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.
Lumina Imaging:
- Maintains the privacy and security of your protected health information (PHI)
- Follows the privacy practices described in this Notice
- Notifies affected individuals following a breach of unsecured PHI
- Provides you with a copy of this Notice if you so request
How Lumina Imaging Uses or Discloses Your PHI for Treatment,Payment or Health Care Operations:
Lumina Imaging uses and discloses your PHI for treatment, payment and health care operations. We provide examples of each in the section below.
Treatment. We may use or disclose your PHI to provide, coordinate or manage your healthcare. Our communications to you may be by telephone, cell phone, email, patient portal, or by mail. For example, we may use your PHI to call and remind you of an appointment or refer your care to another provider. We may use your PHI to provide you information about treatment alternatives or other health-related benefits and services that may be of interest to you. If another provider requests your PHI and they are not providing care and treatment to you, we will request an authorization from you before providing your information.
Payment. We may use or disclose your PHI to obtain payment for your healthcare services. For example, we may use your information to send a bill for your healthcare services to your insurer.
Health Care Operations. We may use or disclose your PHI for activities such as evaluating patient care, reviewing the performance of healthcare providers, business planning, and complying with the law. For example, we may use your PHI to determine the quality of care you received when you had your imaging service.
How Lumina Imaging Uses or Discloses Your PHI for Treatment,Payment or Health Care Operations:
Lumina Imaging:
These are the times Lumina Imaging may use or disclose your PHI without your written authorization:
- Required by Law. We may use and disclose your PHI when required to do so by law. For example, we may disclose PHI to report child abuse or to respond to a court order.
- Public Health. We may release your PHI to local, state or federal public health agencies. For example, we may disclose PHI to report communicable diseases, aid in the prevention or control of certain diseases and report problems with products and reactions to medications to the Food and Drug Administration.
- Victims of Abuse, Neglect or Violence. We may disclose your PHI to a government authority authorized by law to receive reports of abuse, neglect or violence relating to children or the elderly.
- Judicial and Administrative Proceedings. We may disclose your PHI in the course of an administrative or judicial proceeding in response to a court order. Under most circumstances when the request is made through a subpoena, a discovery request or involves another type of administrative order, we will request your authorization before disclosing your PHI.
- Health Oversight Activities. We may disclose your PHI to health agencies authorized by law to conduct audits, investigations, inspections, licensure and other proceedings related to oversight of the health care system.
- Law Enforcement. We may disclose your PHI to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, or missing person, or complying with a court order or other law enforcement purposes. Under some limited circumstances we will request your authorization before disclosing your PHI.
- Coroners and Medical Examiners. We may disclose your PHI to coroners and medical examiners. For example, this may be necessary to determine the cause of death.
- Research. Under certain circumstances, and only after a special approval process, we may use and disclose your PHI to help conduct medical research, which might involve an assessment of whether a certain treatment is working better than another.
- To Avert a Serious Threat to Health of Safety. We may disclose your PHI in a very limited manner to appropriate persons to prevent a serious threat to the health or safety of a person or the general public.
- Specialized Government Functions. Under limited circumstances, we may disclose your PHI for military, national security, or law enforcement custodial situations.
- Workers’ Compensation. Both state and federal law allow us to disclose your PHI that is reasonably related to a worker’s compensation injury.
- Individuals involved in your care. If you do not object and the situation is not an emergency, and disclosure is not otherwise prohibited by law, we are permitted to release your information under the following circumstances:
To individuals involved in your care—we may release your PHI to a family member, other relative, friend or other person who is involved in your healthcare or the payment of your health care;
To family—we may use your PHI to notify a family member, a personal representative or a person responsible for your care, of your location, general condition, or death - Business Associates. We may disclose your PHI to individuals or organizations that provide Lumina Imaging services related to your care, payment for your care and/or Lumina Imaging operations. For example, our business associate might have access to PHI when servicing our MRI machines. We will obtain assurances that these individuals or organizations will safeguard the privacy and security of your PHI.
