Privacy Notification

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.

Our goal is to take appropriate steps to attempt to safeguard any medical or personal information that is provided to us. We are required to: (1) maintain the privacy of medical information provided to us; (2) provide notice of our legal duties and privacy practices; and (3) abide by the terms of our Notice of Privacy Practices currently in effect.

Information Collected About You
In the ordinary course of receiving treatment and health care services from us, you will be providing us with personal information such as:

  • Your name, address and phone number
  • Information relating to your medical history
  • Your insurance information and coverage
  • Information concerning your doctor, nurse or the medical providers.

In addition we will gather certain medical information about you and will create a record of the care provided to you. Some information also may be provided to us by other individuals or organizations that are part of your “circle of care”, such as the referring physician, your other doctors, your health plan and close friends or family.

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 or disclose information will fall within one of the following categories, but not every use or disclosure in a category will be listed.

  • 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 diagnostic CT or other services.
  • Payment – We will use and disclose health information about you to bill for our services and to collect payment from you or your insurance company. For example, we may need to give a payer information about your current medical condition so that it will pay us for diagnostic CT or other services that we have furnished you. We may also need to inform your payer of the tests that you are going to receive in order to obtain approval or to determine whether the service is covered.
  • Health Care Operations – We may use and disclose information about you for the general operation of our business. For example, we sometimes arrange for accreditation organization, auditors or other 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 use and/or disclose information about you as follows:
    • When required by law
    • For public health activities
    • Disclosures about victims of abuse neglect or domestic violence
    • Health oversight activities
    • For judicial and administrative purposes
    • Law enforcement purposes
    • Certain disclosures about decedents
    • Certain organ, eye or tissue donation purposes
    • Research purposes
    • To avert a serious threat to health or safety
    • For specialized government functions
    • Workers Compensation
  • Our Business Associates – We sometimes work with outside individuals and businesses that help us operate our business successfully. We may disclose you health information to these business 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 personal and identifiable health information.
  • Individuals Involved in Your Care or Payment For Your Care – We may disclose information to individuals involved in you care or in the payment for our care, but we will obtain your agreement before doing so. This includes people and organizations that are part of your “circle of care” -- such as your spouse, your other doctors or an aide who may be providing services to you. Although we must be able to speak with your other physicians or health care providers, you can let us know if we should not speak with other individuals such as your spouse or family.
  • Appointment Reminders – We may use and disclose medical information to contact you as a reminder that you have an appointment or that you should schedule an appointment.
  • Treatment Alternatives – We may use and disclose your personal health information in order to tell you about or recommend possible treatment options, alternatives or health related services that may be or interest to you.

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. If you provide us with such permission, you may revoke that permission, in writing, at any time. If you revoke you permission, we will no longer use or disclose personal information about you for the reasons already covered by your written authorization. We will be unable to take back any 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 your medical information 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 protected health information from us by alternative means or at alternative locations. For example, you may ask that we only contact you at home or by mail to a certain address.

Except under certain circumstances, you have the right to request that you receive and inspect copies of medical and billing records about you. This request must be in writing to:
     Privacy Officer
     770 Pine Street Ste 290
     Macon, GA 31201

Upon receipt, your request will be dated and responded to within 30 days. There will be a charge of $1.00 per page of medical reports, $7.00 per page of films and $5.00 for billing records. These fees must be paid at the time of receipt of the records or films.

If you believe that information in your records is incorrect or incomplete, you have the right to ask us to correct the existing information or correct 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 used or disclosed your medical information for reasons other than your treatment, payment for services furnished to you, our health care operations, or disclosures you give us authorization to make. If you ask for this information from us more that once every twelve months, there will be a fee.

You have the right to ask for a paper copy of this Notice at any time or you may obtain a copy on our web site www.ramacon.com.

To exercise any of your rights, please contact us in writing:
     770 Pine Street Ste 290
     Macon, Georgia 31201

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 personal health information we have about you as well as any information 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 Ave.S.W. RM 509F, HHH Building, Washington, DC 20201 (email: ocrmail@hhs.gov). You may also contact us though our Privacy Officer.

To obtain more information concerning this Notice of Privacy Practices, you may contact our Privacy Officer at 770 Pine St, STE 290, Macon, Georgia 31201 or call 478.743.7357.

This Privacy Policy is effective April 14, 2003.