Dear Patient and Family:

Smart Choice MRI is committed to protecting patients’ medical information. Maintaining patient privacy is a part of our mission to serve the needs of the patient first.
This notice describes how your medical information may be used and disclosed as well as how to get access to this information.

Background: The United States government created rules for the use and protection of medical and health information. The rules are a result of the 1996 Health Insurance Portability and Account- ability Act (HIPAA). They are meant to provide all patients with standard privacy practices.

Commitment: At Smart Choice MRI, our principle goal is to protect the privacy of your Protected Health Information (PHI), as defined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Smart Choice MRI reserves the right to change the terms of this notice of privacy practices and make the new notice provisions effective for all protected health information. We are required by law to:

  1. Keep all your medical information private.
  2. Give you this Notice of our legal duties and privacy practices with respect to your PHI.
  3. Notify you if you have been affected by a breach of unsecured PHI

Use of Information: SCMRI may use or disclose your health information with or without your authorization for the following purposes:
We may need to use and disclose your health information to other health care providers from within or outside of Smart Choice MRI, LLC. This information may be disclosed to help manage your care and treatment.

  1. We may use your health information to provide you with appointment reminders.
  2. We may use health information to submit a bill to your insurance company that states your name, diagnosis, and other information in order for us to receive payment. In a situation of an unpaid bill your information may be submitted to a collection agency.
  3. We may also use your information to help support and improve the quality of the care that we provide at Smart Choice MRI.
  4. We may provide health information to proper authorities if we believe in good faith that disclosing information will help prevent or lessen a serious threat to you.
  5. We may comply with the laws related to Workers’ Compensation. These programs may provide benefits for work-related injuries or illnesses.

Disclosures requiring your permission: Other uses and disclosures not described in the previous section of this notice may be made only with your permission. We are required to obtain your permission for the following purposes:

  1. We would obtain your permission before using your health information for marketing purposes.
  2. We would obtain our permission before making any disclosures that constitute a sale of health information.
  3. We would obtain your permission for uses and disclosures of psychotherapy notes.
  4. In circumstances that require your permission, you may withdraw such permission at any time by notifying us in writing. If you withdraw your permission, we will no longer use or disclose your health information for the purposes specified-unless we have already taken action based on your permission.

Your Rights Regarding your “PHI”:

  1. You have the right to ask us to communicate with you in a certain way or at a certain location regarding your PHI. We will use our best efforts to accommodate all reasonable requests as to where and how you wish to be contacted.
  2. You have the right to obtain a copy of your medical records. You may be charged a printing fee.
  3. You have the right to limit how we use or disclose your medical information.
  4. You have the right to receive a copy of this notice.

We will consider your request, but are not legally bound to agree to the restriction. All requests must be made in writing to the Compliance Privacy Officer of SCMRI at the address below.
Smart Choice MRI
10532 North Port Washington Road Mequon, WI 53092
Patient Complaint Process: If you believe your privacy rights have been violated, you may file complaint with Smart Choice MRI. There will be no retaliation against you for ling a complaint. Our Compliance Privacy Officer will investigate the situation.
If you have any questions or concerns regarding your privacy rights or the information in this notice please contact Smart Choice MRI.

Contact Us:
Smart Choice MRI
10532 North Port Washington Road Suite 1B
Mequon, WI 53092

Phone: 844-NEED-MRI
Email: info@smartchoiceMRI.com Website: smartchoiceMRI.com

Sincerely,
Smart Choice MRI, LLC