Notice of Privacy Practices for Protected Health
Lumberton Radiological Associates, P.A. (LRA) is permitted by federal privacy
laws to make uses and disclosures of your health information for purposes of
treatment, payment, and health care operations. Protected health information is
the information we create and obtain in providing our services to you. Such
information may include documenting your symptoms, examination and test results,
diagnoses, treatment, and applying for future care or treatment. It also
includes billing documents for those services.
Examples of Use for Treatment include but are not limited to, LRA staff
obtaining treatment information and recording it in your health record, another
example would be where an LRA physician consults with your personal
physician/specialist regarding your particular case.
An example of Use of Your Health Information for Payment Purposes includes
but is not limited to submitting payment requests to your health insurance
company. Also we might provide to your health insurance company (or other
business associate) information regarding medical care given. We will provide
information to them about you and the care that you were given.
An example of Use of Your Information for Health Care Operations includes but
is not limited to obtaining services from our insurers or other business
associates such as quality assessment, outcome evaluations, clinical protocol
development, medical review, legal services and insurance. We will share
information about you with these insurers and business associates as necessary
to obtain these services.
Any disclosures other than for the categories listed above (treatment,
payment, or health care operations) will be made only with your written
authorization. You also have the right to revoke any previous written
authorization. This request to revoke must also be provided to Lumberton
Radiological Associates in writing. We will honor this revocation provided that
we have not taken action in reliance upon the authorization.
Your Health Information Rights
The health and billing records we maintain are the physical property of
Lumberton Radiological Associates. The information however belongs to you. You
have a right to:
Request a restriction on certain uses and disclosures of your health
information by delivering the request in writing to our office - we are not
required to grant the request but we will comply with any request granted;
Obtain a paper copy of the Notice of Privacy Practices for Protected Health
Information ("Notice") by making a request at our office;
Request that you be allowed to inspect and copy your health record and
billing record - you may exercise this right by delivering the request in
writing to our office using the form we provide to you upon request;
Appeal a denial of access to your protected health information except in
Request that your health care record be amended to correct incomplete or
incorrect information by delivering a written request to our office using the
form we provide to you upon request (The physician or other health care provider
is not required to make such amendments);
File a Statement of Disagreement if your amendment is denied, and require
that the request for amendment and any denial be attached in all future
disclosures of your protected health information;
Obtain an Accounting of Disclosure of Your Health Information as required
to be maintained by law by delivering a written request to our office using the
form we provide to you upon request. An accounting will not include internal
uses of information for treatment, payment, or operations, disclosures made to
you or made at your request, or disclosures made to family members or friends in
the course of providing care;
Request that communications of your health information be made by
alternative means or at an alternative location by delivering the request in
writing to our office using the form we give you upon request; and
Revoke authorizations that you made previously to use or disclose
information, except to the extent information or action has already been taken,
by delivering a written revocation to our office.
If you want to exercise any of the above rights, please contact the Privacy
Officer in person or in writing. He can be reached at 209 West 27th St.,
Lumberton NC 28358. He will provide you with assistance on the steps to take to
exercise your right.
Lumberton Radiological has the following responsibilities:
Maintain the privacy of your health information as required by law;
Provide you with a notice as to our duties and privacy practices as they
pertain to your health information and records;
Abide by the terms of this Notice;
Notify you if we cannot accommodate a requested restriction or
Accommodate your reasonable requests regarding methods to communicate
health information to you.
We reserve the right to amend, change, or eliminate provisions in our privacy
practices and access practices and to enact new provisions regarding the
protected health information we maintain. If our information practices change,
we will amend our Notice. You are entitled to receive a revised copy of the
"Notice" by calling and requesting a copy or by visiting our office.
Any person/patient may file a complaint with LRA and/or to the Secretary of
Health and Human Services if they believe their privacy rights have been
violated. To file a complaint with LRA, please contact the Privacy Officer at
the following address/phone number: LRA 209 West 27th St. Lumberton NC 28358,
telephone 910-738-8222. All complaints will be addressed and the results will be
reported to the Privacy Officer. We cannot, and will not, require you to waive
the right to file a complaint with the Secretary of Health and Human Services (HHS)
as a condition of receiving treatment from the office/hospital nor will we
retaliate in any way for filing such a complaint.
Other Disclosures and Uses
Notification - Unless you object, we may use or disclose your
protected health information to notify, or assist in notifying a family member,
or other person responsible for your care, about your location, and about your
Communication with Family - Using our best judgment, we may disclose
to a family member, other relative, or any other person you authorize, health
information relevant to that person's involvement in your care or in payment for
such care if you do not object or in an emergency.
Research - We may disclose information to researchers when their
research has been approved by an institutional review board that has reviewed
the research proposal and established protocols to ensure the privacy of your
protected health information.
- We may use and disclose your protected health
information to assist in disaster relief efforts.
Funeral Directors or Coroners - We may disclose your protected health
information to funeral directors or coroners consistent with applicable laws to
allow them to carry out their duties.
Marketing - We may contact you to provide you with appointment
reminders, with information about treatment alternatives, or with information
about other health-related benefits and services that may be of interest to you.
Fund Raising - We may contact you as part of a fund raising effort.
Food and Drug Administration (FDA) - If you are seeking compensation
through Workers Compensation, we may disclose your protected health information
to the extent necessary to comply with laws relating to Workers Compensation.
Public Health - As required by law, we may disclose your protected
health information to public health or legal authorities charged with preventing
or controlling disease, injury, or disability.
Abuse & Neglect
- We may disclose your protected health
information to public authorities as allowed by law to report abuse or neglect.
Correctional Institutions - If you are an inmate of a correctional
institution, we may disclose to the institution or its agents the protected
health information necessary for your health and the health and safety of other
Enforcement - We may disclose your protected health information
for law enforcement purposes as required by law, i.e., by a court order, or in
cases involving felony prosecutions, or to the extent an individual is in the
custody of law enforcement.
- Federal law allows us to release your protected
health information to appropriate health oversight agencies or for health
Judicial/Administrative Proceedings - We may disclose your protected
health information in the course of any judicial or administrative proceeding as
allowed or required by law, with your consent, or as directed by a proper court
to Health or Safety - To avert a serious threat to
health or safety, we may disclose your protected health information consistent
with applicable law to prevent or lessen a serious, imminent threat to the
health or safety of a person or the public.
For Specialized Governmental Functions - We may disclose your
protected health information for specialized government functions authorized by
law such as to Armed Forces personnel, for national security purposes, or to
public assistance program personnel.
Other Uses - Other uses and disclosures besides those identified in
this Notice will be made only as otherwise authorized by law or with written
authorization and you may revoke the authorization as previously provided.
Effective Date: April 14, 2003