HIPAA Notice Of Privacy Practices

Our Commitment To Your Privacy

Georgia Health Imaging LLC ("GHI," "we," "us," or "our") is committed to protecting the privacy of your health information. We are required by federal law — specifically the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and its implementing regulations — to maintain the privacy of your Protected Health Information (PHI), to provide you with this Notice of our legal duties and privacy practices with respect to your PHI, and to follow the terms of the Notice currently in effect.

What Is Protected Health Information?

Protected Health Information (PHI) is information about you — including demographic data — that relates to your past, present, or future physical or mental health or condition, the provision of health care to you, or the past, present, or future payment for the provision of health care to you, and that identifies you or for which there is a reasonable basis to believe it can be used to identify you.

How We May Use And Disclose Your Health Information

The following describes the ways we may use and disclose your PHI. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

For Treatment

We may use or disclose your PHI to provide, coordinate, or manage your health care and related services. For example, we may share your imaging results with your referring physician or other treating providers so they can coordinate your care.

For Payment

We may use or disclose your PHI so that treatment and services provided to you may be billed to, and payment collected from, you, an insurance company, or a third party. For example, we may share your PHI with your insurance company to obtain payment for services rendered.

For Health Care Operations

We may use and disclose your PHI for our health care operations. These activities are necessary for running our facility and maintaining quality services. For example, we may use PHI to review the quality of care we provide, for training purposes, or for auditing functions.

Appointment Reminders

We may use and disclose your PHI to contact you as a reminder that you have an appointment scheduled at our facility.

As Required By Law

We will disclose your PHI when required to do so by applicable federal, state, or local law.

For Public Health Activities

We may disclose your PHI to public health authorities for activities such as reporting disease, injury, or vital statistics as required or authorized by law.

For Health Oversight Activities

We may disclose your PHI to a health oversight agency for activities authorized by law, including audits, investigations, inspections, and licensure.

For Judicial and Administrative Proceedings

If you are involved in a lawsuit or a dispute, we may disclose your PHI in response to a court or administrative order. We may also disclose PHI in response to a subpoena, discovery request, or other lawful process from someone else involved in the dispute.

To Law Enforcement

We may release your PHI if asked to do so by a law enforcement official under specific circumstances as defined by law, including to report certain types of wounds or injuries, and to respond to a court order, subpoena, warrant, or similar process.

For Serious Threats to Health or Safety

We may use and disclose your PHI when necessary to prevent a serious threat to your health or safety or the health or safety of the public or another person.

For Workers' Compensation

We may release your PHI for workers' compensation or similar programs providing benefits for work-related injuries or illness.

For Coroners, Medical Examiners, and Funeral Directors

We may release your PHI to a coroner or medical examiner when necessary to identify a deceased person or determine cause of death. We may also release PHI to funeral directors as necessary to carry out their duties.

For Military and Veterans

If you are a member of the armed forces, we may release your PHI as required by military command authorities or the Department of Veterans Affairs.

For Research

Under certain circumstances and with proper approvals, we may use and disclose your PHI for research purposes.

Business Associates

We may share your PHI with third-party "business associates" who perform functions or services on our behalf, such as billing services, IT providers, or other administrative service companies. We require all business associates to protect the privacy of your PHI through written agreements that comply with HIPAA.

Uses And Disclosures That Require Your Authorization

For uses and disclosures of your PHI not described in this Notice, we will ask for your written authorization before using or sharing your information. If you provide authorization, you may revoke it in writing at any time. Revocation will not apply to information already released in reliance on your prior authorization.

Uses and disclosures that always require your specific written authorization include:

• Most uses and disclosures of psychotherapy notes
• Uses and disclosures of PHI for marketing purposes
• Disclosures that constitute a sale of PHI

Your Rights Regarding Your Health Information

You have the following rights regarding your PHI that we maintain:

Right To Access And Receive Copies

You have the right to inspect and obtain a copy of PHI that we maintain about you in a designated record set, which generally includes medical and billing records. To request access, submit your request in writing to our Privacy Officer. We may charge a reasonable fee for copies. We will respond within 30 days of receiving your written request.

Right To Request Amendment

If you believe that PHI we have about you is incorrect or incomplete, you may request an amendment. To request an amendment, submit your request in writing to our Privacy Officer and provide a reason that supports your request. We may deny your request under certain circumstances and will provide a written explanation if we do.

Right To An Accounting Of Disclosures

You have the right to request an accounting of certain disclosures we have made of your PHI in the six years prior to your request. The accounting will not include disclosures made for treatment, payment, or health care operations, or disclosures made to you or pursuant to your authorization.

Right To Request Restrictions

You have the right to request a restriction on the PHI we use or disclose for treatment, payment, or health care operations. You also have the right to request restriction of disclosures to family members, friends, or others involved in your care. We are not required to agree to your requested restriction except in one circumstance: if you pay out-of-pocket in full for a specific item or service and request that we not disclose PHI related to that service to your health plan, we must honor that restriction.

Right To Request Confidential Communications

You have the right to request that we communicate with you about your health matters in a certain way or at a certain location. For example, you may ask that we contact you only at a specific phone number or mailing address. We will accommodate all reasonable requests.

Right To A Paper Copy Of This Notice

You have the right to a paper copy of this Notice at any time, even if you have received this Notice electronically. To request a paper copy, contact us using the information at the top of this Notice.

Right To Be Notified Of A Breach

If a breach of your unsecured PHI occurs, you have the right to be notified of that breach in accordance with applicable federal and state law.

Our Duties

We are required by law to:

• Maintain the privacy of your PHI
• Provide you with notice of our legal duties and privacy practices with respect to your PHI
• Notify you following a breach of your unsecured PHI
• Follow the terms of the Notice currently in effect

We reserve the right to change this Notice and to make the revised or changed Notice effective for PHI we already have about you as well as any PHI we receive in the future. We will post a current copy of this Notice on our website at gahealthimaging.com. You may also request a current copy from our office at any time.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services. To file a complaint with us, contact our Privacy Officer at the address or phone number listed below. All complaints must be submitted in writing.

We will not retaliate against you for filing a complaint.

To file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights:

• Online: www.hhs.gov/ocr/privacy/hipaa/complaints
• By mail: 200 Independence Avenue S.W., Washington, D.C. 20201
• By phone: 1-877-696-6775

Contact Our Privacy Officer

For questions about this Notice or to exercise any of your rights described in this Notice, please contact:

Privacy Officer
Georgia Health Imaging LLC
3653 Lawrenceville Highway, Suite 150
Lawrenceville, GA 30044
Phone: (678) 924-0964
Fax: (678) 924-0965
Email: info@gahealthimaging.com