RUME MEDICAL GROUP, INC.
HIPAA NOTICE OF PRIVACY PRACTICES
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.
WHO WILL FOLLOW THIS NOTICE
This Notice of Privacy Practices (the “Notice”) describes Rume Medical Group, Inc.’s (“we” and “our”) practices and those of our employees, staff, volunteers, and other personnel who are involved in the provision of services to you. We and these individuals will follow the terms of this Notice, and may use or disclose medical information about you to carry out treatment, payment or health care operations, or for other purposes as permitted or required by law. This Notice describes your rights to access and control medical information about you, including information that may identify you and that relates to your past, present, or future physical, medical, or mental condition and medical care and related health care services.
OUR PLEDGE REGARDING MEDICAL INFORMATION
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. In order to provide you with quality care and to comply with certain state and federal legal requirements, we create a record of the services you receive from us. This Notice applies to all of the records of your care generated or maintained by us. This Notice will tell you about the ways in which we may use and disclose medical information about you. It also describes your rights and certain obligations we have regarding the use and disclosure of medical information. We are required by law to: (1) make sure that medical information that identifies you is kept private; (2) give you this Notice of our legal duties and privacy practices concerning medical information about you; (3) follow the terms of the Notice that are currently in effect, and (4) notify you in case there is an unauthorized use or disclosure of your unsecured medical information.
A WORD ABOUT FEDERAL AND STATE LAW
Federal and state laws both have rules and regulations regarding the protection of your health information. When state law and federal law differ, federal law requires that providers comply with the federal or state law that provides you with greater protection.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
The following categories describe different ways that we may use or disclose protected medical information. For each category of uses and disclosures, we will explain what is meant and may give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories. Some information such as psychotherapy notes, certain drug and alcohol information, HIV, or mental health information is entitled to special restrictions.
For Treatment. We may use medical information about you to provide you with medical treatment and to coordinate or manage your medical treatment and any related services. We may disclose information about you to our staff or other providers involved in your treatment. For example, we may share your protected health information between or among our personnel to assist your health care providers in treating you.
For Payment. To the extent applicable, we may use and disclose medical information about you so that we can get paid for the treatment and services you receive from us. For example, we may need to give information to your health plan or to the Medicaid or Medicare program about treatment you receive from us so that they will pay us or reimburse you for your care. We may also tell your health plan about a proposed treatment to determine whether your plan will cover the treatment.
For Health Care Operations. To the extent applicable, we may use and disclose medical information about you to carry out activities that are necessary for our operations. These uses or disclosures are made for quality of care, compliance activities, administrative purposes, contractual obligations, grievances or lawsuits. For example, we may use medical information to review treatment and services provided by us or to evaluate the performance of our staff and contractors in caring for you.
To Individuals or Family Members Involved in Your Health Care. Unless you object, we may disclose medical information about you to a member of your family, a relative, close friend or any other person that you identify who is involved in your care. We may also tell your family or friends, personal representative, or any other person who is responsible for your care, of your location, general condition or death, unless you object.
For Appointment Reminders. We reserve the right to contact you, in a manner permitted by law, with appointment reminders or information about treatment alternatives and other health related benefits that may be appropriate for you.
For Fundraising Activities. We may use medical information about you to contact you about our sponsored activities including fundraising events. We will only use contact information such as your name, address, and phone number.
As Required By Law. We will disclose your health information when required to do so by federal, state or local law.
Workers’ Compensation. We may release medical information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
For Public Health Activities. We may disclose medical information about you for public health activities. These purposes generally include the following: (1) to prevent or control disease, injury, or disability; (2) to report deaths; (3) to report abuse or neglect of children, elders, and dependent adults; (4) to report reactions to medications or problems with products; (5) to notify people of recalls of products they may be using; and (6) to notify a person who may have been exposed to a disease or who may be at risk for contracting or spreading a disease or condition.
For Health Oversight Activities. We may disclose medical information about you to a health oversight agency for activities authorized by law.
For Lawsuits and Disputes. We may disclose medical information about you in response to a court or administrative order, subpoena, discovery request, or other lawful process.
