Who Presents This Notice
This Notice describes the privacy practices of South Jersey Radiology Associates and members of its workforce. This Notice applies to services furnished to you at all South Jersey Radiology Associates facilities which involve the use or disclosure of your health information.
South Jersey Radiology Associates is required by law to maintain the privacy of your health information (“protected health information” or “PHI”) and to provide you with this Notice of legal duties and privacy practices with respect to your PHI. South Jersey Radiology Associates uses computerized systems that may electronically disclose your PHI for purposes of treatment, payment and/or health care operations as described below. South Jersey Radiology Associates uses or discloses your PHI, South Jersey Radiology Associates is required to abide by the terms of this Notice (or other notice in effect at the time of the use or disclosure).
South Jersey Radiology Associates is required by law to protect the privacy of your health information, distribute this Notice of Privacy Practices to you, and follow the terms of this Notice. South Jersey Radiology Associates is also required to notify you if there is a breach of your PHI.
Permissible Uses and Disclosures Without Your Written Authorization
In certain situations, your written authorization must be obtained in order to use and/or disclose your PHI. However, an authorization is not required for the following uses and disclosures:
Uses and Disclosures for Treatment, Payment, and Health Care Operations
We will use your health information for treatment:
For example: We may disclose your protected health information to other physicians who may be treating you or consulting with us regarding your care. We may disclose your protected health information to those who may be involved in your care after you leave here, such as family members or your personal representative.
We will use your health information for payment:
For example: We may communicate with your health insurance company to get approval for the services we render, to verify your health insurance coverage, to verify that particular services are covered under your insurance plan, or to demonstrate medical necessity. We may disclose your protected health information to anesthesia care providers involved in your care so they can obtain payment for their services.
We will use your health information for regular health care operations:
For example: We may use your PHI to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also disclose PHI to doctors, nurses, technicians, medical students, and other personnel for review and learning purposes. We may also use or disclose your PHI in the course of maintenance and management of our electronic health information systems.
We will use and disclose your health information as otherwise permitted or required by law. Examples of those uses and disclosures follow.
Uses and Disclosures Requiring Your Written Authorization
Uses or Disclosures with Your Authorization. For any purpose other than the ones described above, your PHI may be used or disclosed only when you provide your written authorization on an authorization form. For instance, you will need to execute an authorization form before your PHI can be sent to your life insurance company or to the attorney representing the other party in litigation in which you are involved.
Except to the extent that South Jersey Radiology Associates has taken action in reliance upon it, you may revoke any written authorization obtained in connection with your PHI by delivering a written revocation statement to South Jersey Radiology Associates.
Your Health Information Rights
Although your health record is the physical property of South Jersey Radiology Associates, the information belongs to you. You have the right to:
- Request a restriction on certain uses and disclosures of your PHI for treatment, payment, health care operations as to disclosures permitted to persons, including family members involved with your care and as provided by law. However, we are not required by law to agree to a requested restriction, unless the request relates to a restriction on disclosures to your health insurer regarding health care items or services for which you have paid out-of-pocket and in-full;
- Obtain a paper copy of this notice of privacy practices;
- Inspect and/or receive a copy of your health record, as provided by law;
- Request that we amend your health record, as provided by law. We will notify you if we are unable to grant your request to amend your health record;
- Obtain an accounting of disclosures of your health information, as provided by law;
- Request communication of your health information by alternative means or at alternative locations. We will accommodate reasonable requests.
You may exercise your rights set forth in this notice by providing a written request, except for requests to obtain a paper copy of the notice, to the Privacy Officer at the contact listed below.
Effective Date. This Notice is effective on 5/1/2022.
Right to Change Terms of this Notice. The terms of this Notice may be changed at any time. If this Notice is changed, the new notice terms may be made effective for all PHI that South Jersey Radiology Associates maintains, including any information created or received prior to issuing the new notice. If this Notice is changed, the new notice will be posted in waiting areas at all South Jersey Radiology Associates facilities and on our Internet site at www.sjra.com. You also may obtain any new notice by contacting the Privacy Officer.
For Additional Information or to File a Complaint: If you have questions regarding this Notice or have a concern that your privacy rights may have been violated, you may contact us using the information below.
South Jersey Radiology Associates Contact Information:
Privacy Officer, E-mail: firstname.lastname@example.org, Phone: 844-754-1507, Fax: 704-941-3464, Online: www.usrs-feedback.com
You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting https://www.hhs.gov/hipaa/filing-a-complaint. We will not retaliate against you for filing a complaint.