NOTICE OF PRIVACY PRACTICES OF
EASTERN RADIOLOGISTS, INC.
GREENVILLE MRI, LLC
REVISED MAY 21, 2010
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
WHO WILL FOLLOW THIS NOTICE
This Notice describes the privacy practices of (a) Eastern Radiologists, Inc. at all of the office locations it operates in Greenville, North
Carolina, and (b) Greenville MRI, LLC at its facility in Greenville, North Carolina, which is managed by Eastern Radiologists, Inc. This
Notice covers all employees, staff and other personnel of Eastern Radiologists, Inc. and Greenville MRI, LLC, as well as any students,
trainees, independent contractors or volunteers who may provide services to you as a patient of Eastern Radiologists, Inc. or Greenville MRI,
LLC. Eastern Radiologists, Inc. and Greenville MRI, LLC are participants in an "organized health care arrangement" as defined by the
privacy regulations implementing the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of
1996 ("HIPAA"). As such participants, Eastern Radiologists, Inc. and Greenville MRI, LLC may share information with each other not only
for your treatment, but for other purposes stated in this Notice. Throughout this Notice, "we" or "us" or "our" means Eastern Radiologists,
Inc. and Greenville MRI, LLC.
OUR PLEDGE REGARDING PROTECTED HEALTH INFORMATION
In the ordinary course of receiving treatment and healthcare services from us, you will be providing us with personal information such as:
¨Your name, address, and phone number
¨Your date of birth and social security number
¨Your insurance information and coverage
¨Information concerning your physician, nurse or other healthcare providers
In addition, we will gather certain medical information about you and will create a record of the care provided to you. Also, some
information may be provided to us by other individuals or organizations that are part of your “circle of care”- such as your referring
physician, your other physicians, your health plan, and close friends or family members. Your medical information is contained in a medical
record that is the physical property of Eastern Radiologists, Inc. We need this record to provide you with quality care and to comply with
certain legal requirements. Our goal is to take appropriate steps to attempt to safeguard any medical or other information that is created by us
or provided to us which relates to your past, present, or future physical or mental health or condition or the provision of health care to you or
the past, present or future payment for the provision of health care to you that identifies you or could be used to identify you (all this
information is referred to in this Notice as "protected health information"). Under the HIPAA privacy regulations (the "Privacy Rule"), we
are required to: (i) maintain the privacy of your protected health information; (ii) provide notice of our legal duties and privacy practices
with respect to your protected health information (which we are doing in this Notice); and (iii) abide by the terms of our Notice of Privacy
Practices currently in effect (the "Notice"). When using or disclosing protected health information or when requesting protected health
information from another entity covered by the Privacy Rule, we will make reasonable efforts not to use, disclose or request more than the
minimum amount of protected health information necessary to accomplish the intended purpose of the use, disclosure or request. However,
this minimum necessary standard does not apply to disclosures to or requests by us or other health care providers for treatment, uses or
disclosures to you, disclosures to the Secretary of the U.S. Department of Health and Human Services, or uses or disclosures required by law.
HOW WE MAY USE AND DISCLOSE INFORMATION ABOUT YOU
We may use and disclose your protected health information in different ways. All of the ways in which we may use and disclose information
will fall within one of the following categories, but not every use or disclosure in a category will be listed. In this Notice, to "use" protected
health information means we are sharing that information with someone who is a member of our workforce and to "disclose" protected health
information means we are sharing that information with someone outside of our workforce.
Required Disclosures. We are required to make disclosures of your protected health information (a) to you in certain circumstances
(See the discussion in the "Individual Rights" section of this Notice), and (b) to the Secretary of the U. S. Department of Health and Human
Services for its investigation or determination of our compliance with the Privacy Rule.
Treatment. We may use and disclose your protected health information to furnish services and supplies to you, in accordance with our
policies and procedures. For example, (a) we may use your medical history, such as any presence or absence of heart disease, to assess your
health and perform requested imaging procedures or other diagnostic services and (b) we may disclose the results of any diagnostic test we
perform on you to your referring doctor.
Payment. We may use health information about you to bill for our services and to collect payment from your insurance company. For
example, our billing, accounts receivable and collections employees may access your health information for the purpose of billing and
collecting for services we have provided to you. North Carolina law requires us to get your written consent to the disclosure of your
protected health information for payment purposes. If you are an existing patient, you have already signed a consent allowing us to share
your protected health information with your health insurance company (or any other person or entity responsible for paying for your
healthcare services) for payment purposes. If you are a new patient, you will be asked to sign a consent during your first visit with us on or
after April 14, 2003. Other than in an emergency situation, we can refuse to provide services to you if you do not sign the consent form
allowing us to share your protected health information with your insurance company or other person or entity responsible for paying for your
healthcare services. For example, after obtaining your consent, we may need to (a) give a payer information about your current medical
condition so that it will pay us for the ultrasound examinations or other services that we have furnished you or (b) to inform your payer of the
tests that you are scheduled to receive in order to obtain prior approval or to determine whether the service is covered.
