Our Privacy Promise to You:
At Delta Radiology, we are committed to protecting your health information
and using it responsibly.
Your information is confidential.
Delta Radiology is committed to following all laws and regulations
that protect your privacy: the Confidentiality of Medical Information
Act, the Patient Access to Medical Records Act and the
Health Insurance Portability and Accountability Act. Our employees
are trained on the importance and methods of keeping your information
We will not sell your information.
Your medical information will only be used for your care and our
healthcare operations. We will not sell or give your information to
other companies for marketing uses.
We will use your information to serve you better.
We collect information about you, our patients, to help us deliver
a high quality of healthcare. For instance, we may ask for information
from your physician or you, to schedule an examination for you. Also,
we need information to bill your insurance company on your behalf.
We protect your information.
Delta Radiology has procedures to ensure the security and confidentiality
of your personal information, both from outside and within our company.
You have rights with regards to your protected health information.
The following Notice of Privacy Practices describes how Delta Radiology
may use your protected health information and what your rights are.
We ask that you read it carefully.
NOTICE OF PRIVACY PRACTICES
We are required by law to maintain the privacy of medical
health information and to provide patients with notice of our legal
duties, our privacy practices, and patients' rights with regard to their
protected health information. Protected health information is information
about you that may identify you and relates to your past, present, or
future physical or mental health, our provision of healthcare to you,
or payment for healthcare services.
Delta Radiology is required to abide by the terms of
this Notice of Privacy Practices. We reserve the right to change it
from time to time. The new Notice will be effective for all protected
health information in our possession at that time. We will provide you
with a new Notice upon your request. You can also view our current Notice
at our website: www.deltarad.com
- Uses and Disclosures of Protected Health Information
for Treatment, Payment, and Health Care Operations.
Delta Radiology is allowed to and will use or disclose your
protected health information as described in this section.
Treatment: We will use and disclose your protected health
information to provide and coordinate your healthcare and any
related services. For example, we will disclose the results
of your radiologic examination to your referring physician or
to another health care provider (e.g. a specialist or a laboratory)
involved in your care.
Payment: We will use your protected health information
as needed to obtain payment for our healthcare services to you.
For example, we may be asked to send your examination results
to your insurance company in order to receive payment.
Healthcare Operations: We may use your protected health
information to support our own operations, which may include
activities that improve our quality of care and cost effectiveness.
- We may review your examination in order to evaluate
the quality and effectiveness of our own staff.
- We may disclose your information to your insurance company
to resolve any complaints that you may raise.
- We may use a sign-in sheet at a registration desk, where
you are asked to sign your name to indicate your arrival.
- We may call you by name in the waiting area when we
are ready to provide your service.
- We may use your information to contact you to remind
you of an appointment or to schedule your appointment.
- We may share your protected health information with
a third party "business associate" that performs a task
for our practice, for example, a billing service. Our business
associates must sign agreements that they will respect the
confidential nature of your protected health information.
- We may send you information about our practice or new
services that we offer.
- Other Permitted Uses and Disclosures That May be Made
With Your Agreement.
Your "circle of care": We may disclose information about
you to individuals involved in your care, such as your spouse,
other physicians, or a health aide. Generally, we will obtain
your verbal agreement before disclosing health information to
these people, however in certain situations, such as an emergency,
we are allowed to make these disclosures without your agreement.
- Other Permitted Uses and Disclosures That May be made
Without Your Authorization or Agreement:
- Research: We may disclose your protected health information
to researchers, when an Institutional Review Board or Privacy
Board has reviewed the research protocol to ensure the privacy
of your protected health information. In these instances, the
Institutional Review Board may grant a waiver of authorization
- Public Health Activities: We may disclosure your information
to public health authorities, as required. For example, for
the purpose of preventing or controlling disease, or to report
suspected child, elder, or dependent adult abuse or neglect.
- Worker's Compensation: We may disclose information as
authorized by and to the extent necessary to comply with laws
relating to worker's compensation and other similar programs.
