Western Kentucky Diagnostic Imaging offers Digital Mammography, the new ally in the fight against breast cancer

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Western Kentucky Diagnostic Imaging respects your privacy. 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: (A.) maintain the privacy of information provided to us; (B.) provide notice of our legal duties and privacy practices; and (C.) abide by the terms of our Notice of Privacy Practices currently in effect.

Who will follow this notice:
This notice describes the practices of our employees and staff, as well as:

· Physicians’ Choice Inc. (an independent billing company retained to provide all billing services), Cardinal Health Care (a pharmaceutical company providing substances used in delivery of our Nuclear Medicine services and requiring specific personal health information (PHI) in order to fill such orders), all affiliated medical and supply vendors having access to PHI located within various hardware and software housed at Western Kentucky Diagnostic Imaging and whose services are necessary to maintain said equipment, Credit Bureau Systems (a collection agency secured to provide account collection services for accounts in default of payment), all affiliated health care plans, networks, insurers, referring physicians, entities holding prior medical records on you, and employers contacted for PHI in the course of normal healthcare operations, treatment/diagnosis, and payment for rendered services. Any of the above mentioned may share information for previously mentioned normal operational reasons.

Information collected about you:
In the ordinary course of receiving treatment, diagnosis, and health care services from us, you and your referring physician will be providing us with personal information such as, but not limited to:

· Information such as your name, address, pertinent phone #’s, employment, guardian/responsible party information, legal counsel when applicable, your marital status, your sex, your Social Security Number, and emergency contact information.
· Information relating to your medical history.
· Information regarding any insurances and coverage you may hold, including any injury or accident dates and information, as well as benefit plan level descriptives.
· Information concerning your referring physician, any other physicians requiring copies of any test results, and information concerning the location of any medical records pertinent to your proper diagnosis, treatment, and continuity of care.
· Possible financial information provided by you in order to establish payment worthiness for services rendered to you.

We will create an electronic medical record (EMR), as well as a film record of the care and services rendered to you. As indicated above, some information also may be provided to us by other individuals or organizations that are part of your “circle of care”- such as referring physicians, other doctors fluent in any area of concern regarding your diagnosis and whose advise is sought in order to better evaluate your treatment, your health plans and its representatives, and possibly close friends and 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 in which we may use and disclose information 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 furnish services and supplies to you, in accordance with our policies and procedures. For example, we will use your medical history, such as any presence or absence of heart disease, to assess your health and perform requested ultrasound or other diagnostic services. This same medical history will be used to perform proper coding and billing to your insurance plans for claim payment.

For Payment- We will use and disclose PHI to bill for our services and to collect payment from you or your insurance company, no-fault auto insurance coverage, worker’s compensation carrier, or attorney. For example, we may need to give PHI to a payor about your current medical condition so that it will pay us for any diagnostic services we have rendered to you. We may also need to inform your payor of the tests that you are going to receive in order to obtain prior approval or to determine whether the service is a covered benefit under your current policy.

For Health Care Operations- We may use and disclose PHI about you for the general operations of our business. For example, we sometimes arrange for accreditation organizations, accountants, and business valuation consultants to review our practice, evaluate our operations, and tell us how to improve our services.

Public Policy Uses and Disclosures- There are a number of public policy reasons why we may disclose PHI.

We may disclose PHI when we are required to do so by federal, state, or local law.

We may disclose PHI about you in connection with certain public health reporting activities. For instance, we may disclose such PHI to a public health authority authorized to collect or receive PHI for the purpose of preventing or controlling disease, injury or disability, or at the direction of a public health authority, to an official or a foreign government agency that is acting in collaboration with a public health authority. Public health authorities include state health departments, the Center for Disease Control (CDC), the Food and Drug Administration (FDA), the Occupational Safety and Health Administration (OSHA), and the Environmental Protection Agency (EPA), to name a few.

We are also permitted to disclose PHI to a public health authority or other government authority authorized by law to receive reports of child abuse or neglect. Additionally, we may disclose PHI 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, or to conduct post marketing surveillance.

We may disclose your PHI in situations of domestic abuse or elder abuse.

We may disclose PHI in connection with certain health oversight activities of licensing and other agencies. Health oversight activities include audit, investigation, inspection, licensure or disciplinary actions, and civil, criminal, or administrative proceedings or actions or any other activity necessary for the oversight of the a.) health care system, b.) governmental benefit programs for which PHI is relevant to determining beneficiary eligibility, c.) entities subject to governmental regulatory programs for which PHI is necessary for determining compliance with program standards, or d.) entities subject to civil rights laws for which health information is necessary for determining compliance.

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.

We may release PHI to a coroner or medical examiner to identify a deceased person or determine the cause of death. We may also release PHI to organ procurement organizations, transplant centers, and eye or tissue banks.

We may release your PHI to worker’s compensation or similar programs.

