NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION MAY BE USED AND DISCLOSED. PLEASE REVIEW CAREFULLY.

US X-Ray respects the privacy of protected health information (PHI) and is committed to maintaining such information in a confidential manner. This Notice applies to all information and records related to the services and care that US X-Ray provides. It extends to information received or performed by our employees, staff, radiologists and referring physicians. This Notice informs you about the possible uses and disclosures of PHI.

Law requires US X-Ray to:

Maintain the privacy of all PHI;
Provide a detailed Notice of our legal duties and privacy practices relating to PHI; and
Abide by the terms of this Notice that are currently in effect.

For purposes of the HIPAA Privacy Rules, US X-Ray is considered an entity and is covered by a HIPAA compliance plan.

I. US X-Ray MAY USE AND DISCLOSE PATIENT PHI FOR TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS

We have described these uses and disclosures below and have provided examples of the types of uses and disclosures that US X-Ray may make in each of these categories.

A. For Treatment. US X-Ray will use and disclose patient PHI in providing patients with mobile x-ray and EKG services. US X-Ray may disclose patient PHI to both US X-Ray and non-US X-Ray personnel who may be involved in your care and diagnosis, such as radiologists; referring physicians; facility nurses and/or nurse aides; x-ray technicians and our staff that is involved in arranging for your mobile health care needs. For example, US X-Ray will report our findings to your facility nurse caring for you; your facility nurse will then report our findings to your physician. We also may disclose PHI to your physician specialist that may become involved with your care.

B. For Payment. US X-Ray may use and disclose PHI so that we can bill and receive payment for health care services performed by our staff. For billing and payment purposes, US X-Ray may disclose patient PHI to your insurance carrier (i.e. managed-care organization, Medicare, Medicaid, your facility and other third party payers).

C. For Quality Assurance Program. US X-Ray may use and disclose patient PHI from quality assurance programs.

· US X-Ray may use and disclose patient PHI from our quality assurance programs. These uses and disclosures are necessary to monitor the quality of services we provide. US X-Ray uses PHI to evaluate our company’s services, including the performance of our staff and/or how our services are delivered.

· US X-Ray may use and disclose patient PHI from your facility quality assurance programs. These uses and disclosures are necessary to monitor the quality of services you receive through a coordination of health care services between US X-Ray and your facility. QA meetings are generally held by your facility on a monthly/quarterly basis. Your facility asks that all health care vendors that are providers of medical services to your facility be present during this meeting. Your facility may use PHI to evaluate your patient care and the services performed by our company.

D. US X-Ray may also provide certain services by contracting with third parties, referred to as a Business Associates.

In some cases, US X-Ray will need to disclose your PHI to a Business Associate in order for them to provide the appropriate services to you and/or your facility. We will only disclose your PHI to a Business Associate after we have received adequate contractual assurances from them that they will safeguard and keep confidential your PHI.

II. US X-Ray MAY USE AND DISCLOSE PROTECTED HEALTH INFORMATION ABOUT YOU FOR SPECIFIC PURPOSES (without obtaining your additional consent or authorization)

A. As Required By Law. US X-Ray will disclose your PHI when required by federal, state or local law to do so.

B. Public Health Activities. US X-Ray may disclose your PHI for public health activities.

These activities may include, for example:

· reporting to a public health or other government authority for preventing or controlling disease, injury or disability, or reporting abuse or neglect;

· reporting to the Federal Food and Drug Administration (FDA) concerning adverse events or problems that develop with products, and/or for the tracking of products in certain circumstances; to enable product recalls or to comply with other FDA requirements;

· to notify a person/persons who may have been exposed to a communicable disease and/or may otherwise be at risk of contracting or spreading a disease or condition.

· for certain purposes involving workplace illness or injuries.

C. Judicial and Administrative Proceedings. US X-Ray may disclose your PHI in response to a court or administrative law. US X-Ray may also disclose information in response to a subpoena, discovery request, or other lawful process.

