RNA 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. 

 

If you have any questions about this notice, please contact our privacy officer who is: Holly Curry, RN BSN. 

 

Rockford Nephrology Associates (RNA) is dedicated to maintaining the privacy of your personal health information. Each time a patient visits this office; a record is made that describes the treatments and services provided. Federal law outlines specific privacy protections and individual rights related to the information we maintain that identifies you as a patient. Protected information includes demographic data and facts about your past, present or future physical or mental health. Our office has put in place policies and procedures to help protect your health information. We are required to provide this notice outlining our legal duties and responsibilities related to the use and disclosure of patient identifiable health information, Privacy Practices, and examples of how your information may be used or disclosed. Company will abide by the terms of this notice. We may revise this notice at any time. The new notice will be posted in our office in a prominent location. You may request a revised version by accessing our website, your patient portal or calling the office and requesting that a revised copy be sent to you in the mail or asking for one at the time of your next appointment. Revisions to the notice will be effective for all health care information this office maintains: past, present or future. 

 

Company may use your individually identifiable health information for the following purposes without your authorization: 

 

  1. Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with another provider. For instance, we may send a copy of your records to another doctor so that you can be evaluated for a specific condition. 

In this regard, we disclose patient data to the CommonWell network as part of a query-based data exchange for permissible treatment purposes. 

  1. Payment: Your protected health information will be used and disclosed, as needed, to obtain payment for your health care services provided by us or by another provider. This may include providing your insurance company with the details of your treatment, sharing your payment information with other treatment providers, contacting you over the phone or through the mail about balances, or sending unpaid balances to a collection agency. 

  1. Health Care Operations: We may use and disclose health information in order to support the business activities of your physician's practice. For example, your health information may be used to evaluate the quality of care we provide, for state licensing or to identify you by name when you visit the office. 

You understand and acknowledge that we will disclose information in accordance with HIPAA laws to our affiliates (namely, Renal Care Organization, LLC and RCO Analytics, LLC) for the purposes of creating a population health care delivery model with goals of improving quality of health care and outcome, reducing costs of health care, and increasing savings to patients. 

  1. Appointment Reminders: We may use and disclose your information to remind you of appointments. We may also mail you a reminder postcard for follow-up visits. 

  1. Treatment Options: We may use your health information to inform you of treatment options or other health-related services which may be of interest to you. 

  1. Business Associates: We may share your health information with other individuals or companies that perform various activities for, or on behalf of, our office such as afterhour's telephone answering, billing or quality assurance. Our Business Associates agree to protect the privacy of your health information. 

  1. Research: We may use your information in conjunction with agents of the Practice who may be required to review your files, just as our employees are so permitted, in order to determine whether you are qualified for a research project. If you are asked to join a research project, you will be asked first to execute an authorization, granting the Practice or a research organization the right to use your protected health information. 

Company may disclose your health information without your authorization when permitted or required to by law, including: 

 

  • For public health activities including reporting of certain communicable diseases. 

  • Food and Drug Administration. 

  • For workers' compensation or similar programs as required by law. 

  • To authorities when we suspect abuse, neglect or domestic violence. 

  • If you are an inmate of a correctional facility. 

  • To health oversight agencies. 

  • To your employer if we provide health care services to you at the request of the employer, whereupon we shall provide you written notice of release so such information. 

  • For certain judicial and administrative proceedings pursuant to an administrative order. 

  • For law enforcement purposes. 

  • To a medical examiner, coroner or funeral director. 

  • For the facilitation of organ, eye or tissue donation if you are an organ donor. 

  • For research purposes under strictly limited circumstances. 

  • To avert a serious threat to your health and safety or that of others. 

  • In order to follow various mandates for clinical quality metric reporting, benchmarking, and related matters 

  • For governmental purposes such as military service or for national security. 

  • In the event of an emergency or for disaster relief, In any other instance required by law. 

  • Sign in sheet. 

 

 

 

Unless you object, company may also disclose your information to family members and/or other persons involved in your care or payment for your care. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care, general condition or death. 

 

Company may leave messages for you at work or home about your visits. If you do not want us to do so, please inform our Privacy Officer in writing. 

 

All other uses and disclosures of your information to others will require a written, signed authorization from you. You have the right to revoke your authorization at any time except to the extent that we have already acted on it. Should you require your records to be released, Company will provide you with an authorization form to complete and return to the address listed on it. 

 

YOUR HEALTH RECORD IS THE PHYSICAL PROPERTY OF PRACTICE. THE INFORMATION CONTAINED IN IT BELONGS TO YOU. BELOW IS A LIST OF YOUR RIGHTS REGARDING INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION. ALL REQUESTS RELATED TO THESE ITEMS MUST BE MADE IN WRITING TO OUR PRIVACY OFFICER AT THE ADDRESS LISTED BELOW. WE WILL PROVIDE YOU WITH APPROPRIATE FORMS TO EXERCISE THESE RIGHTS. WE WILL NOTIFY YOU, IN WRITING, IF YOUR REQUESTS CANNOT BE GRANTED. 

 

  1. Restrictions on Use and Disclosure: You have the right to request restrictions on how we use and disclose your health information. This includes requests to restrict disclosure of your health information to only certain individuals or entities, involved in your care such as family members and insurance companies. We are not required to agree with your request. If we agree, we are bound to the agreement unless disclosure is otherwise required or authorized by law. 

  1. Confidential Communications: You have the right to request that we communicate with you in a particular manner or at a certain location. For example, you may request that we only contact you at home. We will accommodate reasonable requests. 

  1. Access: You have the right to inspect or request a copy of records used to make decisions about your health care, including your medical chart and billing records. This office will schedule appointments for record inspection. We may charge a fee for providing you copies of your records. Under special circumstances, we may deny your request to inspect and/or copy your records. You may request a review of this denial. 

  1. Record Amendment: You have the right to request amendments to your health records created by and for this Company if you feel they are incorrect or incomplete. We may accept or deny your request. If we deny your request, you have the right to provide a statement of disagreement or rebuttal statement. 

  1. Accounting of Disclosures: You have the right to receive an accounting of the disclosures. This means you may request a list of certain disclosures Company has made of your records. Upon your request, we will provide this information to you one time free during each twelve (12) month period. There may be a fee for additional copies. 

  1. Copy of Notice: You have the right to request that we provide you with a paper copy of this notice of Privacy Practices. 

 

 

Complaints: 

You may complain to us or to the Secretary of Health and Human Services (Office for Civil Rights/U.S. Department of Health & Human Services) on-line at HHS.gov if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our Privacy Officer of your complaint. We will not retaliate against you for filing a complaint. 

 

You may contact our Privacy Officer Holly Curry, RN BSN at (815) 227-8331 for further information about the complaint process.  

 

If you have any questions about this notice, please contact Holly Curry, RN BSN at (815) 227-8331. 

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