Healthcare Operations. We may use information about you for the general operation of our businesses for such purposes, among others, as
developing procedures and protocols, reviewing employee performance, training employees, business planning and development and general
administrative activities ("healthcare operations"). For example, our human resources department may access your protected health
information to conduct a performance review of the nurse or technician who provides services to you. North Carolina law requires us to get
your written consent to the disclosure of your protected health information for our healthcare operations. You will be asked to sign a consent
during your first visit with us on and after April 14, 2003. Other than in an emergency situation, we can refuse treatment to any patient who
does not sign a consent allowing us to share protected health information for our healthcare operations. For example, after obtaining your
consent, we may arrange for accreditation organizations, auditors or other consultants to review our practice, evaluate our operations, and tell
us how to improve our services and they may need access to your protected health information (as well as that of other patients) to provide
these services to us.
Other Uses and Disclosures. We may use and disclose your protected health information without your consent or authorization for the
When the Use or Disclosure is Required by Law. We may use or disclose protected health information about you when we are required to do
so by federal, state or local law or other judicial or administrative proceeding.
When the Use or Disclosure is Necessary For Public Health Activities. We may use or disclose protected health information about you in
connection with certain public health reporting activities. For instance, we may disclose such information to a public health authority
authorized to collect or receive protected health information for the purpose of preventing or controlling disease, injury or disability, or at the
direction of a public health authority, to an official of a foreign governmental agency that is acting in collaboration with a public health
authority. Public health authorities include county and state health departments, the Centers for Disease Control and Prevention, the Food
and Drug Administration, the Occupational Safety and Health Administration and the Environmental Protection Agency, to name a few.
We are also permitted to disclose protected health information to a public health authority or other governmental authority authorized by law
to receive reports of child abuse or neglect. Additionally, we may disclose protected health information to a person subject to the Food and
Drug Administration’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.
When the Disclosure Relates to Victims of Abuse, Neglect or Domestic Violence. We may disclose your protected health information in
situations where we reasonably believe you are a victim of domestic abuse or elder abuse.
When the Use or Disclosure is For Health Oversight Activities. We may disclose protected health information 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 1) the
health care system, 2) governmental benefit programs for which health information is relevant to determining beneficiary eligibility, 3)
entities subject to governmental regulatory programs for which health information is necessary for determining compliance with program
standards, or 4) entities subject to civil rights laws for which health information is necessary for determining compliance.
When the Disclosure is For Judicial or Administrative Proceedings or Law Enforcement Purposes. We may disclose information in response
to an order of a court or administrative hearing body and in connection with certain government investigations and law enforcement
When the Use or Disclosure Relates to Decedents. We may disclose protected health information to a coroner or medical examiner to
identify a deceased person or determine the cause of death. We also may disclose protected health information to organ procurement
organizations, transplant centers, and eye or tissue banks.
When the Use or Disclosure is for Workers' Compensation Purposes. We may disclose your protected health information to Workers'
Compensation or similar programs that provide benefits for work-related injuries or illnesses without regard to fault.
When the Use or Disclosure is to Avert a Serious Threat to Health or Safety. Information about you also may be disclosed when necessary to
prevent a serious threat to your health and safety or the health and safety of others.
When the Use or Disclosure Relates to Medical Research. Under certain circumstances, we may use and disclose certain protected health
information for research purposes.
When the Use or Disclosure Relates to Specialized Government Functions. If you are a member of the Armed Forces, we may use or
disclose protected health information about you as required by military command authorities. We also may disclose protected health
information 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.
When the Use or Disclosure Relates to Correctional Institutions or Other Law Enforcement Custodial Situations. If you are an inmate, we
may disclose protected health information about you to a correctional institution where you are incarcerated or to law enforcement officials
having lawful custody of you, under certain circumstances.
Disclosures to Our Business Associates. We sometimes work with outside individuals and businesses that help us operate our businesses
successfully. We may disclose your 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 privacy of your protected health information. For example, we
may disclose your protected health information to a billing service that takes information we give it and creates an electronic claim which is
submitted to the payer so long as we have entered into a business associate agreement with the billing service where it agrees to protect the
information we give it.
Disclosures to Individuals Involved in Your Care or Payment. We may disclose information to individuals involved in your care or in the
payment for your care provided that (a) you are present when such disclosures are made and do not object or (b) there is an emergency
situation where you are not present or are incapacitated and we determine, in the exercise of professional judgment, that the disclosure is in
your best interests. In either of these situations, we will only disclose the information that is directly relevant to such person's involvement
with your care or the payment for your care. This includes people who are part of your “circle of care” – such as your spouse, your other
family members, your close friends, or an aide who may be providing services to you. If you want to object to our disclosure of your
protected health information in this way, please call or write our Privacy Officer listed in this Notice.
