Patient's Rights Regarding Protected Health Information (PHI)

The records we create and store are the property of The Center for Medical Imaging (CMI). The information in it, however, belongs to you. You have the following rights relating to your Protected Health Information (PHI):

Release of your PHI from another party to CMI - release of a patient's medical record from one medical institution or individual to The Center for Medical Imaging.

Revoke an authorization previously given at your request - This form is used to - revoke or to confirm revocation of an authorization previously given on an individual's Authorization for Release of Protected Health Information to The Center for Medical Imaging.

Authorize release of your PHI from CMI to another party - This form provides a legal document for you to - release of your health information from the Center for Medical Imaging to another organization.

Request amendment to your PHI - If you believe that the health-care information that we may use to make decisions about you is incorrect or incomplete, you may ask us to amend the information.

We may deny your request if the records:

• Are complete and accurate
• Were not created by CMI, and the records' author is available
• Are not maintained by us
• Are otherwise not subject to your access

We will explain our reasons for denial in a written response to you. You have the right to respond in writing to our explanation of denial.

All documents about a requested amendment are retained in your records and are included in any future disclosures that you authorize or that are otherwise allowable by law.

Choose how we contact you

You have the right to request that we communicate with you about health-care matters in a certain way or at a certain location. For example, you can ask us not to call you at home, but rather to communicate only by mail.

Find out what disclosures have been made

You have the right to a listing of the disclosures we made of your health-care information after April 14, 2003, except for the following:

• Disclosures made for the purposes of treatment, payment, or health-care operations
• Disclosures you authorized
• Disclosures to you
• Incidental disclosures
• Disclosures from the facility directory
• Disclosures to family or other persons involved in your care
• Disclosures to correctional institutions and law enforcement in some circumstances
• Disclosures of limited data set information
• Disclosures for national security or intelligence purposes

Health oversight agencies and law enforcement may request that we temporarily suspend your right to a specific disclosure.

Request restrictions on uses/disclosures

This form lets you request a restriction or limitation on the health-care information we use or disclose about you for treatment or for payment of health-care operations. Additionally, you have the right to request our disclosure of your health information to only certain individuals involved in your care or the payment for your care, such as family members or friends.

We are not required to agree to your request for a restriction. If we do agree, we will comply with your request unless the information is needed to provide emergency treatment for you.

Right to a paper copy of this notice

You have a right to receive a paper copy of this notice and/or an electronic copy by e-mail upon request.

Changes to this notice

We reserve the right to change our health-information privacy practices and the terms of this notice and to make the new provisions effective for all health-care information we maintain, including health-care information created or received prior to the effective date of any such revised notice. Should our privacy practices change, we will post the revised notice at prominent locations within our facilities and make the revised notice available to you at your request.

Complaints

You may complain to us or to the Secretary of the U.S. Department of Health and Human Services if you believe your privacy rights have been violated. You may file a complaint with us by notifying our privacy officer. We will not retaliate against you for filing a complaint.

The Center for Medical Imaging
1885 NW 185th Avenue
Suite 100
Aloha, OR 97006
Phone: (503) 216-8400
Fax: (503) 216-8410

Office for Civil Rights
Secretary of the U.S. Department of Health and Human Services
2201 Sixth Avenue - Suite 900
Seattle, WA 98121-1831
Voice: 206-615-2287
TDD: 206-615-2296
Fax: 206-615-2297
E-mail: OCRComplaint@hhs.gov