receive information about the programs and services of Advanced Vein Therapy and/or Gem State Radiology. You may request to be deleted from this database by contacting the GSR Privacy Officer.
IV. Use or Disclosure Requiring Your Authorization
The following disclosures or use of your PHI will occur only upon your providing written authorization for us to use or disclose the information for the purposes described below:
GSR is not permitted to provide your PHI to any other person or entity for marketing any products or services to you, other than Advanced Vein Therapy’s or Gem State Radiology’s products or services, or otherwise as described in paragraph III (B) above, unless you have signed an authorization permitting such use or disclosure.
GSR will use or disclosure your PHI as part of research that includes providing you with treatment if you have signed a written authorization permitting the use or disclosure for such research purposes. For example, if you are part of a research study that includes treatment, GSR will require that you sign an authorization to allow the researcher to use or disclose your PHI for this research. However, GSR may condition the provision of such medical care or treatment that is part of the research upon your signing the research authorization.
C. Other Uses
Any other uses or disclosures that are not for purposes of treatment, payment, or health care operations of GSR, or that are not otherwise permitted as described herein, will be made only with your written authorization. When disclosure is permitted only with written authorization, the authorization will inform you of why we are requesting use or disclosure of your PHI and to whom the PHI may be disclosed or by whom it may be used. If we are required to obtain an authorization that you signed, you may, in writing, revoke such authorization to the extent that GSR has not already relied upon the authorization in the use and disclosure of your PHI.
V. Your Health Information Privacy Rights
GSR maintains records related to the care and services you receive at an GSR location, which includes records pertaining to care provided by Advanced Vein Therapy employees and work force members and Gem State Radiology. These records are owned by GSR, but you have the following rights concerning your PHI maintained by GSR:
A. Right to Request Restrictions
You may ask GSR to not use or disclose any part of your PHI for purposes of treatment, payment, or health care operations. Your request must be put in writing and specify the restriction requested and the scope to which you would like the restriction to apply. GSR is not required to agree to such a restriction that you may request, however. If GSR does agree to the requested restriction, it will do so only in writing, and GSR will not use or disclose your PHI to the extent agreed to in writing by GSR, unless it is necessary for you to receive emergency treatment, or if the restriction is terminated by you, or by GSR by notifying you of our termination of agreement to the restriction. If, however, you pay for your care yourself, out of your own pocket, you may request we not share your PHI about this care with your health plan or health insurer, and GSR is required to comply with this request.
B. Right to Request to Receive Communication by Alternative Means
GSR will accommodate reasonable requests to receive communications by alternative means or to an alternative location (e.g., by calling you at work or sending information to a different address). Such requests must be made in writing. GSR may condition this accommodation by requiring you to provide information as to how payment will be handled and by requiring specification from you of an alternative address or other method of contact. Such a request should be made in writing to our Privacy Officer.
C. Right to Access your Private Health Information by Inspection and/or Copying
You have a right to access your PHI and to inspect and copy your PHI contained in your designated record set as long as it is maintained by GSR except, that no such right of access shall apply to psychotherapy notes; information that will be used in a civil, criminal, or administrative action or proceeding; PHI to which by law, GSR may elect or be required to deny you access. Depending upon the basis for denial of a request to access your PHI, that decision to deny access may be reviewable by another health care professional that GSR may choose, so long as that person was not involved in the original decision to deny your request for access. Some denials are not subject to any right of review. To the extent we maintain your medical records in electronic format; you may request to receive a copy of such records in electronic form. Before providing copies of your PHI, GSR may require the payment by you of a reasonable cost-based copying charge for medical records and medical images. You must make your request to access and copy your PHI in writing to GSR’s Privacy Officer. GSR will respond to your request within thirty (30) days of the receipt of the written request. If GSR cannot respond to your request within that time frame, GSR will notify you in writing to explain the delay and the date by which GSR will act upon your request.
