Notice of Privacy
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
I. Who Presents this Notice
This Notice describes the privacy practices of Capitol Imaging Services (CIS) (“Organization”), including members of its workforce, employed or contracted physicians and allied health professionals who provide services at Organization’s practice locations or otherwise on Organization’s behalf. The Organization and the individual health care providers together are sometimes called “the Organization and Health Professionals” in this Notice. While the Organization and Health Professionals engage in many joint activities and provide services in a clinically integrated care setting, the Organization and Health Professionals each are separate legal entities.
This Notice applies to services furnished to you at:
- Advanced Imaging of Lafayette – Lafayette LA
935 Camellia Blvd #101, Lafayette LA 70508 - Alliance – Clear Lake
17490 Hwy 3 Ste. B300, Webster, TX 77598 - Alliance – Katy
21800 Katy Fwy, , #140, Katy, TX 77449 - Alliance – Lake Houston
5514 Atascocita Rd. #180, Humble, TX 77346 - Alliance – Lake Jackson
2760 Brazos Parkway. Suite B&C, Angleton, TX 77515 - Alliance – Montgomery County
9851 FM 1097 Rd West, Ste. 190, Willis, TX 77318 - Alliance – Pearland
1910 Country Place Pkwy, Ste 154, Pearland, TX 77584 - Alliance – Spring
20639 Kuykendahl Rd, Ste 250, Spring, TX 77379 - Alliance – The Woodlands
1011 Medical Plaza Dr, Ste 120, , The Woodlands, TX 77380 - Alliance – Woodforest
Woodforest Medical Plaza 1, Suite 180, 750 Fish Creek Thoroughfare, Montgomery, TX 77316 - Ascension Open MRI – Gonzales LA
2622 S Ruby Ave, Gonzales LA 70737 - Baton Rouge Imaging Center – Baton Rouge LA
8044 Summa Ave, Baton Rouge LA 70809 - Bluebonnet Imaging Center – Baton Rouge LA
4570 Bluebonnet Blvd #A, Baton Rouge LA 70809 - Central Imaging Center – Baton Rouge LA
11424 Sullivan Rd Bldg B #C, Baton Rouge LA 70818 - Diagnostic Imaging Services – Covington, LA Highway 21
71154 Highway 21, Covington LA 70433 - Diagnostic Imaging Services – Covington, LA Pinnacle Parkway
1200 Pinnacle Pkwy #5, Covington LA 70433 - Diagnostic Imaging Services – Marrero, LA
925 Avenue C, Marrero LA 70072 - Diagnostic Imaging Services – Metairie, LA Houma Boulevard
3434 Houma Blvd #100, Metairie LA 70006 - Diagnostic Imaging Services – Metairie, LA Veterans Boulevard
4241 Veterans Memorial Blvd #100, Metairie LA 70006 - Diagnostic Imaging Services – Slidell, LA
1310 Gause Blvd, Slidell, LA 70458 - Diagnostic Imaging Services – Thibodaux, LA
2100 Audubon Ave, Thibodaux, LA 70301 - Doctors Imaging – Metairie LA
4204 Teuton St, Metairie, LA 70006 - Flourish Imaging – Gainesville GA
2022 Windward Lane, Suite 3, Gainesville, GA 30501 - Heritage Diagnostic Center – Cullman AL
1705 Main Ave SW #C, Cullman AL 35055 - Homosassa Open MRI – Homosassa FL
8464 W Aquaduct St, Homosassa FL 34448 - Houston MRI – Cypress
27126 Northwest Fwy., Ste. 200 Cypress, TX 77433 - Houston MRI – East Houston
5630 East Sam Houston, Pkwy. N. Houston, TX 77015 - Houston MRI – Friendswood
1505 E. Winding Way, Ste. 110 Friendswood, TX 77546 - Houston MRI – Katy
1336 Pin Oak Road Katy, TX 77494 - Houston MRI – Sugar Land
15555 Creek Bend Dr., Suite 300 Sugar Land, TX, 77478 - Houston MRI – The Woodlands
1733 Woodstead Ct., Suite 100 The Woodlands, TX 77380 - Houston MRI – West Houston
2600 Gessner Road, Suite 150 Houston, TX 77080 - Houston Premier Radiology Center – Houston, TX