There are times Lumina Imaging is Required to Obtain Your Written AuthorizationBefore Using or Disclosing Your PHI:
Except as described in this Notice, we will not use or disclose your PHI without written authorization from you. For example, we will obtain your authorization before using or disclosing PHI for the purposes related to:
- Psychotherapy
- Marketing; and
- The sale of PHI
You have the right to opt out of receiving fundraising communications, if Lumina Imaging were to engage in fundraising.
If you do authorize us to use or disclose your PHI for another purpose, you may revoke your authorization in writing at any time. If you revoke your authorization, we will no longer be able to use or disclose PHI about you for the reasons covered by your written authorization, though we will be unable to take back any disclosures we have already made with your permission. To revoke your authorization, please contact: Bryan Crowley (Manager), 8401 Mentor Avenue Suite B, Mentor, OH 44060, 440-592-6095.
How Lumina Imaging Uses or Discloses Your PHI for Treatment,Payment or Health Care Operations:
- Inspect and Copy Your PHI. You have the right to inspect and obtain a copy of your PHI. You have the right to request that we provide the copy in an electronic form or format, such as Dicom and PDF. If the form and format are not readily producible, then Lumina Imaging will work with you to provide it in a reasonable electronic form or format. This right of access does not apply to psychotherapy notes, which are maintained for the personal use of a mental health professional. Your request for inspection or access must be submitted in writing to Bryan Crowley (Manager), 8401 Mentor Avenue Suite B, Mentor, OH 44060, 440-592-6095. In addition, we may charge you a reasonable fee to cover our expenses for copying your PHI.
- Request to Correct Your PHI. You have a right to request that Lumina Imaging amend your PHI that you believe is incorrect or incomplete. To request an amendment, you must make your request in writing to Bryan Crowley (Manager), 8401 Mentor Avenue Suite B, Mentor, OH 44060, 440-592-6095. You must also provide a reason for your request. We are not required to change your PHI and if your request is denied, we will provide you with information about our denial and how you can disagree with the denial.
- Request Restrictions on Certain Uses and Disclosures. You have the right to request that we not use or disclose certain PHI for treatment, payment, or our operations. We are not required to agree to your request in every instance. However, if you pay for a service or healthcare item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will agree to your request, unless the law requires us to share your PHI.
- Receive Confidential Communications of PHI. You have the right to request that we communicate with you in different ways or places. For example, you can ask us to contact you at home or mail your health information to a different address. We must accommodate reasonable requests.
- Receive a List of Disclosures of Your PHI. You have the right to request a list (or “accounting”) of the disclosures of your PHI that we have made for six years prior to the date you ask. We will provide you a list of the PHI we disclosed, to whom, when, and for what purpose. We will include all disclosures except for those about treatment, payment, and healthcare operations, and certain other disclosures (such as those you authorized). We will provide you one accounting a year for free, but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
- Obtain A Paper Copy of This Notice. You may obtain a paper copy of this Notice, by sending your written request to Bryan Crowley (Manager), 8401 Mentor Avenue Suite B, Mentor, OH 44060, 440-592-6095.
- Be Notified of a Breach. Lumina Imaging is required by law to notify you following a breach of unsecured PHI.
- Make a Complaint. If you believe your privacy rights have been violated, you may file a complaint with Bryan Crowley (Manager), 8401 Mentor Avenue Suite B, Mentor, OH 44060, 440-592-6095. We request that you file your complaint in writing so that we may better assist in the investigation of your complaint. You may also file a complaint with the Secretary of the Department of Health and Human Services:
Centralized Case Management Operations
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F HHH Bldg.
Washington, D.C. 20201 - There will be no retaliation against you in any way for filing a complaint.
Questions?
If you have any questions about any part of this Notice or if you want more information about the privacy practices of Lumina Imaging, please contact Bryan Crowley (Manager), 8401 Mentor Avenue Suite B, Mentor, OH 44060, 440-592-6095.
This Notice Might Change.
We reserve the right to change the privacy practices described in this Notice. We will make the new Notice provisions effective for all the PHI that we maintain. If we change our privacy practices, information about that change will be made available to you. Information will also be posted at the location of service.
