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Notice of Privacy Practices

Effective Date of Revised Notice: December 1, 2023

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.

Introduction

This Notice of Privacy Practices (“Notice”) describes how Clarus Imaging LLC may use and disclose your Protected Health Information (“PHI”) to carry out treatment, payment, and/or health care operations and for other purposes that are permitted or required by law. It also describes your rights concerning your PHI. PHI is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health or condition and related health care services.

Who Will Follow This Notice

This Notice describes the privacy practices of Clarus Imaging LLC, including:

Clarus Imaging LLC

All employees, staff, and other Clarus Imaging LLC personnel;

All authorized persons who have access to your information at our facility.

Our Legal Duty

We are required by law to:

  • Maintain the privacy of your PHI;
  • Provide you with this notice of our legal duties and privacy practices with respect to your PHI;
  • Follow the terms of the Notice currently in effect.

How We May Use and Disclose Medical Information About You

The following categories describe different ways we may use and disclose PHI.  Not every use or disclosure in a category will be listed.

a. Your Treatment:  We may use and disclose your PHI to provide you with medical treatment or services.  For example, we may disclose your PHI to doctors, nurses, and other health care personnel or providers to coordinate imaging services.  We may also permit disclosure of your electronic health record via electronic transfer to other facilities and providers for treatment purposes. We also may disclose your PHI to other people who provide services that are part of your care, such as a hospice or home care agency. We may use or disclosure your PHI through telemedicine technology for treatment purposes.

b. Obtaining Payment: We may use and disclose your PHI to bill and collect payment for your health care services.  We may disclose your PHI to other health care providers and organizations involved in your care to assist in their billing and collection efforts.  For example, this may include disclosures to your health insurance plan so your plan can determine eligibility, coverage, or medical necessity or for utilization review activities.  We also may disclose your PHI to third parties like Noterro and Square for collection of payment and administration of grants that fund our programs.

c. Health Care Operations: We may use your PHI or share it with others in the course of operating our facilities.  For example, we may use your information to evaluate: the performance of our staff in caring for you; the quality of our services; and effectiveness of various treatments. We may call you by name in the waiting areas.  We also may disclose your PHI to third parties who perform various activities on our behalf, such as accounting, transcription services, data analysis, and risk management.

In addition, we may disclose your PHI for payment activities and certain business operations of another health care provider or health plan as long as they have or had a relationship with you; the information disclosed pertains to that relationship; and the information is used for one of the following health care operations: quality assessment and improvement; case management and care coordination.

d. Personal Representatives: We may disclose your PHI to a personal representative who has authority under applicable law to make health care decisions on your behalf.

We May Make The Following Uses and Disclosures Without Your Authorization

  • When Required By Law:  We will use and disclose your PHI when we are required to do so by federal, state, or local law.
  • To Avert a Serious Threat to Health or Safety:  We may use and disclose your PHI to prevent a serious threat to your health and safety or the health and safety of others. 
  • For Specific Government Functions: We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law, as well as to others so they may provide protection to the President and other authorized persons or foreign heads of state. If you are a member of the armed forces, we may release your information as required to your military command authorities.
  • For Legal Proceedings:  We may disclose your PHI in response to a subpoena, discovery request, or other lawful process by someone involved in a dispute, but only after efforts have been made to tell you about the request or to obtain an order protecting the PHI requested.
  • For Law Enforcement: We may use or disclose your PHI for law enforcement purposes, such as legal processes, limited information requests for identification and location purposes, information pertaining to victims of a crime, suspicion that death has occurred as a result of criminal conduct, a crime occurring on our premises, and certain medical emergencies (not on the premises).
  • For Health Oversight: We may disclose PHI about you to a state or federal health oversight agency that is authorized by law to oversee our operations. These activities are necessary for the government to monitor our health care system, government programs, and compliance with civil rights laws.
  • To Coroners, Medical Examiners, and Funeral Directors:  We may disclose your PHI to a coroner or medical examiner.  This may be necessary, for example, to identify a deceased person or to determine the cause of death.  We also may release PHI to funeral directors as necessary for them to carry out their duties.
  • For Workers’ Compensation: We may disclose your PHI as permitted by workers’ compensation laws and other similar programs. 
  • For Public Health:  We will disclose PHI to public health authorities for public health activities, investigations, or interventions as required by law.  Public health activities generally include:
    • Reporting births and deaths, birth defects, children at risk, and child abuse or neglect;
    • Preventing or controlling disease, injury, or disability;
    • Notifying people of recalls of medical products they may be using;
    • Notifying a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
    • Reporting reactions to medications or problems with products; and
    • Notifying the appropriate government authority if we believe a patient has been the victim of abuse or neglect.
  • Regarding Inmates or Individuals in Custody:  If you are in legal custody, we may disclose your PHI to a correctional institution or law enforcement official.  PHI may be disclosed to provide you health care, to protect your health and safety or the health and safety of others, or for the safety and security of the correctional institution.