12853 Gulf Freeway, Houston, TX 77034 - Imaging Center of Columbus – Columbus MS
2526 5th St N, Columbus MS 39705 - Imaging Center of Meridian – Meridian MS
2021 24th Ave #B, Meridian MS 39301 - Louisiana PET/CT Imaging of Lake Charles – Lake Charles LA
831 Lakeshore Dr, Lake Charles LA 70601 - M.R. Imaging Systems – Alexandria LA
211 N 3rd St #B, Alexandria LA 71301 - Northeast Imaging – Monroe LA
1703 Lamy Ln, Monroe LA 71201 - Northwest Imaging – Shreveport LA
1460 E Bert Kouns Industrial Loop #708, Shreveport LA 71105 - Open Air MRI of CENLA – Alexandria LA
5413 Jackson Street Ext, Alexandria LA 71303 - Open MRI of Hammond – Hammond LA
1420 SW Railroad Ave., Suite B, Hammond LA 70403 - Open MRI of Mississippi – Flowood MS
2630 Courthouse Cir #A, Flowood MS 39232 - OPI – Atlanta
2284 Peachtree Road N.W., Atlanta, GA 30309 - OPI – Canton
2000 Village Professional DR, STE 100, Canton, GA, 30114 - OPI – Decatur
1376 Church St #100, Decatur, Georgia 30030 - OPI – Fayetteville
1233 HWY 54 STE 110, Fayetteville, GA 30214 - OPI – Kennestone
335 Roselane ST NW STE 103, Marietta, Ga 30060 - OPI – Marietta
1070 Woodlawn Dr. STE 150, Marietta, Georgia 30068 - OPI – Newnan
60 Oak Hill Blvd., Suite 101, Newnan, GA 30265 - OPI – Peachtree City
10 Eastbrook Bend, Peachtree City, GA 30269 - OPI – Statesboro
1601 Fair Road, STE 100, Statesboro, GA 30458 - PARS Imaging – Baytown TX
1010 W Baker Rd #101, Baytown TX 77521 - Radiology & Imaging – Alameda – Corpus Christi, TX
3226 S Alameda St, Corpus Christi, TX 78404 - Radiology & Imaging – South – Corpus Christi, TX
2825 Spohn South Dr, Corpus Christi, TX 78414 - River Bend Imaging – Laplace LA
490 Belle Terre Blvd, Laplace LA 70068 - Southern Imaging Specialists – Montgomery AL
465 Saint Lukes Dr, Montgomery AL 36117 - Texarkana PET/CT imaging Institute – Texarkana TX
1929 Moores Ln, Texarkana TX 75503 - Vestavia Hills Imaging Center – Vestavia Hills AL
2017 Canyon Rd #25, Vestavia Hills AL 35216
Privacy Obligations
The Organization and health Professionals each are required by law to maintain the privacy of your health information (“Protected Health Information” or “PHI”) and to provide you with this Notice of our legal duties and privacy practices with respect to your PHI. When the Organization and Health Professionals use or disclose your PHI, the Organization and Health Professionals are required to abide by the terms of this Notice (or other notice in effect at the time of the use or disclosure).
II. Permissible Uses and Disclosures Without Your Written Authorization
In certain situations, which are described in Section IV below, your written authorization must be obtained in order to use and/or disclose your PHI. However, the Organization and Health Professionals do not need any type of authorization from you for the following uses and disclosures:
A. Uses and Disclosures for Treatment, Payment and Health Care Operations. Your PHI, but not your “Highly Confidential Information” (defined in Section IV.C below), may be used in order to treat you, obtain payment for services provided to you and conduct our “health care operations” as detailed below:
Treatment. Your PHI may be used and disclosed to provide treatment and other services to you–for example, diagnose and treat your injury or illness. In addition, you may be contacted to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you. Your PHI also may be disclosed to other providers involved in your treatment.
