Oracle Imaging Services, Inc.
Neil Chafetz, M.D.,
Medical Director

1360 West 6th Street
West Building, Suite 100
San Pedro, CA 90732
(310) 833-2233
Fax: (310) 833-2213
Toll Free: (888) 535-3300

Copyright © 2006
Oracle Imaging Services, Inc.
All rights reserved.

Oracle Imaging Services, Inc.
Neil Chafetz, M.D., Medical Director

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 it carefully. Pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have a right to adequate notice of the uses and disclosures of your protected health information ("PHI") (i.e., information that discloses your identity or leads to disclosure of your Identity) that may be made by Oracle Imaging Services and Neil Chafetz, MD, Inc. ("OIS/NIC"). You are also entitled to notice of your rights and the duties of OIS/NIC with respect to your personal health information. We respect your right to privacy. We create paper and electronic records about your health and the care we provide. Your personal health information is confidential and this notice is intended to help you understand how OIS/NIC uses and discloses your personal health information and what rights you have with respect to your medical information.

REQUIRED BY LAW: OIS/NIC has the following duties with respect to your personal health information: I) We are required by law to maintain the privacy of your personal health information. 2) We must provide you with notice of our legal duties and privacy practices with respect to personal health information. 3) We must abide by the terms of the notice of privacy practices that is currently in effect.

HOW WE MAY USE & DISCLOSE YOUR INFORMATION: The following describes how OIS/NIC is permitted by law to share your personal health information with others in order to provide you with medical care. This notice does not describe every use or disclosures OIS/NIC makes. It is intended as a general overview.

Medical Treatment: We may need to share information about you in order to provide medical care to you. For example, we may share information with other physicians, nurses or healthcare professional entering information into your medical records relating to your medical care and treatment. We may share information about you including x-rays, prescriptions and requests for lab work.

Payment: We may need to disclose information about this treatment, procedures or care our practice provided to you in order to bill and receive payment for services we provided. We may share this information with an insurance company or any third party responsible for payment. We may also need to disclose personal health information about you with your health plan and/or referring physician in order to obtain prior authorization for treatment, to determine whether payment for the treatment is covered by your plan or to facilitate payment. Healthcare Operations. In order to help us run OIS/NIC more efficiently and provide better patient care, we may use and disclose your personal health information to business associates who need to use or disclose your information to provide a service for our medical practice, such as our billing company or software vendors who provide assistance with data management on our behalf.

Required by Law: We will disclose medical information related to you if required to do so by state, federal or local law. Public Health Activities / Risks. Your medical information may be disclosed to a public health authority that is authorized by law to collect or receive such information for public health activities. Certain disclosures may be made for public health activities in the following circumstances: I) to prevent or control disease, injury or disability; 2) to report births or deaths; 3) to report child abuse or neglect, 4) to report reactions to medications or product defects; 5) to notify individuals of product recalls; 6) to notify a person who may have been exposed to a communicable disease or at risk of contracting or spreading a disease or condition; 7) if OIS/NIC reasonably believes a person is the victim of abuse, neglect, or domestic violence, we may disclose personal health information to the appropriate authority. We will only make this disclosure if you agree to the disclosure or we are required or authorized to do so by law without your permission.

Appointment Reminders or Treatment Alternatives: OIS/NIC may use and disclose medical information about you to provide you with reminders that you are due for care or you have an upcoming appointment. We may also wish to provide you with Information on treatment alternatives or other health related benefits that may be of interest to you. We may contact you by phone, fax or e-mail. We will make every effort to protect your privacy when leaving a message for you and try to reveal as little confidential information as possible (e.g., when leaving a message on your answering machine that may be heard by others).

Research: Under certain circumstances, OIS/NIC may use or disclose your personal health information for research purposes. OIS/NIC may also disclose information about you in preparing to conduct research (e.g., to help them find patients who may be qualified to participate in a particular study), but your information will not leave our practice. We will make all attempts to make your information non-identifiable, but we may not always be able to guarantee this. Worker's Compensation. We may release medical information about you for work-related illness or injury as it relates to workers compensation or other related programs.

Health Oversight Activities: Your personal health information may be disclosed to federal, state or local authorities as part of an investigation or government activity authorized by law. This may include audits, civil, administrative or criminal investigations, inspections, licensure or disciplinary actions or other activities necessary for the oversight of the health care-system, government benefit programs and compliance with government regulatory programs or civil rights laws.

Law Enforcement: We may disclose your personal health information to law enforcement individuals if we are required to do so by law. We may also disclose medical information about you in compliance with a court order, warrant or subpoena or summons issued by the court We will make our best effort to contact you about these types of requests so that you can obtain an order restricting or prohibiting disclosures of the information requested We may also use such information to defend ourselves in actions or threatened actions that may be brought against our practice.

