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Notice of Privacy Practices
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review this document carefully.
iCardia uses and shares your medical information to provide diagnostic services, to obtain payment for services, for administrative purposes, and to evaluate the quality of care that you receive. We are committed to protecting your medical information.
We reserve the right to change our information practices and to make the new provisions effective for all health information we maintain. Should our privacy practices change, we will post the changes on our website. A copy of the revised notice will be available after the effective date of the changes upon request.
We will not use or disclose your health information without your authorization, except as described in this notice.
If you have questions and would like additional information, you may contact iCardia’s Privacy Officer at 935 Lakeview Parkway, Suite 198, Vernon Hills, IL 60061 or by calling 866-736-3324.
How We Will Use or Disclose Your Health Information.
Treatment. We will use and disclose your personal health information in providing cardiac diagnostic services. We may disclose your personal health information to personnel who may be involved in your care, such as physicians and clinicians. For example, we will disclose to your physician the results obtained during your monitoring period.
Payment. We may use and disclose your personal health information so that we can bill and receive payment for the service you receive. For billing and payment purposes, we may disclose your personal health information to your representative, an insurance or managed care company, Medicare, Medicaid or another third-party payer. For example, we may contact Medicare or your health plan to confirm your coverage or to request prior approval for a proposed treatment or service.
Health Care Operations. We may use and disclose your personal health information for our regular health operations. These uses and disclosures are necessary to manage our operations and to monitor our quality of care. For example, we may use personal health information to evaluate our services, including the performance of our staff.
Business Associates. People and entities outside our company provide some services for us. Examples of these "business associates" include our accountants, consultants and attorneys. We may disclose your health information to our business associates so that they can perform the job we've asked them to do. We require the business associates to safeguard your information so that it is protected.
Notification. We may use or disclose information to notify or assist in notifying a family member, personal representative or another person responsible for your care, of your location and general condition. If we are unable to reach your family member or personal representative, then we may leave a message for him or her at the phone number that he or she has provided us, e.g. on an answering machine.
Communication with Family. We may disclose to a family member, other relative, close personal friend or any other person involved in your health care, health information relevant to that person's involvement in your care or payment related to your care.
Research. We may disclose information to researchers when certain conditions have been met.
Coroners, Funeral Directors, and Medical Examiners. We may disclose health information to funeral directors, medical examiners and coroners to carry out these duties consistent with applicable law.
Food and Drug Administration (FDA).We may disclose to the FDA, or to a person or entity subject to the jurisdiction of the FDA, health information relative to adverse events, product defects or problems, biologic product deviations, etc. to conduct post marketing surveillance or to enable product recalls, repairs or replacement as required.
Workers' Compensation. We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers' compensation or other similar programs established by law.
Public Health. As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury or disability.
Correctional Institution. Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health and safety of other individuals.
Law Enforcement. We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.
Reports. Federal law allows a member of our work force or a business associate to release your health information to an appropriate health oversight agency, public health authority or attorney, if the work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.
Your Health Information Rights
You have the following rights regarding your personal health information:
Right to Request Restrictions. You have the right to request restrictions on our use or disclosure of your personal health information for treatment, payment or health care operations. You also have the right to restrict the personal health information we disclose about you to a family member, friend or other person who is involved in your care or the payment for your care.
We are not required to agree to your requested restriction If we do agree to accept your requested restriction, we will comply with your request except as needed to provide you emergency treatment.
Right to Access Personal Health Information. You have the right to inspect and obtain a copy of your medical information. These records will be provided to you in the time frames established by law. We may charge a reasonable fee for our costs in copying and mailing your requested information.
We may deny your request to inspect or receive copies in certain limited circumstances. If you are denied access to personal health information, in some cases you will have a right to request review of the denial.
Right to Amend Your Health Information. If you believe that any health information in your record is incorrect or if you believe that important information is missing, you may request that we correct the existing information or add the missing information. Such requests must be made in writing, and must provide a reason to support the amendment.
We may deny your request for amendment in certain circumstances. If we deny your request for amendment, we will give you a written denial including the reasons for the denial and the right to submit a written statement disagreeing with the denial.
Right to an Accounting of Disclosures. You have the right to request an "accounting" of our disclosures of your personal health information. This is a listing of certain disclosures of your personal health information made by us or by others on our behalf, but does not include disclosures for treatment, payment and health care operations or certain other exceptions.
To request an accounting of disclosures, you must submit a request in writing, stating a time period beginning after April 13, 2003 that is within six years from the date of your request. An accounting will include, if requested: the disclosure date; the name of the person or entity that received the information and address, if known; a brief description of the information disclosed; a brief statement of the purpose of the disclosure or a copy of the authorization request; or certain summary information concerning multiple similar disclosures. The first accounting provided within a 12-month period will be free; for further requests, we may charge you our costs.
Right to a Paper Copy of This Notice. You have the right to obtain a paper copy of this notice, even if you have agreed to receive this notice electronically. You may request of copy of this notice at any time.
Right to Request Confidential Communications. You have the right to request that we communicate with you concerning personal health matters in a certain manner or at a certain location. For example, you can request that we contact you only at a certain phone number. We will accommodate your reasonable requests.
Right to Revoke Authorization. You may revoke an authorization to use or disclose health information, except to the extent that action has already been taken. This request must be made in writing.
For More Information or to Report a Problem
If you believe that your privacy rights have been violated, you may file a written complaint directly with the U.S. Department of Health and Human Services or by writing iCardia’s Privacy Officer at 935 Lakeview Parkway, Suite 198, Vernon Hills, IL 60061. We will not retaliate against you in any way if you file a complaint.
If you have any questions about this Notice or would like further information concerning your privacy rights, please contact iCardia’s Privacy Officer at 935 Lakeview Parkway, Suite 198, Vernon Hills, IL 60061 or by calling 866-736-3324.
Effective April 14, 2003
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