This Notice describes certain privacy practices of Radisphere and its affiliated entities
(collectively “Radisphere”). Affiliates include, but are not limited to, Radisphere National
Radiology Group Inc., F&S Radiology, P.C., FSH Radiology, Inc., Franklin & Seidelmann, Inc. and
Franklin & Seidelmann Medical Corp. Radisphere uses health information about you for
treatment, to obtain payment for treatment, for administrative purposes, and to evaluate the
quality of care that you receive. We are committed to ensuring the privacy and security of
patient health information, and will ensure any use or disclosure of protected health
information is in compliance with all applicable federal, state and/or local laws and regulations.
Your health information is contained in a medical record that is the physical property of
Radisphere May Use or Disclose Your Health Information, Without Consent, in the Following
For Treatment: We may use your health information to provide you with medical treatment or
services. We may disclose medical information about you to doctors, nurses, technicians or
other personnel who are involved in your care and treatment at our facility. We may also
disclose medical information about you to people outside our facility who may be involved in
your medical care, such as other physicians, family members you designate, or other health care
related entities with whom you seek treatment.
For Payment: We may use and disclose your health information to others for purposes of
receiving payment for treatment and services your receive. A bill may be sent to you or a thirdparty
payer, such as an insurance company or health plan. The information on the bill may
contain information that identifies you, your diagnosis, and treatment or supplies used in the
course of treatment.
For Healthcare Operations: We may use and disclose your health information for operational
purposes. Your health information may be disclosed to members of our the medical staff, risk or
quality improvement personnel, and others to evaluate the performance of our staff; assess the
quality of care and outcomes in your case or similar cases; learn how to improve our facilities
and services; and determine how to continually improve the quality and effectiveness of the
healthcare we provide.
Appointments: We may use and disclose your health information to contact you as a reminder
that you have an appointment at our facility.
Required by Law: We may use and disclose information about you as required by law.
Radisphere may disclose information for judicial and administrative proceedings pursuant to
legal authority; to report information related to victims of abuse, neglect, or domestic violence;
and to assist law enforcement officials in their law enforcement duties.
Public Health: Your health information may be used or disclosed for public health activities such
as assisting public health authorities or other legal authorities to prevent or control disease,
injury, or disability, or for other health oversight activities.
Decedents: Health information may be disclosed to funeral directors, coroners, or medical
examiners to enable them to carry out their lawful duties.
Research: We may use or disclose your health information for research purposes. Research
projects are subject to a special approval process. This process evaluates a proposed research
project and its use of medical information, trying to balance the research needs with patients’
need for privacy of their medical information.
Health and Safety: Your health information may be disclosed to avert a serious threat to the
health and safety of you and or any other person pursuant to applicable law.
Family and Friends: If you are unavailable to communicate, such as in a medical emergency or
disaster relief, we may disclose your personal and health information to a family member, friend
or other person to the extent necessary to help with your health care or with payment for your
Law Enforcement: We may disclose limited information to law enforcement officials concerning
the personal and health information of a suspect, fugitive, material witness, crime victim or
missing person. We may disclose the personal and health information of an inmate or other
person in lawful custody to a law enforcement official or correctional institution.
Military and National Security: We may disclose to military authorities the personal and health
information of Armed Forces personnel under certain circumstances. We may disclose to
authorized federal officials personal and health information required for lawful intelligence,
counterintelligence, and other national security activities.
Workers Compensation: Your health information may be used or disclosed in order to comply
with laws and regulations related to Workers Compensation or similar programs which provide
benefits for work-related injuries or illness.
Marketing: We may use or disclose protected health information to make a face-to-face
marketing communication to an individual and to provide a promotional gift of nominal value to
Affiliated Covered Entity: We are part of an affiliated covered entity with other entities that are
owned, operated and/or managed by Radisphere. The affiliated covered entity treats itself as a
single entity for purposes of using and disclosing health information about you.
Other Uses of Your Health Information:
Other uses and disclosures of your medical information not covered by this Notice or required
by laws that apply to us, will be made only with your written permission (Authorization). If you
provide your permission to use or disclose medical information about you, you may revoke that
permission in writing at any time. If you revoke permission, we will no longer use or disclose
medical information about you for the reasons indicated in your written authorization. You
understand that we are unable to take back any disclosures that we made before we received
your written notice revoking your Authorization. You may submit your request in writing using
the contact information listed at the end of this notice.
Your Health Information Rights:
Right to Request Additional Restrictions: You have the right to request restrictions in our use or
disclosure of your medical information for treatment, payment or health care operations
explained in this notice. You must submit your request in writing using the contact information
listed at the end of this notice. While we will consider all requests carefully, we are not required
to agree to your request for restrictions EXCEPT for a request for a restriction on disclosure of
your medical information to your health plan for purposes of payment if the restriction pertains
solely to a health care item or service that you have paid for entirely out-of-pocket.
Right to Receive Paper Copy of this Notice: You have the right to receive a paper copy of this
notice upon request. Please contact us by using the information listed at the end of this notice.
Right to Inspect and Copy Your Confidential Information: You have the right to inspect and
receive a copy of the medical information that may be used to make decisions about you,
including patient medical records and billing records. We may charge a fee for the costs of
copying, mailing, labor and supplies associated with your request. Under limited circumstances,
we may deny you access to a portion of your records. You may submit your request in writing
using the contact information listed at the end of this notice.
Right to Amend Your Health Records: You have the right to ask us to amend your medical
information if you believe it is incorrect or incomplete, and you may request an amendment for
as long as the information is kept by or for our organization. If we determine that the record is
inaccurate, and the law permits us to amend it, we will correct it. If your treating physician or
another person created the information that you want changed, you should ask that person to
amend the information. You may submit your request in writing using the contact information
listed at the end of this notice.
Right to Receive Confidential Communications: You have the right to request that we
communicate with you about your health and related issues in a particular manner, or at a
certain location. While we will consider reasonable requests, we are not required to agree to all
requests. You may submit your request in writing using the contact information listed at the end
of this notice.
Right to Receive an Accounting of Disclosures: You have the right to request an accounting of
the disclosures we have made of your medical information for purposes other than specified
above. All requests for an accounting of disclosures may not be longer than six years and may
not include dates before April 14, 2003. If you request an accounting more than once during any
12-month period, we will charge you a reasonable fee for each accounting statement after the
first one. We will notify you of the costs involved with additional requests, and you may
withdraw your request before you incur any costs. You may submit your request in writing using
the contact information listed at the end of this notice.
Right to File a Complaint: If you believe your privacy rights have been violated, you may file a
complaint with us or with the Secretary of the Department of Health and Human Services. All
complaints must be submitted in writing. To file a complaint with us you may submit your
complaint using the contact information listed at the end of this notice. We will not take any
action against you if you file a complaint with the Secretary of the Department of Health and
Human Services or us.
CHANGES TO THIS NOTICE: We reserve the right to change our practices and to make the new
provisions effective for all protected health information we maintain. We will post a copy of the
Current Notice on our website at www.radisphere.net. Revised notices will be made available to
you upon request.
IF YOU HAVE A REQUEST: If you wish to make any of the requests listed above under “Your
Health Information Rights,” please submit your request in writing to:
Radisphere ATTN: Privacy Officer
3700 Park East, Third Floor
Beachwood, OH 44122