- Food and Drug Administration: We may disclose information
to the FDA or to a company authorized by the FDA to report adverse
events, product problems, or to enable product recalls.
- Health Oversight: We may disclose protected health information
to a health oversight agency, whose activities are authorized
- Legal Proceedings: We may disclose protected health information
in the course of a judicial or administrative proceeding in
response to a legal order.
- Law Enforcement Officials: We may disclose your protected
health information as required by law, including in response
to a warrant, subpoena, or other order of a court or to assist
law enforcement to identify or locate a suspect, fugitive, material
witness or missing person.
- Criminal Activity: We may disclose information if we
believe that the disclosure is necessary to prevent or lessen
an imminent threat to the health or safety of another person
or the public.
- Coroners: We may disclose information to a coroner, medical
examiner, or funeral director to allow them to perform their
duties authorized by law. We may disclose information to organ
procurement organizations, if you are organ donor.
- Specialized Government Functions: We may disclose your
information to units of the government with special functions,
under certain specific circumstances.
- Inmates: We may disclose your protected health information
to prison officials, if you are an inmate in a facility.
- Marketing: We may use your information to engage in face-to-face
marketing communications with you, regarding our company.
- Uses and Disclosures That Require Your Authorization.
Other uses and disclosures of your protected health information
besides those covered in Sections 1-3 will only be made with
your authorization. You may revoke your authorization at any
time, in writing, except to the extent that Delta Radiology
has already taken an action based upon your prior authorization.
- Your Rights.
This is a list of your rights, with respect to your medical
information and a description of how you may exercise them.
Some of these rights have limitations, in that as a provider
of medical care, we do not have to grant them in all circumstances.
We do, however, have to respond to your written request. If
you have a question about the denial of a request, contact our
Privacy Officer, at (209) 334-4416, or in writing at 1121 West
Vine Street, Ste. 16 Lodi, CA 95240.
Right to inspect and copy your health information: You
may request access to your medical record file, billing records,
radiology exam reports, films, and other designated record sets
maintained by us. You may inspect these records or request copies
of them. In limited circumstances, we may deny your access to
a portion of your records. If you wish to access your records,
you will be asked to complete and sign a form. If you request
copies, there may be a charge for the copies and any mailing
fees or supplies associated with fulfilling your request. You
will be informed of the amount before the copies are made.
Right to request restrictions: You may request restrictions
on our use of your protected health information, for the purposes
of treatment, payment, and healthcare operations. You may also
request that your information not be shared with your family
members or for notification purposes as described in this notice.
We are not required to agree to a restriction that you request,
but are required to respond to your request. We cannot agree
to restrictions on uses or disclosures that are legally required
or which are necessary to administer our business. Your written
request should be made to our Privacy Officer, at the address
Right to confidential communications: You may request
that we contact you by alternate means, such as at a different
phone number or a post office box. You must make this request
in writing and we will accommodate any reasonable request.
Right to amend records: You may request that we amend
your protected health information that is created and maintained
in records held by Delta Radiology, if you feel is it inaccurate
or incomplete. In certain cases, we may deny your request. If
we do, you have the right to file a statement of disagreement
with us, which will be placed in your medical record. All requests
for amendment must be made in writing.
Right to receive an accounting of disclosures: You may
request, in writing, an accounting of disclosures that Delta
Radiology has made of your protected health information. We
do not have to include disclosures for treatment, payment or
operations, among others.
Right to receive a paper copy: You may request and receive
a paper copy of this Notice of Privacy Practices at any time.
- More information or to report a problem.
You may contact our Privacy Officer, at (209) 334-4416, or in
writing at 1121 West Vine Street, Ste. 16 Lodi, CA 95240 if
you have questions or a complaint about your medical privacy.
You may also complain to the Secretary of Health and Human Services,
if you believe your privacy rights have been violated by us.
Information about how to contact the Secretary of HHS may be
http://www.hhs.gov/ocr/privacyhowtofile There will be no
retaliation against you for filing a complaint.
This notice was published and effective on April 14, 2003.