D. Right to Request Amendment
You may request an amendment of PHI about you that is maintained by GSR in a designated record set for as long as GSR maintains this information. You must submit a written request for amendment that provides the reasons for the requested amendment. GSR may deny the request for amendment for any reason permitted by law, including for example, that GSR did not create the information; the information is not part of GSR’s designated record set, the information is not of a type that would be available for you to access, or the information is accurate and complete. If GSR denies your request for amendment, you may file a statement of disagreement with us. You may ask that GSR include your request for amendment and the denial of the same any time that GSR discloses the information about which you requested amendment. GSR may prepare a rebuttal to your statement of disagreement and will provide you with a copy of that rebuttal. Please contact the GSR Privacy Officer if you wish to make such a request for amendment to your PHI.
E. Right to An Accounting of Certain Disclosures of PHI
You have the right to receive an accounting of certain disclosures of your PHI that GSR has made. However, GSR does not and will not provide an accounting of the following disclosures:
1) Disclosures to carry out treatment, payment, or health care operations, or that are incidental to such activities;
2) Disclosures to you;
3) Disclosures that are incidental;
4) Disclosures to persons involved in your care such as family and friends;
5) Disclosures pursuant to a written authorization
6) Disclosures for national security or intelligence purposes;
7) Disclosures to correctional institutions or law enforcement officials;
8) Disclosures that occurred prior to April 14, 2003; and
9) Other disclosures for which accounting is not required in accordance with applicable law.
The first accounting requested by you and provided within the twelve (12) month period will be provided without charge. However, you will be charged for subsequent accountings requested by you within the same twelve (12) month period based upon a reasonable cost-based fee for preparing the accounting.
For each disclosure for which we must account, you will receive: the date of the disclosure, the name of the receiving organization and address if known, a brief description of the PHI disclosed and a brief statement of the purpose of the disclosure or a copy of the written request for the information, if there was one. However, for certain research disclosures, we will provide more limited information to you.
You must make your request for an accounting of disclosure of your PHI in writing to GSR. You must include the time period for which you are requesting the accounting, which may not be longer than six (6) years. GSR will respond to your request within sixty (60) days from the receipt of the written request. GSR will notify you within the sixty (60) day period in writing if it needs additional time to respond to your request. In any event, GSR will act on your request and provide such accounting within ninety (90) days of the receipt of the original request for accounting.
F. Right to Receive a Copy of This Notice
If you received this Notice electronically, you have a right to receive a paper copy of this Notice of Privacy Practices upon request.
G. Breach Notification
GSR and/or its’ Business Associate(s) are required to notify when the privacy of your “unsecured” protected health information (PHI) is breached, unless it is determined, consistent with applicable regulations or laws, that we are not required to provide such notice because we determine you are not at risk of harm as a result of such breach.
VI. Changes to this Notice
GSR reserves 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 already 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, or if permitted, a summary of such Notice will be posted at our facilities and on our website (www.aboutAVT.com). You may also obtain a copy of the current Notice by contacting the Privacy Officer or by going to any GSR facility.
We at GSR are committed to compliance with this Notice of Privacy Practices and the requirements imposed upon us by applicable federal and state law. If you believe that your privacy rights have been violated, you may file a complaint with GSR, or with the Secretary of the Department of Health and Human Services, Office of Civil Rights. To file a complaint with GSR, please contact the GSR Privacy Officer. All complaints must be submitted in writing and directed to the GSR Privacy Officer. GSR assures you that there will be no retaliation for filing of a complaint and that all complaints will be treated seriously.
VIII. Additional Information and Privacy Officer Contact
For further information regarding the issues covered by this Notice of Privacy Practice, or any other questions regarding the privacy of your PHI as a patient of GSR, including to exercise any of the rights you have as explained in this Notice, please contact the following:
HIPAA Privacy Officer
Advanced Vein Therapy
877 W. Main Street, Suite 603
Boise, Idaho 83702