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.


This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or healthcare operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related healthcare services.


We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. 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. The new notice will be effective for all protected health information that we maintain at that time. Upon your request, you can receive any revised Notice of Privacy Practices upon request.


How We May Use and Disclose Your Protected Health Information. Your healthcare provider will use or disclose your protected health information as described in this Notice of Privacy Practices. Your protected health information may be used and disclosed by your healthcare provider, our office staff and others outside of our facility that are involved in your care and treatment for the purpose of providing healthcare services to you. Your protected health information may also be used and disclosed to pay your healthcare bills and to support the operation of Park City Imaging.


Following are examples of the types of uses and disclosures of your protected healthcare information that Park City Imaging is permitted to make without your authorization or opportunity to object. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our facility.


Treatment: Your protected health information may be used by staff members or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example, results of procedures will be available in your medical record to all health professionals who may provide treatment or who may be consulted by staff members.


Payment: Your protected health information may be used to seek payment from your health insurance plan or from credit card companies that you may use to pay for services. For example, your health plan may request and receive information on dates of service, the services provided, and the medical condition being treated.

Healthcare Operations: We may use or disclose as-needed, your protected health information in order to support the business activities of your healthcare provider and Park City Imaging. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, marketing and fundraising activities, and conducting or arranging for other business activities.


In addition, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician or therapist. We may also call you by name in the waiting room when your healthcare provider is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.


We will share your protected health information with third party “business associates” that may perform various activities (e.g., billing, transcription services) for Park City Imaging. Whenever an arrangement between our facility and a business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.


We may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you.


Law Enforcement: Your protected health information may be disclosed to law enforcement agencies to support government audits and inspections, to facilitate law-enforcement investigations, and to comply with government mandated reporting.


Public Health: Your protected health information may be disclosed to public health agencies as required by law. For example, we are required to report certain communicable diseases to the state’s public health department.


Other Permitted Disclosures: In addition to the situations listed above, we may use or disclose your protected health information without your authorization if required by law, to a person who may have been exposed to a communicable disease, to a health oversight agency, to a public health authority if abuse, neglect or domestic violence is suspected, to the Food and Drug Administration, to a coroner, medical examiner, funeral director or for the purpose of organ donation, for research purposes, in the event of suspected criminal activity, to comply with worker’s compensation laws, in response to any judicial order, or for military activity and/or national security.


Disclosure of your health information or its use for any purpose other than those listed above requires your specific written authorization. If you change your mind after authorizing a use or disclosure of your information, you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision to revoke your authorization.


Individual Rights. You have certain rights under the federal privacy standards. These include:



Other Permitted and Required Uses and Disclosures That May Be Made With Your Authorization, or Opportunity to Object. You have the opportunity to agree or object to the use of disclosure of all or part of your protected health information. If you are not present or able to agree or object to the use or disclosure of the protected health information, then your healthcare provider may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the protected health information that is relevant to your healthcare will be disclosed.


Complaints. You may file a complaint with us or with the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our Privacy Officer of your complaint. We will not retaliate against you for filing a complaint. The Privacy Officer may be contacted at (435) 615-0251.


This notice is effective as of October 1, 2006.