NOTICE OF PRIVACY
THIS NOTICE DESCRIBES
HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU
CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT
Our goal is to take appropriate steps to attempt to safeguard
any medical or other personal information that is provided to
us. We are required to: (i) maintain the privacy of medical
information provided to us; (ii) provide notice of our legal duties and
privacy practices; and (iii) abide by the terms of our Notice of Privacy
Practices currently in effect.
WHO WILL FOLLOW
This notice describes the practices of the employees and staff
of Tower Imaging, Inc.
INFORMATION COLLECTED ABOUT YOU
In the ordinary course of receiving treatment and health care
services from us, you will be providing us with personal information
- Your name, address and phone number
- Information relating to your medical history
- Your insurance information and coverage
- Information concerning your doctor, nurse or other medical
In addition, we will gather certain medical information about
you and will create a record of the care provided to you. Some
information also may be provided to us by other individuals or
organizations that are part of your "circle of care" - such as the
referring physician, your other doctors, your health plan, and close
friends or family members.
HOW WE MAY USE
AND DISCLOSE INFORMATION ABOUT YOU
We may use and disclose personal and identifiable health
information about you 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
Treatment. We will use health information about
you to furnish services and supplies to you, in accordance with our
policies and procedures. For example, we will use your medical history,
such as any presence or absence of heart disease, to assess your health
and perform requested diagnostic services. We may also send a report of
our findings to one or more of your other physicians.
Payment. We will use and disclose health information about
you to bill for our services and to collect payment from you or your
insurance company. For example, we may need to give a payor
information about your current medical condition so that it will pay us
for the 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 prior approval or to
determine whether the service is covered.
For Health Care
Operations. We may use and disclose information
about you for the general operation of our business. For
example, we sometimes arrange for accreditation organizations, auditors
or other consultants to review our practice, evaluate our operations,
and tell us how to improve our services. We may also call you
to give you instructions about your appointment. We will use
the number(s) you give us at the time you make your
appointment. We may call you to conduct satisfaction
surveys. Your home number will be used for the survey unless
you give us other instructions.
Reminders. We may use and disclose medical information to
contact you as a reminder that you have an appointment or that you
should schedule an appointment.
- Lay letters for
Alternatives. We may use and disclose your
personal 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.Public Policy Uses and Disclosures. There are
a number of public policy reasons why we may disclose information about
We may disclose health information about you when we are
required to do so by federal, state, or local law.
We may disclose protected health
information2 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 PHI for the purpose of preventing or
controlling disease, injury or disability, or at the direction of the
public health authority, to an official of a foreign government agency
that is acting in collaboration with a public health
authority. Public health authorities include state health
departments, the Center for Disease Control, the Food and Drug
Administration, the Occupational Safety and Health Administration and
the Environmental Protection Agency, to name a few. For more information
are also permitted to disclose protected health information to a public
health authority or other government 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 of biological product
deviations, to track products to enable product recalls, repairs or
replacements, or to conduct post-marketing surveillance.
We may disclose your protected health information in situations
of domestic abuse or elder abuse.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.
result letters sent to the patient as required by Mammography Quality
Health Information: Protected health information is individually
identifiable health information which becomes protected health
information when it is: (i) transmitted by electronic media; (ii)
maintained in electronic media, or (iii) transmitted or maintained in
any other form or medium. The final version covers paper and
even verbal disclosure of individually identifiable health
We may disclose information in response to a warrant, subpoena,
or other order of a court or administrative hearing body, and in
connection with certain government investigations and law enforcement
We may release personal health information to a coroner or
medical examiner to identify a deceased person or determine the cause of
death. We also may release personal health information to organ
procurement organizations, transplant centers, and eye or tissue
We may release your personal health information to workers'
compensation or similar programs.
Information about you also will be disclosed when necessary to
prevent a serious threat to your health and safety or the health and
safety of others.
We may use or disclose certain personal health information
about your condition and treatment for research purposes where an
Institutional Review Board or a similar body referred to as a Privacy
Board determines that your privacy interests will be adequately
protected in the study. We may also use and disclose your protected
health information to prepare or analyze a research protocol and for
other research purposes.