Appointment Reminders. We may use and disclose your protected health information to contact you as a reminder that you have an
appointment or that you should schedule an appointment.
Treatment Alternatives. We may use or disclose your protected health information in order to tell you about or recommend possible
treatment options, alternatives or health related services that may be of interest to you.
Incidental Disclosures. We may use or disclose your protected health information incident to a use or disclosure permitted in this Notice.
For example, if a physician providing your care is engaged in a conversation about your care with a nurse or technician in one of our practice
sites and another patient who is walking down the hall to be tested happens to overhear the conversation, this would be a permitted incidental
disclosure. Our privacy policies contain procedures to limit these incidental disclosures as much as reasonably possible.
OTHER USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
WE ARE REQUIRED TO OBTAIN YOUR WRITTEN PERMISSION (AN "AUTHORIZATION") FOR ANY OTHER USES AND
DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION OTHER THAN THOSE DESCRIBED ABOVE. IF YOU
PROVIDE US WITH AN AUTHORIZATION, YOU MAY REVOKE THAT AUTHORIZATION, IN WRITING, AT ANY TIME.
IF YOU REVOKE YOUR AUTHORIZATION, WE WILL NO LONGER USE OR DISCLOSE YOUR PROTECTED HEALTH
INFORMATION FOR THE REASONS COVERED BY YOUR WRITTEN AUTHORIZATION; HOWEVER, WE WILL BE
UNABLE TO TAKE BACK ANY DISCLOSURES ALREADY MADE BASED UPON YOUR ORIGINAL AUTHORIZATION.
YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
You have the following rights with respect to your protected health information. To exercise any of the rights listed below, you must
submit a written request to Eastern Radiologists, Inc., #9 Doctors Park, Greenville, NC 27834, Attention: Privacy Officer.
Right to Request Restrictions. You have the right to ask for restrictions on the ways in which we use and disclose your protected health
information beyond those imposed by law. We will consider your request, but we are not required to accept it.
Right to Request Different forms of Communication. 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.
Right to Inspect and Copy Your Protected Health Information. Except under certain circumstances, you have the right to inspect and copy
your protected health information maintained by us in a designated record set. If you request copies of this information, we may charge you
a reasonable, cost-based fee for copying and mailing.
Right to Request an Amendment of Your Protected Health Information. If you believe that protected health information about you which we
maintain in a designated record set is incorrect or incomplete, you have the right to ask us to correct the existing information or add the
missing information. Under certain circumstances, we may deny your request. If we deny your request, you will be notified and you may
have a written statement of your disagreement added to your protected health information maintained by us in a designated record set.
Right to Receive an Accounting of Disclosures of Your Protected Health Information. You have the right to ask for a list of instances when
we have disclosed your protected health information. You may ask for a list of disclosures made by us during the six (6) years before your
request. We are required to provide a list of all disclosures EXCEPT (a) disclosures made for the treatment, payment or healthcare
operations of Eastern Radiologists, Inc. and/or Greenville MRI, LLC, (b) disclosures made to you or your personal representative or that you
give us authorization to make, (c) disclosures that occur incidentally to permitted uses and disclosures, (d) disclosures made to family
members or friends to which you do not object, (e) disclosures for national security or intelligence activities, (f) disclosures to correctional
institutions or law enforcement officials under certain circumstances, and (g) disclosures made before April 14, 2003. We will provide one
(1) accounting of disclosures free of charge once every twelve (12) months. If you ask for this information from us more than once every
twelve months, we will charge you a reasonable fee for each additional accounting.
Right to File a Complaint. You have the right to file a complaint if you feel your privacy rights have been violated. For details, see the
section of this Notice entitled "Complaints/Comments."
Right to a Paper Copy of this Notice. You have the right to a copy of this Notice in paper form. You may request a copy at any time. You
may also obtain a copy of this form at our website, www.easternrad.com; however, you still have the right to receive a paper copy of this
Notice from us upon request.
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 protected
health information we already have about you as of the date of the change to this Notice as well as any information we receive after the
change. In the event there is a material change to this Notice, the revised Notice will be posted at each of our locations where healthcare
services are provided to patients. In addition, you may request a copy of the revised Notice at any time.
If you think we have violated your privacy rights, or you have any complaints concerning our privacy practices, you may contact the
Secretary of the U. S. Department of Health and Human Services and you may also submit a written complaint to the following:
Eastern Radiologists, Inc.
2101 W. Arlington Blvd, Ste 210
Greenville, NC 27834
You will not be retaliated against for filing a complaint with our Privacy Officer or with the Secretary of the U.S. Department of
Health and Human Services.
You may obtain more information concerning or ask questions about this Notice by contacting the following:
Eastern Radiologists, Inc.
2101 W. Arlington Blvd, Ste 210
Greenville, NC 27834
Telephone: (252) 752-5000 ext. 5216