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Please review it carefully.

This Notice of Privacy Practices describes how CMI PROFESSIONAL SERVICES, LLP d/b/a COOPERATIVE MAGNETIC IMAGING CENTER (hereinafter referred to as “CMI”) may use and/or disclose your protected health information (“PHI”) to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your PHI. PHI 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 health care services.

CMI uses health information about you for your treatment, to obtain payment for your treatment, for administrative purposes and to evaluate the quality of care you receive. Your health information is contained in a medical record that is the physical property of CMI. Your PHI may be used and/or disclosed by your physician, CMI staff and others outside of CMI’s organization who are involved in your care and treatment for the purpose of providing health care services to you. CMI will not disclose your health information without your consent or authorization, except as described in this Notice of Privacy Practices.

Uses and Disclosures of PHI

The following examples highlight the types of uses and/or disclosures of your PHI that CMI is permitted to make. These examples are not meant to be exhaustive, but are provided as educational information that underscores the various types of disclosures that may be made by CMI.

For Treatment: CMI may use your PHI to provide you with medical treatment or services. CMI may disclose your PHI to doctors, nurses, technicians, office staff, or other personnel who are involved in providing you with medical treatment or services or who are involved in taking care of you and your health.

For example, different personnel in CMI’s office may share information about you and disclose your PHI to people who do not work in CMI’s office in order to coordinate your care, such as scheduling and ordering X-rays. Family members and other health care providers may be part of your medical care outside CMI’s office and may require information about you.

For Payment: CMI may use and disclose your PHI to others for purposes of receiving payment for treatment and health care services you received. For example, CMI may give you or a third-party payor, such as an insurance company or health plan, a bill containing information which identifies you, your current health information, diagnosis, and treatment or supplies related to the services you received from CMI. We may also tell your insurer about a procedure you are going to have in order to obtain prior approval or determine whether your insurer will cover the procedure.

For Healthcare Operations: CMI may use or disclose your PHI in order to support CMI’s operational activities. These activities include, but are not limited to: quality assessment, employee review, training, assessing the quality of care and outcomes in your case and similar cases, and learning how to improve CMI’s facilities and services.

CMI will share your PHI with third party “business associates” that perform various activities (i.e. billing, transcription services) for CMI. Whenever an arrangement between CMI and a “business associate” involves the use or disclosure of your PHI, CMI will have a written contract that contains terms that will protect the privacy of your PHI.

Appointments: CMI may use your PHI to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you. Please notify us if you do not wish to be contacted for appointment reminders or if you do not wish to receive communications about other services.

Fund-Raising: Unless you object in writing, CMI may use your PHI to contact you as part of general fund-raising activities.

Workers’ Compensation: CMI may use or disclose your PHI in order to comply with the laws and regulations related to Workers’ Compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.

Research: CMI may use or disclose your PHI for research projects that are subject to a special approval process. CMI will ask for your permission if the researchers will have access to your name, address or other information that reveals who you are.

Public Health and Oversight: CMI may disclose your PHI for public health activities such as assisting public health authorities or other legal authorities to prevent or control disease, injury, disability, or for other health oversight activities. Other health oversight activities include audits, investigations, inspections, licensure or disciplinary actions, civil, criminal, or administrative proceedings, or any other activity necessary for the oversight of the health care system for: 

Governmental benefit programs for which PHI is relevant to determining beneficiary eligibility;
Entities subject to governmental regulatory programs for which PHI is necessary for determining compliance with programs’ standards;
and Entities subject to civil rights laws for which PHI is necessary for determining compliance.

To Avert a Serious Threat to Health or Safety: CMI will disclose your PHI when necessary to prevent a serious threat to your health and safety or the health and safety of others.

Required by Law: CMI may use and disclose your PHI as required by federal, state or local law. For example:

Assist in Law Enforcement: CMI may disclose your PHI for judicial and administrative proceedings pursuant to legal authority or to assist law enforcement officials in their law enforcement duties;
Lawsuits and Disputes: If you are involved in a lawsuit or dispute, CMI may disclose your PHI in response to a court or administrative order. Subject to all applicable legal requirements, CMI may also disclose your PHI in response to a subpoena;
Abuse or Neglect: CMI may disclose your PHI to a public health authority or other government authority authorized by law to receive reports related to victims of abuse, neglect or domestic violence; and
Military, Veterans, National Security and Intelligence: If you are or were a member of the armed services, or part of the national security or intelligence communities, CMI may be required by military command or other government authorities to release your PHI. CMI may also release information about foreign military personnel to the appropriate foreign military authority.

Family and Friends: CMI may disclose your PHI to your family members or friends if CMI obtains your verbal agreement to do so or if you are given an opportunity to object to such a disclosure and you do not raise an objection. CMI may disclose your PHI to your family or friends if CMI can infer from the circumstances, based on CMI’s professional judgment, that you would not object. For example, CMI may assume that you agree to the disclosure of your PHI to your spouse when you bring your spouse with you into the exam room during a procedure or while a procedure is discussed with you.

In situations where you are not capable of giving consent (because you are not present or due to your incapacity or medical emergency), CMI may, in its professional judgment, determine that disclosure of your PHI to your family or friends is in your best interest. In such a situation, CMI will disclose only the PHI that is relevant to such person’s involvement in your care. CMI may also use its professional judgment and experience to make reasonable inferences that it is in your best interest to allow another person to act on your behalf to pick up, for example, filled prescriptions, medical supplies, or X-rays.

