HIPAA Notice of Privacy Practices

Effective Date: July 8, 2025

This Notice describes how your medical information (Protected Health Information or “PHI”) may be used and disclosed, and how you can access your information. Please review it carefully.

Our Commitment to Your Privacy

At Mosaic Diagnostic Imaging, PLLC (“Mosaic”), we respect your privacy and are committed to safeguarding your PHI. We are required by law to protect your health information and to provide you with this Notice explaining your rights and our legal obligations.

How We May Use and Disclose Your PHI — Without Authorization

Treatment

We may use or share your PHI to provide, coordinate, or manage your medical care. Example: A radiologist may consult with your referring physician about your scan results.

Payment

We may use or share your PHI to bill your health plan or collect payment for services provided. Example: We may send your insurance company the diagnosis and procedures used to support a claim.

Healthcare Operations

We may use your PHI for activities that support our operations, such as quality reviews, staff evaluations, or internal training.

Other Permitted Uses and Disclosures

We may also disclose your PHI in these situations, as allowed or required by law:

When required by law or government authorities
For public health activities (e.g., disease control, FDA reporting)
To report abuse, neglect, or domestic violence
For health oversight activities (e.g., audits, investigations)
In connection with lawsuits or legal proceedings
To law enforcement officials (within limits set by law)
To coroners, medical examiners, or funeral directors
For organ and tissue donation purposes
If you’re an inmate or in custody
To avert serious threats to health or safety
For national security or protective services
To our business associates (e.g., billing or IT vendors under contract to protect your data)

Note: Certain categories of sensitive PHI (e.g., HIV status, substance use, psychotherapy notes) receive extra protection under federal/state laws.

Uses and Disclosures With Your Opportunity to Object

Unless you object, we may share your PHI with:

Family members or others involved in your care
Someone helping pay for your medical services If you’re not able to agree or object (e.g., unconscious), we may disclose based on our professional judgment if it’s in your best interest.

Uses and Disclosures That Require Your Written Authorization

We will only use or disclose your PHI for the following purposes with your explicit written authorization:

Marketing or sale of your PHI
Most disclosures of psychotherapy notes
Other uses not described in this Notice

You may revoke your authorization at any time in writing, except to the extent we’ve already relied on it.

Your Rights Regarding Your PHI

You have the right to:

Request restrictions You may request limits on how we use/disclose your PHI. While we’re not required to agree, we must honor certain requests (e.g., if you pay out-of-pocket for a service and request that it not be disclosed to your insurer).
Request confidential communications You may ask us to contact you in specific ways (e.g., via mail, phone, or alternate address). We will accommodate reasonable requests.
Access your records You may inspect or request a copy of your medical and billing records. A fee may apply. We may deny access in limited circumstances, and you may request a review of the denial.
Request amendments You can request corrections to your PHI if you believe it is incorrect or incomplete. If we deny your request, we’ll provide an explanation and allow you to submit a written statement of disagreement.
Request an accounting of disclosures You may request a list of certain disclosures of your PHI made in the past 6 years (excluding those for treatment, payment, and operations). Your first request in a 12-month period is free; additional requests may incur a fee.
Receive a paper copy of this Notice You may request a physical copy of this Notice at any time, even if you agreed to receive it electronically.
Opt out of fundraising communications If we contact you for fundraising, you have the right to opt out.
Be notified of a data breach You will be notified if your unsecured PHI is accessed, used, or disclosed in a way that compromises your privacy or security.

How to File a Complaint

If you believe your privacy rights have been violated, you may file a complaint without fear of retaliation.

Contact Mosaic’s Privacy Officer: Phone: (888) 220-0508 Email or Web: https://mosaicdiagnostic.com/contact
Or file with: U.S. Department of Health and Human Services https://www.hhs.gov/hipaa/filing-a-complaint/index.html

Updates to This Notice

We reserve the right to change this Notice and apply changes to all PHI we maintain. A current version will always be available at our facility and on our website: https://mosaicdiagnostics.com/hipaa-notice-of-privacy-practices/

Contact Information

Mosaic Diagnostic Imaging, PLLC — Privacy Officer
Phone: (888) 220-0508
Email: [email protected]