Payment. Your PHI may be used and disclosed to obtain payment for services provided to you–for example, disclosures to claim and obtain payment from your health insurer, HMO, or other company that arranges or pays the cost of some or all of your health care (“Your Payor”) to verify that Your Payor will pay for health care.
Health Care Operations. Your PHI may be used and disclosed for our health care operations, which include internal administration and planning and various activities that improve the quality and cost effectiveness of the care delivered to you (except for billing audits which require your Authorization under Louisiana law). For example, PHI may be used to evaluate the quality and competence of physicians, nurses or other health care workers. PHI may be disclosed to the Privacy Officer in order to resolve any complaints you may have.
Your PHI also may be disclosed to your other health care providers when such PHI is required for them to treat you, receive payment for services they render to you, or conduct certain health care operations, such as quality assessment and improvement activities, reviewing the quality and competence of health care professionals, or for health care fraud and abuse detection or compliance (except for billing audits which require your Authorization under Louisiana law). In addition, PHI may be shared with business associates who perform treatment, payment and health care operations services on our behalf of the Organization and Health Professionals.
B. Disclosure to Relatives, Close Friends and Other Caregivers. Your PHI may be disclosed to a family member, other relative, a close personal friend or any other person identified by you when you are present for, or otherwise available prior to, the disclosure, if (1) your agreement is obtained; (2) you do not object to the disclosure after being provided the opportunity to object; or (3) it can be reasonably inferred that you do not object to the disclosure.
If you are not present, or the opportunity to agree or object to a use or disclosure cannot practicably be provided because of your incapacity or an emergency circumstance, the Organization and/or Health Professionals may exercise professional judgment to determine whether a disclosure is in your best interests. If information is disclosed to a family member, other relative or a close personal friend, the Organization and /or Health Professionals would disclose only information believed to be directly relevant to the person’s involvement with your health care or payment related to your health care. Your PHI also may be disclosed in order to notify (or assist in notifying) such persons of your location or general condition.
C. Public Health Activities. Your PHI may be disclosed for the following public health activities: (1) to report health information to public health authorities for the purpose of preventing or controlling disease, injury or disability or otherwise reporting births, abortions, severe head injuries, cancers, the misadministration of radiopharmaceuticals, the presence of lead in your blood stream or that you are engaged in a lead hazard reduction activity, and for certain other public health reporting purposes as required under Louisiana law; (2) to report child abuse and neglect to public health authorities or other government authorities authorized by law to receive such reports; (3) to report information about products and services under the jurisdiction of the U.S. Food and Drug Administration; (4) to alert a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition; and (5) to report information to your employer as required under laws addressing work-related illnesses and injuries or workplace medical surveillance.
D. Victims of Abuse, Neglect or Domestic Violence. Your PHI may be disclosed to a governmental authority, including the Louisiana Department of Health and Hospitals, the Medicaid Fraud Control Unit or a social service or protective services agency, authorized by law to receive reports of such abuse, neglect, or domestic violence if there is a reasonable belief that you are a victim of abuse, neglect or domestic violence.
E. Health Oversight Activities. Your PHI may be disclosed to a health oversight agency that oversees the health care system and is charged with responsibility for ensuring compliance with the rules of government health programs such as Medicare or Medicaid.
F. Judicial and Administrative Proceedings. Your PHI may be disclosed in the course of a judicial or administrative proceeding in response to a legal order or other lawful process.
G. Law Enforcement Officials. Your PHI may be disclosed to a coroner or medical examiner as authorized by law.
H. Decedents. Your PHI may be disclosed to a coroner or medical examiner as authorized by law.
I. Organ and Tissue Procurement. Your PHI may be disclosed to organizations that facilitate organ, eye or tissue procurement, banking or transplantation.