Disclosure to Law Enforcement. If asked to do so by law enforcement and as authorized or required by law, we may release medical information: (1) to identify or locate a suspect, fugitive, material witness, or missing person; (2) about a suspected victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement; (3) about a death suspected to be the result of criminal conduct; (4) about criminal conduct; and (5) in case of a medical emergency, to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime.
Decedents. We may release medical information about you to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about you to funeral directors. We may also release information to any individual known to us as a family member, close personal friend of the family, or any other person identified, who was involved in your care or the payment for your care prior to your death, unless you indicate otherwise. Your medical information may be used or disclosed to others without your authorization after fifty (50) years from the date of your death.
For Specialized Government Functions. We may disclose medical information about you to authorized federal officials for intelligence, counter intelligence, and other national security activities.
Information About Inmates/Individuals in Custody. If you are an inmate or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official responsible for you as authorized or required by law.
Disclosure For Threats to Health and Safety. In certain circumstances, we may be required to disclose medical information to avert a serious threat to your health and safety or the health and safety of another person as required by law enforcement. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law.
SPECIAL PROVISIONS RELATED TO MEMBER PRIVACY
Psychotherapy Notes. We will not release any psychotherapy notes without a specific authorization from you that allows us to release the notes.
Marketing. We will not release your medical information for marketing purposes without an authorization from you.
Sale of Medical Information. We will not sell your medical information without an authorization from you.
HIV/AIDS Test Results. We will not disclose the results of an HIV/AIDS test unless you give us specific written authorization. We may disclose HIV/AIDS test results without your specific authorization as required by state or federal reporting laws.
You have the following rights regarding your medical information. In order to exercise these rights, you must contact our HIPAA Privacy Officer. You may be asked to submit a written request. The HIPAA Privacy Officer may be contacted using the following information:
Rume Medical Group, Inc.
Attn: Privacy Officer
Right to Inspect and Copy. With certain exceptions, you have the right to inspect and receive copies of your medical information.
Amendment. If you feel that medical information about you is incorrect or incomplete, you may ask us to amend the information.
Right to an Accounting of Disclosures. You have the right to receive a list of certain disclosures that we may have made of your medical information.
Right to Request Restrictions. You have the right to request a restriction or limitation on medical information that we use or disclose about you for treatment, payment or health care operations, and to request a limit on the medical information that we may disclose to family members or friends involved in your care.
Request Confidential Communications. You have the right to request that we communicate with you about your appointments or other matters related to your treatment in a specific way or at a specific location.
Receive a Copy. You have the right to obtain a copy of this notice.
CHANGES TO THIS NOTICE
We reserve the right to change the terms of this Notice at any time. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any we receive in the future. We will post a copy of the current Notice. The Notice will contain an effective date.
QUESTIONS AND COMPLAINTS
If you have any questions or believe that your privacy rights have been violated, you may contact our HIPAA Privacy Officer in person or mail a written summary of your concern to the address listed above.
You may also file a complaint with the Department of Health and Human Services as follows:
Email: email@example.com or call 1(800) 368-1019
You will not be penalized or retaliated against for filing a complaint.
OTHER USES OF MEDICAL INFORMATION
Other uses and disclosures of medical information not covered by this Notice or the laws that apply to use will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission in writing at any time. If you revoke your permission we will stop any further use or disclosure of your medical information for the purposes covered by your written authorization, except if we have already acted in reliance on your permission. You understand that we are unable to take back any disclosure we have already made with your permission and that we are required to retain its records of the care that we provided to you.
ACKNOWLEDGMENT OF RECEIPT
You acknowledge that you have received the HIPAA Notice of Privacy Practices of Rume Medical Group, Inc.
THE FOREGOING IS ACKNOWLEDGED AS RECEIVED THROUGH THE EXECUTION OF THE ACCOMPANYING CLIENT AGREEMENT BY THE CLIENT, Rume Medical Group, INC., AND ANY FINANCIALLY RESPONSIBLE PARTY.