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Notice of Privacy Practices

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.

Envision Imaging of Frisco is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. If you have questions about any part of this notice or if you want more information about the privacy practices at Envision Imaging of Frisco please contact:

Renee Sydney
Privacy Officer
3211 Internet Blvd, Ste 120
Frisco, TX 73034
972.334.0908

Envision Imaging of Frisco collects health information from you and stores it in an x-ray folder, on a computer and on computer storage devices. This is your medical record. The medical record is the property of Envision Imaging of Frisco, but the information in the medical record belongs to you. Envision Imaging of Frisco protects the privacy of your health information. The law permits Envision Imaging of Frisco to use or disclose your health information for the following purposes:

Treatment: We will use and disclose your protected health information to provide, coordinate or manage your health care in accordance with our policies and procedures. For example, we will use your medical history, such as any presence or absence of low back pain, to perform a requested lumbar MRI exam.

Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. For example, we may need to give a payer information about your current medical condition so that it will pay us for the MRI examinations 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 pre-authorization or to determine whether the service is covered.

Healthcare Operations: We may use and disclose information about you for the general operations of our business. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing and conducting or arranging for other business activities. For example, we sometimes arrange for accreditation organizations, auditors or other consultants to review our practice and evaluate our operations in order to improve our services. We may also call you by name in the waiting room when the technologist is ready to begin your procedure. We may use or disclose your protected health information as necessary to contact you in order to schedule or remind you of your appointment.

Public Policy Uses and Disclosures: We may use or disclose your protected health information in the following situations without your authorization. These situations include: as Required By Law, Public Health issues for purposes related to preventing or controlling disease, injury or disability; reporting elder or child abuse or neglect; reporting domestic violence; reporting to the FDA problems with products and reactions to medications; and reporting disease or infection exposure. We may release your protected health information to workers' compensation or other similar programs. If you are a member of the Armed Forces, we may release protected health information as required by military command authorities. In order to prevent or lessen a serious and imminent threat of public safety, we may disclose your protected health information. We may disclose your health information to coroners, medical examiners and funeral directors. We may disclose your protected health information to researchers conducting research that has been approved by Envision Imaging of Frisco's Privacy Officer. We may use your protected health information to contact you in order to tell you about health related services that may be of interest to you. In the event that Envision Imaging of Frisco is sold or merged with another organization, your health record will become the property of the new owner.

Notification and Communication with Family: We may disclose your health information to notify or assist in notifying a family member, your personal representative or another person responsible for your care about your location, your general condition or in the event of your death. If you are able and available to agree or object, we will give you the opportunity to object prior to making this notification. If you are unable or unavailable to agree or object, our health professionals will use their best judgement in communication with your family and others.

Other Uses and Disclosure 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 your permission, we will no longer use or disclose personal information about you for the reasons covered by your written authorization. We will be unable to take back any disclosures already made upon your original authorization.

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 receive your health information through a reasonable alternative means or at an alternative location. For example, you may request that we only contact you at work or by mail.
Except under certain circumstances, you have the right to inspect and copy medical and billing records about you. If you ask for copies of this information, we may charge you a fee for copying and mailing.
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. Envision Imaging of Frisco is not required to change your health information and will provide you will information about Envision Imaging of Frisco's denial and how you can disagree with the denial.
You have the right to receive an accounting of disclosures of your health information made by Envision Imaging of Frisco for reasons other than your treatment, payment for services furnished to you, our health care operations or certain government functions described above.

Changes To This Notice: We reserve the right to amend this Notice of Privacy at any time in the future. Until such amendment is made, Envision Imaging of Frisco is required by law to comply with this Notice. In the event there is a material change to this Notice, the revised Notice will be made available. In addition, you may request a copy of the revised Notice at any time.

Complaints: Complaints about this Notice of Privacy or how Envision Imaging of Frisco handles your health information should be directed to:

Renee Sydney, Privacy Officer
3211 Internet Blvd, Ste 120
Frisco, TX 73034
972.334.0908 Fax 972.335.0375

If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to:

Department of Health and Human Services
200 Independence Ave., S.W.
Room 509F, HHH Building
Washington, D.C. 20201
e-mail: ocrmail@hhs.gov

This Notice was published and becomes effective on/or before April 14, 2003.

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