J. Health or Safety. Your PHI may be disclosed to prevent or lessen a serious and imminent threat to a person’s or the public’s health or safety as permitted or required by Louisiana law.
K. Specialized Government Functions. Your PHI may be disclosed to units of the government with special functions, such as the U.S. military or the U.S. Department of State under certain circumstances.
L. Workers’ Compensation. Your PHI may be disclosed as authorized by and to the extent necessary to comply with Louisiana law relating to workers’ compensation or other similar programs.
M. As Required by Law. Your PHI may be disclosed when required to do so by any other law not already referred to in the preceding categories.
III. Uses and Disclosures Requiring Your Written Authorization
A. Use or Disclosure with Your Authorization. For any purpose other than the ones described above in Section III, your PHI may be used or disclosed only when you provide us your written authorization on our authorization form (“Your Authorization”). For instance, you will need to execute an authorization form before your PHI can be sent to your life insurance company or to the attorney representing the other party in litigation in which you are involved.
B. Marketing. Your written authorization (“Your Marketing Authorization”) also must be obtained prior to using your PHI to send you any marketing materials. However, marketing materials can be provided to you in a face-to-face encounter without obtaining Your Marketing Authorization. The Organization and/or Health Professionals are also permitted to give you a promotional gift of nominal value, if they so choose, without obtaining Your Marketing Authorization. In addition, the Organization and/or Health Professionals may communicate with you about products or services relating to your treatment, case management or care coordination, or alternative treatments, therapies, providers or care settings without Your Marketing Authorization.
C. Uses and Disclosures of Your Highly Confidential Information. In addition, federal and state law require special privacy protections for certain highly confidential information about you (“Highly Confidential Information”), including the subset of your PHI that: (1) is maintained in psychotherapy notes; (2) is about mental health and developmental disabilities services; (3) is about HIV/AIDS testing, diagnosis or treatment, (4) is about genetic information (and the genetic testing is for purposes other than investigating a death or crime, determining paternity, determining the identify of a deceased person, for anonymous research where the patient’s identity will not be released, pursuant to newborn screening requirements or as otherwise authorized by federal law for identification purposes); (5) is about child abuse and neglect; (6) is about sexual assault (provided that if the patient is age sixteen (16) or younger, we are required by Louisiana law to immediately notify the appropriate law enforcement official); (7) is about the making or acceptance of an anatomical gift; or (8) if the patient is a child, is about such child including such child’s immunization records. In order for your Highly Confidential Information to be disclosed for a purpose other than those permitted by law, your written authorization is required.
For disclosures of genetic information, such authorization must include at least the following information: (a) be in writing, signed and dated by the patient; (b) identify the person permitted to make the disclosure; (c) describe the specific genetic information to be disclosed; (d) describe the purpose of the disclosure; (e) state an expiration date, which can never be more than sixty (60) days after the date of authorization; (f) a statement that the patient may revoke the authorization any time before the disclosure is actually made or the patient is made aware of the details of the genetic information; and (g) a statement that the authorization shall be invalid if used for any purpose other than that specified in the authorization.
IV. Your Rights Regarding Your Protected Health Information
A. For Further Information, Complaints. If you desire further information about your privacy rights, are concerned that your privacy rights have been violated or disagree with a decision made about access to your PHI, you may contact the Privacy Officer. You may also file written complaints with the Director, Office for Civil Rights of the U.S. Department of Health and Human Services. Upon request, the Privacy Officer will provide you with the correct address for the Director. The Organization and Health Professionals will not retaliate against you if you file a complaint with the Privacy Officer or the Director.
B. Right to Request Additional Restrictions. You may request restrictions on the use and disclosure of your PHI (1) for treatment, payment and health care operations, (2) to individuals (such as a family member, other relative, close personal friend or any other person identified by you) involved with your care or with payment related to your care, or (3) to notify or assist in the notification of such individuals regarding your location and general condition. While all requests for additional restrictions will be carefully considered, the Organization and Health Professionals are not required to agree to a requested restriction. If you wish to request additional restrictions, please obtain a request form from the Privacy Officer and submit the completed form to the Privacy Officer. A written response will be sent to you. In addition, you have the right to request that we not disclose information to your health plan about services for which you paid in full out of pocket. We must agree to this type of restriction unless disclosure is otherwise required by law.