D. Law Enforcement. US X-Ray may disclose your PHI for certain law enforcement purposes including:

· as required by law to comply with reporting requirements;

· to comply with a court order, warrant, subpoena, summons, or similar legal process;

· to identify or locate a suspect, fugitive, material witness, or missing person;

· when information is request about the victim of a crime if the individual agrees or under other limited circumstances.

E. Workers’ Compensation. US X-Ray may use or disclose your PHI to comply with laws relating to workers’ compensation or similar programs.

III. YOUR AUTHORIZATION IS REQUIRED FOR OTHER USES OF PROTECTED HEALTH INFORMATION

US X-Ray will use and disclose PHI (other than as described in this Notice or required by law) only with your written Authorization. You may revoke your Authorization for US X-Ray to use or disclose your PHI in writing, at any time. If you revoke Authorization, US X-Ray will no longer use or disclose your PHI for the purposes covered by the Authorization, except where we have already relied on the Authorization.

IV. YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION

You have the following rights regarding your protected health information obtained by US X-Ray:

A. You have the right to inspect and copy your protected health information. This means you may inspect and obtain a copy of your PHI, including both medical and billing information for as long as US X-Ray maintains the PHI. In order to inspect and/or copy your PHI you must submit a written request to US X-Ray. US X-Ray may charge you a reasonable fee for the cost of such copies.

B. You have the right to request a restriction of your PHI. This means you may ask us not to use or disclose any part of your PHI for the purposes of treatment, payment of healthcare claims 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 be in writing and must state the specific restriction requested and to whom you want the restriction(s) to apply. Your health care facility is not required to agree to a restriction that you may request from US X-Ray. If your facility believes it is in your best interest to permit use and disclosure of your PHI, your PHI will not be restricted. If your facility does agree to the requested restriction, we may not use or disclose your PHI in violation of that restriction unless it is needed to provide emergency treatment. You may request a restriction by sending your written request for additional restriction to the Vice President of US X-Ray.

C. You have the right to request confidential communications from us in alternate forms or locations, or that we will not provide such information to certain people. US X-Ray will accommodate all reasonable requests. We may place conditions on this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. US X-Ray will not request an explanation from you as to the basis for your request. Please make this request in writing to our Vice President.

D. You may have the right to have your protected PHI obtained by US X-Ray amended. This means that if you have reason to believe certain PHI is incomplete or incorrect, you may request an amendment of your PHI, for as long as we maintain this information. In certain cases, US X-Ray may deny your request of an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us; we will prepare a rebuttal to your statement and will provide you with a copy of such rebuttal. Please contact our Vice President if you have questions about amending your medical record.

E. You have the right to receive an accounting of certain disclosures we have made, if any, of your PHI. This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you or pursuant to a written authorization signed by you, to family members or friends involved in your care, or for notification purposes. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003. You may request a shorter timeframe. The right to receive this information is subject to certain exceptions, restrictions and limitations.

V. COMPLAINTS

If you believe that your privacy rights have been violated, you may file a complaint in writing to our Vice President at US X-Ray (who also serves as the HIPAA Compliance Officer) or with the Office of Civil Rights in the U.S. Department of Health and Human Services. US X-Ray will not retaliate against you if you file a complaint.

VI. CHANGES TO THIS NOTICE

US X-Ray will promptly revise and distribute this Notice whenever there is a material change to the uses or disclosures, your individual rights, our legal duties, or other privacy practices stated in this Notice. We reserve the right to change this Notice and to make the revised or new Notice provisions effective for all PHI already received and maintained by us as well as for all PHI we receive in the future. US X-Ray will post a copy of our current Notice at our office in addition to you a copy on the first day you receive services from us. In addition, we will provide a copy of any revised Notice to you upon request.

VII. FOR FURTHER INFORMATION

If you have any questions about this Notice please contact our office Vice President.