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 NOTICE CAREFULLY.

To our patients: We are required by law to maintain the privacy of your medical information and to provide you with notice of our legal duties and privacy practices. We are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change those terms and any changes made will be effective for all medical information we maintain, in accordance with federal law. A copy of a revised notice will be available from our web site at www.rivrad.com or at any of our imaging centers or from our Privacy Coordinator. You may also address questions regarding our privacy practices, your privacy rights, or requests for additional information regarding your privacy.

Who will Follow These Practices? This Notice applies to the information privacy practices followed by our employees, staff and other office personnel.

Permitted Uses and Disclosures
We may use and disclose your medical information in the ordinary course of our business. We have described some of these uses and disclosures in the following paragraphs:

o Treatment: We will provide your doctor or other healthcare providers with the results of the diagnostic imaging exams we perform. We may contact you before the exam to remind you of your appointment or to talk with you about preparing for the exam. We normally will call you at the contact number that you provide us. If you are not available or your voice mail answers, we will leave a brief message reminding you of the place and the time of your appointment. If applicable, we will ask you to call us regarding your exam preparations.

o Payment: We will bill your insurance company, you directly, or another person that may be responsible for payment of your account. We may need to contact your health plan to see if they will pay for the exams your doctor has ordered. Throughout this process, we may have to release details of your exam and medical condition, if your health plan or other payor requires this information to make payment.

o Health Care Operations: We often have to use specific patient information to conduct our normal business operations. For example, we routinely review past exams performed to maintain quality assurance goals. One type of review we may conduct includes selecting images for review by another radiologist. We may select your billing information for review by our internal compliance team or by external auditors. In addition, we may use specific patient information to demonstrate our skills to an accreditation body. Accreditation is important to our patients and us because the process causes us to demonstrate some degree of proficiency in conducting examinations and maintaining the quality of our equipment.

Disclosures Without Authorization
We may use and disclose medical information about you, without your specific authorization, as follows:

o Disclosures Required by Law: We may be required by federal, state, or local law to disclose your medical information.

o Public Health Activities: We may disclose your medical information to a public agency, such as the Food and Drug
Administration (FDA), or any other public health agency, at their request.

o Victims of Abuse, Neglect or Domestic Violence: We may be required to disclose your medical information, if we feel that you have been abused or neglected.

o Health Oversight Activities: We may be required to disclose your medical information to Medicare or a related agency if they select your case for a medical review.

o Judicial and Administrative Proceedings: We may have to disclose your medical information, if we receive a subpoena from a judge or administrative tribunal.

o Law Enforcement: We may have to disclose your medical information in conjunction with a criminal investigation by a federal or state law enforcement agency.

o Serious Threats to Health or Safety: We may be required to disclose your medical information, if in our opinion, doing so will help avert a serious threat to the public.

o Military Personnel: We may disclose your medical information to the appropriate command authorities.

o Workers Compensation: We may disclose your medical information to comply with laws regarding Workers’ Compensation.

o Family and Friends: We may disclose information about you to your family members or friends if we obtain your written agreement. In situations where you are not capable of giving consent (because you are not present or due to your incapacity or medical emergency), we may also disclose health information to your family or friends when they provide us verification of your social security number. We may also use our professional judgment and experience to make reasonable inferences that it is in your best interest to allow another person to act on your behalf to pick up your records (i.e. reports, films).

Your rights regarding your health information
You have certain rights with respect to your medical information.

o Requesting Restrictions: You may ask us to limit our use or disclosure of your protected health information. We are not required to agree to your request, but if we agree to it, we will abide by your request, except as required by law, in emergencies or when the information is necessary to treat you. Your request must: 1) be in writing 2) describe the information that you want restricted, 3) state if the restriction is to limit our use or disclosures, and 4) state to whom the restriction applies. You may revoke your restriction at any time by contacting our Privacy Coordinator as noted on the last page. We may ask to reschedule your exam while we consider your request.

o Confidential Communication: You may ask that we communicate with you in a particular way or at a certain location, to maintain your confidentiality. Your request must be in writing, tell us how you intend to satisfy your financial responsibility, and specify an alternate way that we can contact you confidentially. You do not have to give a reason for your request. In certain circumstances, we may require payment in full at the time you have your exam. You may revoke your request at any time by contacting our Privacy Coordinator as noted on the first page. We may ask to reschedule your exam while we consider your request.

o Inspect and Copy: You may request access to inspect and copy your medical information maintained in our records, including medical and billing records. Your request must be in writing. We will act on your request for inspections within 5 working days after we receive the request. We will act on your request for copies within 15 days after we receive the request. If we must deny your request, we will send you a written denial. If this happens, you may request a review of the denial. We may charge you a fee for providing copies. If that is the case, we will advise you of the cost of those copies, at the time that we arrange for you to pick them up or have them delivered to you.

We will compute these costs using state guidelines. You may also have to pay for the cost of postage or shipping, depending on how you ask that we get these copies to you.

o Amendment: You may ask us to amend your health information if you believe that it is incorrect or incomplete. Your request must be in writing and must include a reason to support the amendment. Your request may be denied if we believe that the information is complete and accurate, if the information is not part of the medical information that you would be permitted to inspect or copy, or if we did not create the information. You also have the option of submitting your own amendment. This amendment must be in writing and cannot be longer than 250 words per item that you are trying to correct. We will then include this amendment when we release the medical records in question.

o Accounting of Disclosures: You may request a list of non-routine disclosures that we have made of your medical information over the previous six (6) years. This does not include disclosures we make for your treatment, to seek payment for ourselves, or for our normal business operations as noted in the section on permitted uses and disclosures, or for those you authorize in writing. You may not request an accounting for dates of service prior to April 14, 2003. Your first request within a 12-month period is free, but we may charge for additional lists within the same 12-month period.

o File a Complaint: If you believe that we have violated your privacy rights, you may file a complaint directly with our Privacy Coordinator using the contact information at the bottom of this page or with the Department of Health and Human Services. You will not be penalized for complaining.

Patient Authorization for Certain Disclosures:
We will request your written authorization for uses and disclosures of your medical information that we did not identify in this notice or for those not otherwise permitted by law. These disclosures include your requests or provide exam results to your attorney, for exams related to life insurance or disability insurance applications, or for pre-employment physicals, among others. You may revoke your authorization in writing at any time by contacting our Privacy Coordinator using the contact information on this page. You may demand a copy of your authorization at any time.

If you have any questions regarding this notice or our health information privacy policies, please contact the Privacy Coordinator at:

Privacy Coordinator
Computerized Diagnostic Imaging Centers Riverside Radiology Medical Group, Inc.
2020 Iowa Avenue, Suite 103 Riverside, CA 92507
(951)781-2270