PHI will be disclosed when necessary to prevent a serious threat to your health and safety or the health and safety of others.

We may use or disclose certain PHI about your condition or 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 PHI to prepare or analyze a research protocol and for other research purposes.

If you are a member of the Armed Forces, we may release PHI about you as required by military command authorities. We may also release PHI about foreign military personnel to the appropriate foreign military authority.

We may disclose your PHI for legal or administrative proceedings that involve you. We may release such information upon order of a court or administrative tribunal. We may also release PHI in the absence of such an order and in response to a discovery or other lawful request, if efforts have been made to notify you or secure a protective order.

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

Finally, we may disclose PHI 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 individuals and businesses that help us operate our business successfully. We may disclose your PHI to these businesses 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 PHI.

Individuals Involved in Your care or Payment for Your Care-We may disclose and mutually share information with individuals involved in your care or in the payment for your care, but we will obtain your agreement via our Consent for Release of Medical Records and Lab Results and Payment Agreement, signed upon every service date with Western Kentucky Diagnostic Imaging, before doing so. This includes people and organizations that are part of you “circle of care”—such as your spouse, your referring or other doctors involved in your continuity of care, or an aide who may be providing services to you. Although we must be able to speak with your other physicians and health care providers, we will respect your written request that we not speak or release information to any named individuals. Your written list of any person(s) we should not speak with or use or disclose PHI with must be presented after your reading and signing upon receipt of said notice and prior to any services rendered.

Additional Use and Disclosure Elements

Appointment Reminders – we may use and disclose PHI to contact you, via either/or phone or U.S.P.S. mail, as a reminder that you have an appointment or that you should schedule an appointment. We will only leave PHI disclosing your name, date and time of your appointment, and our number to call if you should have any questions. The only exam specific information disclosed is for annual screening mammography reminders.

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

Fundraising or Marketing- We may use your PHI to contact you in an effort to raise funds for our operation or to make you aware of new or pertinent services that may be of benefit to your demographic group. For example, we may distribute information on screening mammography or bone density evaluation to all patients within the 35-45 year old age range to promote the health benefits of receiving these services.

Other Uses and Disclosures of Personal Information

We are required to obtain written authorization from you for any other uses and disclosures of medical information other than those described above. I f 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 PHI about you for the reasons covered by your written authorization. You must specifically describe any releases you would want us to make and any you would not. For example if you wanted us to be able to continue to forward your medical records, but not allow your spouse to call and inquire about the status of your records, you must specifically identify these two separate disclosure scenarios in writing. We will be unable to take back any uses or 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 you PHI beyond those imposed by law. We will consider your request, but we are not required to accept it. You have the right to request that you receive communications containing your PHI from us by alternative means or at alternatives locations. For example, you may request that we only contact you at home or by mail.

Except under certain circumstances, you have the right to inspect and copy medical and billings records about you. If you ask for copies of your information, we are allowed to charge you a fee for copying and mailing. (The first copy of any paper records is free, beyond that, we will charge $10.00 per record set (a set is defined as either your demographic record, which includes your consents, authorizations, prescriptions, lab results, pathology results, insurance cards copies and reports from testing/exams or your billing record, which includes your billing and payment histor). Copying of your film records is determined on a per sheet (film) price and labor involved. Routinely, MRI and CT copies are $50.00 per set and other diagnostic results less than $50.00 per set. Additional fees to cover mail, priority mail, or overnight or express services will also be charged.

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

You have the right to ask for a list of instances when we have disclosed or used your PHI for reasons other than your treatment, proper maintenance and follow-up of your medical history, payment for services rendered to you, our other routine health care operations, or disclosures you give us authorization to make. If you ask for this information from us more than once per 12-month period, we will charge you a fee. All fees for records reproduction and listing of disclosures and uses must be paid prior to their release.

You have the right to a copy of this Notice in paper form. You may ask us for a copy at any time in person or by writing to us. You may also request in writing to exercise any of your patient rights to:

Western Kentucky Diagnostic Imaging
1635 Scottsville Road
Bowling Green, Kentucky 42104

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 PHI we have about you as well as any PHI we receive in the future. In the event there is a material change to this Notice, the revised Notice will be posted. In addition, you may request a copy of the revised Notice at any time.

Complaints/Comments- If you have any complaints concerning our Privacy Policy, you may contact the Secretary of the Department of Health and Human Services, at 200 Independence Avenue, S.W., Room 509F, HHH Building, Washington D.C. 20201 or e-mail: ocrmail@hhs.gov. You may also contact us at:

Western Kentucky Diagnostic Imaging
1635 Scottsville Road
Bowling Green, Kentucky 42104
Or
Toll Free: (888) 746-9500
Local: (270) 746-9500

To obtain more information concerning this Notice of Privacy Practices, you may contact our office at the above address or phone numbers given.

This Privacy Policy is effective April 14, 2003.