Abuse or Neglect: We may disclose your health information to appropriate authorities is we reasonably believe that you are a possible victim of abuse, neglect or domestic violence or the possible victim of other crimes. We may disclose your health information to the extent necessary to avert a serious threat to your safety or the health or safety of others.

National Security: We may disclose to military authorities the health information if Armed Forces personnel under certain circumstances. We may disclose to authorized federal officials health information required for lawful intelligence, counterintelligence, and other national security activities. We may disclose to correctional institution or law enforcement officials having lawful custody of protected health information of inmate or patient under certain circumstances.

To Coroners, Funeral Directors, and for Organ Donation: Our practice may disclose protected health information to a coroner or medical examiner for the purpose of (I) identification, (2) determination of cause of death, or (3) performance of the coroner or medical examiner's other duties as authorized by law. Protected health information may also be used and disclosed for the purpose of cadaver organ, eye or tissue donation.

Other than the circumstances described above: OIS/NIC will not disclose your health information unless you provide written authorization. You may revoke your authorization in writing at any time except to the extent that OIS/NIC has take action in reliance upon the authorization.

Others Involved in your Healthcare. Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person's involvement in your health care, If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, we may use or disclose your protected health information to any authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care. If you are incapacitated or in an emergency situation, our practice may exercise its professional judgment to determine if the disclosure is in your best interests.

YOUR RIGHTS: You have certain rights regarding your protected health information under the HIPAA privacy regulations.

RIGHTS TO RECEIVE PERSONAL HEALTH INFORMATION CONFIDENTIALLY: You have the right to receive confidential communications of your personal health information by alternate means or at alternated locations. For example, if you would like us only to communicate with you at home, and never at your workplace, you may request this of OIS/NIC. You must make this request in writing but do not need to disclose the reason for your request We will attempt to accommodate all reasonable requests. Please be specific as to how or where you wish us to communicate with you.

RIGHT TO INSPECT AND COPY: You have the right to inspect and copy your medical records. This includes medical and billing records. Records related to your care may also be disclosed to an authorized person such as a parent or guardian upon proof of a legitimate legal relationship. You must submit your request in writing to inspect and copy your records. If you would like us to copy your records, we may charge you fees for the cost of copying records, mailings or other nominal costs associated with your request.

RIGHT TO AMEND: During the time that OIS/NIC holds your protected health information, you may request an amendment of your information in a designated record set OIS/NIC may deny your request in some instances. However, should our practice deny your request for amendment, you have the right to file a statement of disagreement with the practice. In turn, OIS/NIC may develop a rebuttal to your statement If it does so, OIS/NIC will provide you with a copy of the rebuttal. Requests for amendment must be submitted in writing to the practice's Privacy Officer. Your written request must supply a reason to support the requested amendments.

RIGHT TO AN ACCOUNTING OF USES AND DISCLOSURES: You have the right to receive an accounting of the disclosures of your personal health information that our practice makes for purposes other than treatment, payment or healthcare operations. All requests must be submitted in writing. All requests must be for disclosures dated AFTER April 14, 2003. All requests must state a time not longer than six (6) years back. You must state whether you would like the accounting electronic or paper form. One request in a twelve-month period will be provided to you at no charge. We may charge you a fee for all additional requests within a twelve-month period. We will notify you as to the cost. You have the right to obtain a paper copy of this Notice. Our practice will provide a separate paper copy of this Notice upon request even if you have already been given a copy of it or have agreed to review it electronically.

THE PRACTICE'S DUTIES: Our practice is required to ensure the privacy of your health information and to provide you with this Notice of your rights and the practice's duties and procedures regarding your privacy. The practice must abide by the terms of this Notice, and they may be amended periodically. The practice reserves the right to change the terms of this Notice and to make the new Notice provisions effective for all protected health information that OIS/NIC collects and maintains. If the practice alters its Notice, OIS/NIC will provide a copy of the revised Notice through regular mail or in-person contact.

COMPLAINTS: If you believe that your privacy rights have been violated, you have the right to relate complaints to the practice and to the Secretary of the Department of Health and Human Services. You may provide complaints to the practice verbally or in writing. Such complaints should be directed to the practice's Privacy Office. OIS/NIC encourages you to relate any concerns you may have regarding the privacy of your information and you will not be retaliated against in any way for filing a complaint.

CONTACT PERSON: The practice's contact person regarding the practice's duties and your rights under the HIPAA privacy regulations is the Privacy Officer. The Privacy Officer can provide information regarding issues related to this Notice by request. Complaints to the practice should be directed to the Privacy Officer at the following address: Oracle Imaging Services, Inc., 1360 W. 6th St., West Building, Suite 100, San Pedro, CA 90732 ATTN: Privacy Officer (310) 833-2233.