Kettering Network Radiologists, Inc.

KNRI is the premier radiology practice in Southwestern Ohio, offering board certified, fellowship trained physician expertise partnered with state-of-the-art Hospital Networks and Imaging Facilities. Our radiologists provide the highest quality patient care and referring physician consultations with excellent results delivery.

Privacy Notice

Effective November 1, 2010

How Kettering Network Radiologists, Inc. (KNRI), acquires your Medical Information

We may collect medical information about individuals in the following manners: Your imaging location will provide us with a referring physician’s request for imaging (an order form.) Such scheduling is usually accompanied by patient’s name, date of birth, phone number and pertinent clinical history as well as the type of test requested. KNRI may call another service provider that you have or have had a relationship with and request pertinent medical information necessary for us to complete our evaluation of your tests.

What is “Medical Information?”

Medical information is generally any individually identifiable health information about a patient which is received and maintained by KNRI.

Kettering Network Radiologists, Inc., General Responsibilities regarding Medical Information

KNRI is required by law to maintain the privacy of Medical Information, and to provide individuals with this privacy notice, describing KNRI’s legal duties and privacy practices with respect to Medical Information. KNRI is required to abide by the terms of this privacy notice while it is in effect.

Use and Disclosure of Medical Information Generally

KNRI will not use or disclose Medical Information other than described in this Privacy Notice, unless otherwise required by applicable law. If KNRI receives a request from the healthcare provider that disclosed to KNRI your Medical Information, KNRI may use and disclose that information for the following purposes:

Health Care Operations: KNRI may use or disclose an individuals medical Information to perform various administrative and operational functions, such as providing information back to your physician for your individual health care services, or for the purposes of accreditation, licensing, certification or credentialing.

Payment: KNRI may use or disclose an individuals Medical Information to the health care provider that disclosed the information to KNRI, to KNRI’s contracted medical billing company, to the benefits provider listed by the patient for covered services and to the patient and/or designated patient representatives in order to receive payment for services rendered by KNRI.

Treatment: KNRI may use or disclose your Medical Information for the purpose of providing medical treatment or evaluation to you. For example, we will release your diagnostic imaging reports to your physician(s) and other medical institutions that have a relationship with you for the purpose of medical treatment or further evaluation.

Use and Disclosure of Medical Information without Authorization or Consent

Since KNRI has only an indirect treatment relationship with patients, KNRI may use or disclose Medical Information without the individuals consent or authorization if KNRI is ordered to do so by the health care provider who delivered such information to KNRI, or its authorized representative.

Requesting Restrictions on the use or disclosure of Medical Information

An individual may request that KNRI restrict its use and disclosure of the medical Information to carry out treatment, payment or health care operations; however KNRI is not required to agree to such restrictions. To request such restrictions please contact the medical health care provider that initially provided the information or KNRI’s Privacy officer. The request must be in writing and addressed to the office providing the service.

Requesting Confidential Communication of Medical Information

KNRI must permit individuals to make reasonable requests to receive communications of Medical Information by alternative methods or at alternative locations. KNRI will accommodate these requests if they are reasonable. To make such requests please contact the medical health care provider that initially provided the information or KNRI’s Privacy officer. The request must be in writing and addressed to the office providing the service.

Access by Individuals to Their Medical Information

With certain exceptions, KNRI must permit individuals to have access to their Medical Information kept by KNRI, as well as allow the individual to inspect that information and to obtain a copy of that information. In order to access, inspect or obtain a copy of such information please contact the medical health care provider that initially provided the information or KNRI’s Privacy officer. The request must be in writing and addressed to the office providing the service.

Amending Medical Information

With certain exceptions, KNRI must permit individuals to have their Medical Information amended to correct errors or deficiencies. To request amendment of Medical Information please contact the medical health care provider that initially provided the information or KNRI’s Privacy officer. The request must be in writing and addressed to the office providing the service.

Requesting Accountings of Disclosures

With certain exceptions, an individual may require that KNRI provide an accounting of the disclosures that KNRI has made of that individuals information during the six years before the request. To request such an accounting, please contact the medical health care provider that initially provided the information or KNRI’s Privacy officer. The request must be in writing and addressed to the office providing the service.

Complaints Regarding Improper use or Disclosure of Medical Information

Any individual may make a complaint to KNRI if the individual believes his or her rights have been violated. Individuals wishing to file a complaint should contact the medical health care provider that initially provided the information or KNRI’s Privacy officer. In addition, individuals may complain to the secretary of the United States Department of Health and Human Services. KNRI will not retaliate against any individual for filing such a complaint with KNRI or with the department of Health and Human Services.

Obtaining Additional Copies of this Notice

KNRI will provide individuals with additional paper copies of this notice upon request. Please contact any employee of KNRI and make such a request.

Changes to this Privacy Notice

KNRI reserves the right to change the terms of this Privacy Notice and to make a new or revised Privacy Notice apply to all Medical Information maintained by KNRI. KNRI will provide individuals with the revised notice upon request in person or by mail.

Further Information

For further information regarding KNRI’s treatment of Medical Information please contact the medical health care provider that initially provided the information or KNRI’s Privacy officer.