Notice of Privacy Practice
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.
Protecting Your Privacy
Tellica Imaging (Tellica) understands the importance and sensitivity of your health information. We protect the privacy of your health information because it is the right thing to do. We also follow federal and state laws that govern your health information. We use your health information (and allow others to have it) only as permitted by federal and state laws. These laws give you certain rights regarding your health information.
Your Health Information Rights
- Inspect and obtain a copy of your medical or billing records (including an electronic copy if we maintain the records electronically), as allowed by law.
- Request and receive a paper copy of our current Notice of Privacy Practices.
- Require us to communicate with you using an alternate address or phone number.
- Require that we not send information about a healthcare service or related item to your health plan if you or someone else pays in full for that service or item and if you notify us in advance that you — and not your health plan — are going to pay for this service or item (so we don’t automatically bill your health plan).
- Request in writing that restrictions be placed on how your health information is used or shared for treatment or other purposes.
- Request an accounting of when your identifiable health information is shared outside of Tellica for a purpose other than treatment or payment.
- Receive notice if we or our business associates have breached the confidentiality of your health information.
- Report a privacy concern and be assured that we will investigate your concern thoroughly, support you appropriately, and not retaliate against you in any way (you may report any privacy concerns to our Compliance Office at 1-800-442-4845 or [email protected], or to the Office for Civil Rights, U.S. Department of Health and Human Services).
- Request in writing that your health information be amended if you think there is an error.
How Your Health Information Is Used
Common Uses of Health Information. When we care for you, we will gather your health information. The law allows us to use or share this health information to:
- Understand your health condition and to treat you when you are sick. For example, we may look at your medical images or share medical images we take of you with your treating doctor, who may be outside of Tellica, or we may receive your medical history information from other healthcare providers to help you avoid interactions with contrast administration.
- Bill for your healthcare services and receive payment for our services; for example, we share information with your health insurance plan so it will pay for your medical imaging services.
- Determine if a patient is eligible for Medicaid or the Children’s Health Insurance Program by submitting personally identifiable information to these state databases.
- Improve our care. For example, we may contact you to understand what you thought of our care and to learn how to enhance our services to you.
- Improve our services to you by allowing companies with whom we contract, called “business associates,” to perform certain specialized work for us. The law requires these business associates to protect your health information and obey the same privacy laws that we do.
- Perform limited health-data research, where the researcher keeps patient-identifiable information confidential. Tellica reviews every research request to make sure privacy is appropriately protected before sharing health information. Law enforcement, but only as authorized by law.
- Investigate a crime against Tellica or any of its patients.
- The Department of Health, to report communicable diseases, traumatic injuries, or birth defects, or for vital statistics, such as a baby’s birth.
- A funeral director or an organ-donation agency, when a patient dies, or with a medical examiner when appropriate to investigate a death.
Required Uses of Health Information. The law sometimes requires us to share information for specific purposes, with:
- The appropriate governmental agency, if an injury or unexpected death occurs at a Tellica facility.
- State authorities, to report child or elderly abuse.
- Law enforcement, for certain types of crime-related injuries, such as gunshot wounds.
- Governmental inspectors, who, for example, make sure our facilities are safe.
- Military command authorities or the Department of Veterans Affairs, when we treat patients who are in the military or are veterans.
- A correctional institution, if a patient is an inmate.
- The Secret Service or NSA, to protect the country or the President.
- A medical device’s manufacturer, as required by the FDA.
- Court officers, as required by law, in response to a court order or a valid subpoena.
- Governmental authorities, to prevent serious threats to the public’s health or safety.
- Governmental agencies and other affected parties, to report a breach of health-information privacy.
- An employer, but only if the employer contracts with us to help the employer meet OSHA requirements about workplace and employee safety.
- A worker’s compensation program, if a person is injured at work and claims benefits under that program.
Uses According to Your Requests. Your preferences matter. If you let us know how you want us to disclose your information in the following situations, we will follow your directions. You decide:
- If you want us to share any health or payment information related to your care with your family members or friends. Please let our employees know what you want us to share. If you can’t tell us what health or payment information you want us to share, we may use our professional judgment to decide what to share with your family or friends for them to be able to help you.
- Who we should contact in an emergency? If you aren’t able to tell us who to contact, we may ask the public authorities to help. For example, we may ask the police to help find your family, or in a disaster, we may help the Red Cross reconnect you with your family.
- If you want to indicate your religious preference when you are registered at Tellica you may do so.
Uses of Health Information with Your Authorization. Any sharing of your health information, other than as explained above, requires your written authorization. For example, we will not use your health information unless you authorize us in writing to:
- Send copies of your health information to a life insurance company.
- Send information to encourage you to buy a non-Tellica product if we are paid to send that information or make the communication.
- Sell your identifiable health information.
If you authorize us to share your health information but then change your mind, please notify the appropriate Tellica facility in writing that you revoke the authorization. We will honor your revocation, but we will not be able to get back the health information that you authorized us to send before your revocation.
Special Legal Protections for Certain Health Information. Tellica complies with federal and state laws that require extra protection of special records when applicable. These records may include records of treatment in an addiction-treatment program, genetic information, or psychotherapy notes from a treating psychotherapist.
If You Still Have Questions
Our staff is trained to help you with any questions you may have about the privacy of your health information. They can also address any privacy concerns you may have about your health information and help you fill out any forms that are needed to exercise your privacy rights. If you are at one of our Tellica facilities, please ask one of our staff members to help you contact the facility manager, or call 1-800-442-4845 to reach our main Compliance Office.
This privacy notice became effective December 2021. We may change this privacy notice at any time. You can see our current privacy notice that affects all PHI maintained by Tellica on our website, at www.tellicaimaging.com, or posted in our clinics and offices. You can also obtain a copy of this notice from any of our staff by asking for a copy, by visiting our website, or by calling our Compliance Office at 1-800-442-4845.
This notice describes the privacy practices of Tellica employees and volunteers working in our facilities, and service departments and all are required to abide by the terms of this notice. This notice also describes the privacy practices of associated healthcare providers — who are not Tellica employees — while treating you in our facilities, unless they provide you with a notice of their own privacy practices. For more information about the specific privacy practices of associated providers, please contact them directly.