Other Uses and Disclosures of Your PHI:

Other uses and disclosures of your PHI not covered by this Notice or the laws that apply to us will be made only with your written authorization.  If you provide us permission to use or disclose your PHI, you may revoke that permission, in writing, at any time.  If you revoke your permission, we will stop any use or disclosure of PHI previously permitted by your written authorization.  We are unable to retract any disclosures we have already made with your permission.  We generally will not sell your PHI, use or disclose your PHI for marketing without your authorization.

Your Rights Regarding Your PHI

a. You have the right to request restrictions on how we use and disclose your PHI for treatment, payment, or health care operations.  We, however, are not required to agree to your request except as indicated below.  If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.   To request a restriction, your request must be in writing to our Privacy Officer and must describe:

  • The information you wish restricted;
  • Whether you are requesting to limit our use, disclosures, or both; and
  • To whom you want the limitation to apply.

You have a right to request, and we are required to agree to, a restriction on the information disclosed to your health plan if you make arrangements to pay for the related services in full.

b. You have the right to request confidential communications from us by alternative means or at an alternative location. We will accommodate reasonable requests. We may ask you for information as to how payment will be handled or to specify an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request. Please notify our Admissions/Registration staff.

c. You have the right to inspect and obtain a paper or electronic copy your PHI that our facilities use to make decisions about you for as long as we maintain the PHI.  There are a few exceptions.  If we deny your request to inspect your PHI, we will give you reasons in writing for the denial and explain any right to have the denial reviewed.  If you want copies of your PHI, a charge for copying may be imposed.   You may direct that the copy be transmitted directly to an entity or person designated by you, provided that any such designation is clear, conspicuous, and specific with complete name and mailing address or other identifying information.

e. You have the right to find out what disclosures we have made about you, to whom, and why.  This applies to disclosures made for reasons other than treatment, payment, or our health care operations.  It also excludes disclosures we made to you or as authorized by you, for a facility directory, to family members or friends involved in your care, for notification purposes, or as required by law.  The right to receive this information is subject to certain exceptions, restrictions, and limitations. 

f. You have the right to a paper copy of this Notice.  You are entitled to receive a paper copy of our Notice even if you have agreed to accept this Notice electronically.  You may ask us to give you a copy of this Notice at any time.  To obtain a paper copy of this Notice, contact our Privacy Officer. 

Changes to This Notice

We reserve the right to change our practices and this Notice and to make the new Notice effective for all PHI we maintain. The current Notice will be posted in our facility and on our website, including the effective date.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer at Clarus Imaging LLC or with the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

Contact Information

For more information about our privacy practices, or for additional copies of this Notice, please contact:

Privacy Officer

Clarus Imaging LLC

639 S Walker Street STE B

Bloomington, IN 47403

info@clarusimaging.com

NONDISCRIMINATION: Clarus Imaging LLC complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.