If you are a member of the Armed Forces, we may release
personal health information about you as required by military command
authorities. We also may release personal health information
about foreign military personnel to the appropriate foreign military
We may disclose your protected health information for legal or
administrative proceedings that involve you. We may release
such information upon order of a court or administrative
tribunal. We may also release protected health information in
the absence of such an order and in response to a discovery to other
lawful request, if efforts have been made to notify you or secure a
If you are an inmate, we may release protected health
information about you to a correctional institution where you are
incarcerated or to law enforcement officials.
We never market or sell your personal information.
We will not user your personal information to contact you for
services. If you pay for your services
out-of-pocket, in full, you have the right to request that we do not
disclose your protected health information, related solely to those
services, to your health plan. We will say “yes”
unless a law requires us to share that information. You are required to
notify any parties that may receive this protected health information
from us (such as a physician that requests a copy of your medical
records from our office) of the restriction, if applicable.
Finally, we 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 of foreign heads of state.
Associates. We sometimes work with outside
individuals and businesses that help us operate our business
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 confidentiality of your
personal and identifiable health information.
Involved in Your Care or Payment for Your Care. We may
disclose information to individuals involved in your care or in the
payment for your care, but we will obtain your agreement before doing
so. This includes people and organizations that are part of
your "circle of care" - such as your spouse or an aide who may be
providing services to you. Although we must be able to speak with your
other physicians or health care provider, you can let us know if we
should not speak with other individuals, such as your spouse or
If you are not able to tell us your preference, for example, if
you are unconscious, we may go ahead and share your information if we
believe it is in your best interest.
To the extent another state or federal law restricts the
ability of the practice to use or disclose protected health information
as discussed above, the practice's description of the use or disclosure
must reflect the more stringent law.
OTHER USES AND
DISCLOSURES 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 based upon your original permission.
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
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.
Except under certain circumstances, you have the right to
inspect and copy medical and billing records about you. A request must
be made in writing to inspect and copy your records. If you ask for
paper or electronic copies of this information, we will provide this for
you usually within 30 days of your request. We may charge you a
reasonable, cost-based fee for copying and mailing.
If you believe that information in your record is incorrect or
incomplete, you have the right to ask us to correct the existing
information or correct the missing information. Under certain
circumstances, we may deny your request.You have a right to ask for a
list of instances to whom and why we have used or disclosed your medical
information for reasons other than your treatment, payment for services
furnished to you, our health care operations, or disclosures you give
us authorization to make for six years prior to the date of your
request. If you ask for this information from us more than
once every twelve months, we may charge you a reasonable, cost-based
You may choose someone to act for you. If you have given
someone medical power of attorney or if someone is your legal guardian,
that person can exercise your rights and make choices about your health
information. We will make sure the person has this authority and can act
for you before we take any action. You have the right to a
copy of this Notice in paper form, even if you have agreed to receive
the notice electronically. You may ask us for a copy at any
time and we will provide you with a paper copy promptly.
You may complain if you feel your rights have been violated by
contacting us in writing at Tower Imaging, Inc., 2700 University Square
Drive Tampa, FL 33612, (Attn: Privacy Officer), via telephone
at 813-253-2721, or e-mail: firstname.lastname@example.org.
You may file a complaint with the U.S. Department of Health and
Human Services Office for Civil Rights by sending a letter to 200
Independence Avenue, S.W., Washington, D.C. 20201, calling
1-877-696-6775, or visiting: www.hhs.gov/ocr/privacy/hipaa/complaints/
will not retaliate against you for filing a complaint.
We are required by law to maintain the privacy and security of
your protected health information.
We will let you know promptly if a breach occurs that may have
compromised the privacy or security of your information.
We must follow the duties and privacy practices described in
this notice and give you a copy of it. We will not use or share your
information other than as described here unless you tell us we can in
writing. If you tell us we can, you may change your mind at any time.
Let us know in writing if you change your mind.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
CHANGES TO THIS
We reserve the right to make changes to this notice at any
time. We reserve the right to make the revised notice
effective for personal health information we have about you as well as
any information we receive in the future. In the event there is a
material change to the Notice, the revised Notice will be available upon
request, in our office, and on our website. In addition, you
may request a copy of the revised Notice at any time.
may contact the Secretary of the Department ofHealth and Human Services,
at 200 Independence Avenue, S.W., Room 509F, HHH Building, Washington,
D.C.20201 (e-mail: email@example.com).
obtain more information concerning this Notice of Privacy Practices,
you may contact our Privacy Officer at813-253-2721 (e-mail: firstname.lastname@example.org).