NOTICE OF PRIVACY PRACTICES
Effective Date: January 1, 2025

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

UMI Community Imaging Clinic (“the Clinic”) is committed to protecting the privacy of your protected health information (“PHI”). PHI is information that identifies you and relates to your past, present, or future health, healthcare, or payment for healthcare.

This Notice explains how we may use and disclose your PHI and describes your rights and our legal duties regarding your PHI.

OUR DUTIES

We are required by law to:

Maintain the privacy and security of your PHI
Provide you with this Notice of our legal duties and privacy practices
Follow the terms of this Notice currently in effect
Inform you if a breach occurs that may have compromised the privacy or security of your PHI
Provide you with a paper copy of this Notice upon request
Notify you of changes to this Notice and make the revised Notice available

We reserve the right to change our privacy practices and the terms of this Notice as permitted by law. Any changes will apply to all PHI we maintain.

HOW WE MAY USE AND DISCLOSE YOUR PHI

1. Uses and Disclosures That Do NOT Require Your Authorization

a. Treatment

We may use or disclose your PHI to healthcare providers involved in your care.
Example: Sending ultrasound images to your referring physician or contracted teleradiology provider for interpretation.

b. Payment

We may use or disclose PHI to obtain payment for services if applicable.
Note: The Clinic provides free and donation-based services; however, some administrative uses of PHI may relate to billing (e.g., missed appointment fees).

c. Healthcare Operations

We may use PHI for operational purposes such as:

Quality improvement
Training and supervision of students
Accreditation, audits, and administrative activities

d. Individuals Involved in Your Care

We may disclose PHI to a family member or person involved in your care when appropriate, unless you object.

e. Public Health & Safety

We may release PHI as permitted or required for:

Reporting communicable diseases
Preventing serious threats to health or safety
Reporting abuse or neglect

f. Law Enforcement & Legal Requirements

We may disclose PHI:

In response to a court order or subpoena
To comply with federal or state law
For health oversight activities

g. Specialized Government Functions

We may disclose PHI to authorized officials for national security, intelligence, or military purposes as required by law.

h. Coroners, Medical Examiners

We may disclose PHI when required to identify a deceased person or determine cause of death.

2. Uses and Disclosures That Require Your Authorization

We will obtain your written authorization before using or disclosing your PHI for purposes such as:

Marketing
Sale of PHI
Most uses of psychotherapy notes

You may revoke an authorization at any time unless we have already relied on it.

YOUR RIGHTS

1. Right to Access

You may inspect or obtain a copy of your PHI.
Requests must be made in writing. A reasonable fee may apply.

2. Right to Amend

You may request an amendment to your PHI if you believe it is incorrect or incomplete.
We may deny the request in certain circumstances.

3. Right to an Accounting of Disclosures

You may request a list of certain disclosures we have made of your PHI.
One request per 12-month period is free; additional requests may be subject to a fee.

4. Right to Request Restrictions

You may request restrictions on how we use or disclose your PHI.
We are not required to agree, except when the restriction involves out-of-pocket payment in full to a third-party provider.

5. Right to Confidential Communications

You may request that we contact you in a specific way (e.g., alternate phone number or address).
Requests must be made in writing.

6. Right to a Paper Copy of This Notice

You may request a paper copy at any time, even if you have agreed to receive communications electronically.

7. Right to File a Complaint

If you believe your privacy rights have been violated, you may file a complaint with:

UMI COMMUNITY IMAGING CLINIC Privacy Officer
clinical_director@umiclinic.org

or with:

Office for Civil Rights, U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Toll-Free: 1-877-696-6775

We will not retaliate against you for filing a complaint.

CONTACT INFORMATION

For questions, requests, or more information about your rights, contact:

UMI Community Imaging Clinic Privacy Officer
Email: clinical_director@umiclinic.org
Phone: 916-970-0577