C. Right to Receive Confidential Communications. You may request, and the Organization and Health Professionals will accommodate, any reasonable written request for you to receive your PHI by alternative means of communication or at alternative locations.
D. Right to Revoke Your Authorization. You may revoke Your Authorization, Your Marketing Authorization or any written authorization obtained in connection with your Highly Confidential Information, except to the extent that the Organization and Health Professionals have taken action in reliance upon it, by delivering a written revocation statement to the Privacy Officer identified below. A form of written revocation is available upon request from the Privacy Officer.
E. Right to Inspect and Copy Your Health Information. You may request access to your medical record file and billing records maintained by the Organization or Health Professionals in order to inspect and request copies of the records. You have the right to receive an electronic copy of your medical records if they are maintained in an electronic format, or to direct us to transmit a copy to another person or entity of your choosing. Reasonable , cost based fees may apply as permitted by law. Under limited circumstances, you may be denied access to a portion of your records. If you desire access to your records, please obtain a record request form from the Privacy Officer and submit the completed form to the Privacy Officer. If you request copies of paper records, you will be charged in accordance with federal and state law. To the extent the request for records includes portions of records which are not in paper form (e.g., x-ray films), you will be charged the reasonable cost of the copies. You will also be charged for the postage costs, if you request that the copies be mailed to you.
F. Right to Amend Your Records. You have the right to request that Protected Health Information in your medical record file or billing records be amended. If you desire to amend your records, please obtain an amendment request form from the Privacy Officer and submit the completed form to the Privacy Officer. Your request will be accommodated unless the Organization and/or Health Professionals believe that the information that would be amended is accurate and complete or other special circumstances apply.
G. Right to Receive an Accounting of Disclosures. Upon request, you may obtain an accounting of certain disclosures of your PHI made during any period of time prior to the date of your request provided such period does not exceed six years and does not apply to disclosures that occurred prior to April 14, 2003 If you request an accounting more than once during a twelve (12) month period, you will be charged $1.00 for each page for the first 25 pages, $0.50 per page for each page between 25-500 pages and $0.25 per page for pages 501 and higher of the accounting statement.
H. Right to Receive Paper Copy of this Notice. Upon request, you may obtain a paper copy of this Notice, even if you have agreed to receive such notice electronically.
I. Right to Breach Notification. You have the right to be notified following a breach of your unsecured protected health information. The Organization and Health Professionals will notify you in writing without unreasonable delay, consistent with applicable federal and state law requirements.
V. Website Privacy, Cookies, and Tracking
The Organization’s website privacy practices, including the use of cookies, analytics, and other tracking technologies, are not governed by this Notice and do not involve the use or disclosure of Protected Health Information (“PHI”).
Information about how we collect, use, and manage website-related data, including cookies and similar technologies, is available in our Cookie Policy.
VI. Effective Date and Duration of This Notice
A. Effective Date. This Notice is effective as of December 8, 2003. This latest revision of this Notice occurred on January 12, 2026.
B. Right to Change Terms of this Notice. The terms of this Notice may be changed at any time. If this Notice is changed, the new notice terms may be made effective for all PHI that the Organization and Health Professionals maintain, including any information created or received prior to issuing the new notice. If this Notice is changed, the new notice will be posted in waiting areas of the Organization’s practice locations and on the Organization’s Internet site at capitolimagingservices.com. You also may obtain any new notice by contacting the Privacy Officer.
VII. Privacy Officer
You may contact the Privacy Officer at:
Privacy Officer
Capitol Imaging Services
4241 Veterans Memorial Boulevard #200
Metairie, LA 70006
504-888-7921
E-mail: ciscompliance@capitolimagingservices.com