For example, CMI may inform the person who accompanied you to the emergency room that you suffered a fracture and provide such person with updates on your condition.

Coroners, Funeral Directors and Organ Donation: CMI may disclose your PHI to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. CMI may also disclose your PHI to a funeral director, as authorized by law, in order to permit the funeral director to carry out its duties. Your PHI may be used and disclosed for cadaveric organ, eye or tissue donation purposes.

Your Rights
Following is a statement of your rights with respect to your PHI and a brief description of how you may exercise these rights:

Right to Inspect and Copy: You have a right to inspect and obtain a copy of your PHI that is contained in a designated record set for as long as CMI maintains your PHI. A “designated record set” contains medical and billing records and any other records that your physician and CMI uses for making decisions about you. In order to provide the best medical care to our patients, it is CMI’s policy that requests for test results should be made in the first instance to the patient’s primary care or referring physician who is able to review the results in the context of your complete medical history. Requests for copying and mailing your PHI may be charged to you.

CMI may deny your or your qualified representative’s request in certain limited circumstances (for example, if CMI determines that the requested review of the PHI can reasonably be expected to cause substantial and identifiable harm to you or another person which would outweigh your right to access to the information or would have detrimental effects). If you are denied access to your PHI, you may ask that the denial be reviewed. If such a review is required by law, we will select a licensed healthcare professional to review your request and our denial. The person conducting the review will not be the person who denied your request, and we will comply with the outcome of the review. Please contact CMI’s Privacy Contact if you have questions about access to your PHI.

Under federal law, however, you may not inspect or copy the following records: psychotherapy notes, information compiled in reasonable anticipation of, or use in, a civil, criminal or administrative action or proceeding, or other PHI that is restricted from being accessed.

Right to Request Restrictions: You may ask CMI to not use or disclose any part of your PHI for the purposes of treatment, payment, or healthcare operations. You may also request that any part of your PHI not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.

CMI is not required to agree to a restriction that you may request. If CMI believes it is in your best interest to permit use and disclosure of your PHI, your PHI will not be restricted. If CMI agrees to the requested restriction, CMI may not use or disclose your PHI in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with your physician. You may request a restriction by contacting CMI’s Privacy Officer as indicated at the end of this Notice of Privacy Practices.

Right to Request Confidential Communications: You have the right to request that we communicate with you in a certain way or at a certain location. For example, you may request CMI to contact you only by mail or only at home. CMI will accommodate reasonable requests. Please make this request in writing to CMI’s Privacy Officer as indicated at the end of this Notice of Privacy Practices.

Right to Amend: You may request an amendment of your PHI in a designated record set for as long as CMI maintains your PHI. In certain cases, CMI may deny your request for amendment. If CMI denies your request for amendment, you have the right to file a statement of disagreement with CMI. CMI may prepare a rebuttal to your statement and provide you with a copy of any such rebuttal. Please contact CMI’s Privacy Officer if you have questions about amending your PHI.

Right to an Accounting of Disclosures: This right applies to disclosure for purposes other than treatment, payment, or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures CMI may have made to you, to family members or friends involved in your care, for notification purposes or made with your authorization.

You have the right to receive specific information regarding these disclosures that occurred after April 13, 2003. To obtain this information, you should submit your request in writing to CMI’s Privacy Officer. Your request must state a time period, which may not be longer than six (6) years. Your request should indicate in what form you want the list (for example, on paper or electronically). We may charge you for the costs of providing this information. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred. The right to receive this information is subject to certain exceptions, restrictions, and limitations.

Right to a Paper Copy of This Notice: Upon request, you may obtain a paper copy of this Notice of Privacy Practices from CMI, even if you have agreed to accept it electronically. You may request a copy of this notice at any time.

Revocation of Prior Authorization
Uses and disclosures of PHI not permitted as described in this Notice will be made only with your written authorization. You have the right to revoke your authorization to use or disclose health information for reasons other than those listed above or permitted by law except to the extent that action has already been taken.

You may complain to CMI or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by CMI. You may file a complaint with CMI by notifying CMI’s Privacy Officer of your complaint as indicated at the end of this Notice of Privacy Practices. CMI will not retaliate against you for filing a complaint.

Obligations of CMI
CMI’s goal is to take appropriate steps to safeguard any medical or other personal information that is provided to CMI. CMI is required to:
maintain the privacy of PHI;
provide you with this notice of its legal duties and privacy practices with respect to your PHI;
abide by the terms of this notice;
notify you if CMI is unable to agree to a requested restriction on how your PHI is used or disclosed;
accommodate reasonable requests you make to communicate your PHI by alternative means or at alternative locations; and
obtain your written authorization to use or disclose your PHI for reasons other than those listed above or permitted by law.

Changes to This Notice of Privacy Practices
CMI reserves the right to change its information practices and to make the new provisions effective for PHI. This includes information CMI already has about you as well as any information CMI receives in the future. We will post a summary of the current Notice of Privacy Practices with its effective date in the top right hand corner in a prominent location at each of our offices. Revised Notices of Privacy Practices will be made available to you upon request. You are entitled to a copy of the Notice currently in effect.

Contact Information
If you have any questions or complaints, you may contact CMI’s Privacy Officer, Kari Thomson, at (315) 792-4666, 107 Business Park Drive, Utica NY 13502.

This notice was published and becomes effective on April 13, 2003.

Approved by: Steven Fossaceca, Business Manager 4-14-03

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