Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice applies to all Real Time Neuromonitoring Associates (RTNA) entities as the physicians treating patients at various hospitals and facilities. If you have questions about this Notice, please contact RTNA's Privacy Office at 1-615-346-8182. You may also email your questions to firstname.lastname@example.org.
This Notice describes how we will use and disclose your health information. The terms of this Notice apply to all health information generated or received by RTNA, whether recorded in your medical record, billing invoices, paper forms, video, or in other ways.
HOW WE USE AND DISCLOSE YOUR HEALTH INFORMATION
We use or disclose your health information as follow:
· TREATMENT: We may use your health information to provide care and share it with others who are treating you.
· PAYMENT: We may use and share your health information to bill and obtain payment for the healthcare services you receive. For example, we send information about you to your health insurance plan so it will pay for your services. We may also disclose your health information to other healthcare providers for their payment purposes.
· HEALTHCARE OPERATIONS: We may use and share your health information for our day-to-day operations, to improve your care, and contact you when necessary. For example, we may use your medical information to review our treatment and services and evaluate how to improve our quality of care.
We may share your health information in the following situations unless you tell us otherwise. If you are not able to tell us your preference, we may go ahead and share your information if we believe it is in your best interest or needed to lessen a serious and imminent threat to health or safety:
· Friends and Family: We may disclose to your family and close personal friends any health information directly related to that person's involvement in your care upon your approval.
We may also use and share your health information for other reasons without your prior consent:
· When required by law: We will share information about you if state or federal law require it, including with the Department of Health and Human services if it wants to see that we're complying with federal privacy law.
· Law enforcement: We may share information for law enforcement purposes, such as when a crime is committed at one of our facilities/offices. We may also share information to help locate a suspect, fugitive, missing person or witness.
· For public health and safety: We can share information in certain situations to help prevent disease, assist with product recalls, report adverse reactions to medications, and to prevent or reduce a serious threat to anyone's health or safety.
· Lawsuits and legal actions: We may share information about you in response to a court or administrative order, or in response to a subpoena.
· Workers' compensation, correctional institutions and other government requests: We can share information to employers for workers' compensation claims. We also share information with correctional institutions about their inmates. Information me also be shared with health oversight agencies when authorized by law, and other special government functions such as military, national security and presidential protective service.
YOUR RIGHTS THAT APPLY YOUR HEALTH INFORMATION
When it comes to your health information, you have certain rights.
· Get a copy of your medical record: You can ask to see or get a paper or electronic copy of your medical record and other health information we have about you. We will provide a copy or summary to you usually within 30 days of your request. We may charge a reasonable, cost-based fee. Access may be denied in some circumstances, such as to psychotherapy notes or when a certain law prohibits your access. In some circumstances you may have this decision reviewed.
· Ask us to correct your medical record: You can ask us to correct health information that you think is incorrect or incomplete. We may deny your request, but we'll tell you why in writing. These requests should be submitted in writing to the contact listed below.
· Request confidential communications: You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. Reasonable requests will be approved.
· Ask us to limit what we use or share: You can ask us to restrict how we share your health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say "no" if it would affect your care. If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information with your health insurer for the purpose of payment or our operations. We will say "yes" unless a law requires us to share that information.
· Get a list of those with whom we've shared information: You can ask for a list (accounting) of the times we've shared your health information for six years prior, who we've shared it with, and why. We will include all disclosures except for those about your treatment, payment, and our health care operations, and certain other disclosures (such as those you asked us to make). We will provide one accounting a year for free, but we will charge a reasonable cost-based fee if you ask for another within 12 months.
· Get a copy of this privacy notice: You can ask for a paper copy of this Notice at any time, even if you have agreed to receive it electronically. We will provide you with a paper copy promptly.
· Choose someone to act for you: If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
· File a complaint if you feel your rights are violated: You can complain to the U.S. Department of Health and Human Services Office for Civil Rights if you feel we have violated your rights. We can provide you with their address. You can also file a complaint with us by using the contact information below. We will not retaliate against you for filing a complaint.
RTNA Patient and Security
336 22nd Avenue North
Nashville, TN 37203
OUR RESPONSIBILITIES REGARDING YOUR HEALTH INFORMATION
· We are required by law to maintain the privacy and security of your health information.
· We will let you know promptly if a breach occurs that may have compromised the privacy or security of your health information.
· We must follow the duties and privacy practices described in this Notice and offer to give you a copy.
· We will not use or share your information other than as described here unless you tell us to in writing. You may change your mind at any time by letting us know in writing.
CHANGES TO THIS NOTICE
We may change the terms of this Notice, and the changes will apply to all information we have about you. The new Notice will be available upon request and on our website www.sanfordhealth.org.
This Notice of Privacy Practices is effective June 16, 2016.