Re-new Institute, PLLC
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.
OUR COMMITMENT TO PROTECT YOUR HEALTH INFORMATION
Re-new Institute and/or its affiliates is dedicated to protecting your medical information. This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations for other purposes that are permitted or required by law. It also describes your rights to access and control your health information. A federal regulation, known as the “HIPAA Privacy Rule,” requires that we provide detailed notice in writing of our privacy practices. Your Protected Health Information (“PHI”) is information about you that identifies you and that relates to your past, present, or future health or condition, and related health care services. We are required by law to maintain the privacy of your PHI and to give you this Notice about our privacy practices that explains your rights as our patient and how, when, and why we may use or disclose your PHI.
We are required to abide by the terms of this Notice of Privacy Practices. We reserve the right to change the terms of our notice, at any time and apply those changes to all protected health information in our possession. You may request a revised version by accessing our website, or calling the office and requesting a revised copy be sent to you in the mail or asking for one at the time of your next appointment. The new Notice also will be posted on our website at: https://re-newinstitute.com/privacypolicy
Uses and Disclosures of Protected Health Information
Your protected health information may be used and disclosed by your physician, our office staff and others outside of our office who are involved in your care and treatment for the purpose of providing health care services to you. Your protected health information may also be used and disclosed to pay your health care bills and to support the operation of your physician’s practice.
The following are examples of the types of uses and disclosures of your protected health information that your physician’s office is permitted to make. These examples are in no way meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our office.
Treatment: We may use and disclose PHI about you to provide, coordinate or manage your health care and related services. This includes the coordination or management of your health care with another provider. For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you. We may consult with other health care providers regarding your treatment and coordinate and manage your health care with others. For example, we may use and disclose PHI when you need a prescription, lab work, or other health care services. We may also use and disclose PHI about you when referring you to another health care provider. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.
Payment: We may use and disclose PHI so that we can bill and collect payment for any such treatment and or services provided by us or by another provider. This may include certain activities that your health insurance plan may undertake before it approves or pays for health care services we recommend for you such as: making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. We may use and disclose PHI for billing, claims management, and collection activities. We may also disclose PHI to another health care provider or to a company or health plan required to comply with the HIPAA Privacy Rule for the payment activities of that health care provider, company, or health plan. For example, we may allow a health insurance company to review PHI relating to their enrollees to determine the insurance benefits to be paid for their enrollees’ care.
Health Care Operations: We may use and disclose, as needed, PHI in performing certain business activities in order to support the business activities of your physician’s practice. Some examples of these operations include but are not limited to our business, accounting and management activities. Health care operations also may include quality assurance, utilization review, and internal auditing, such as reviewing and evaluating the skills, qualifications, and performance of health care providers. If another health care provider, company, or health plan that is required to comply with the HIPAA Privacy Rule has or once had a relationship with you, we may disclose PHI about you for certain health care operations of that health care provider, company or health plan. For example, health care operations may include assisting with the legal compliance activities of that provider, company or plan.
Business Associates. We may contract with individuals and entities (business associates) to perform various functions or to provide certain types of services (for example, billing or transcription services) for our practice. Whenever an arrangement between our office and a business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.
Communications To You. We may use or disclose medical information in order to contact you to with information about possible or recommend treatment options and or alternatives, or other health-related benefits and services that may be of interest to you.
Other Uses And Disclosures Authorized By The HIPAA Privacy Rule. We may use and disclose PHI about you in the following circumstances, provided that we comply with certain legal conditions set forth in the HIPAA Privacy Rule.
Required By Law. We may use or disclose PHI as required by federal, state, or local law if the disclosure complies with the law and is limited to the requirements of the law.
Public Health Activities. We may disclose PHI to public health authorities or other authorized persons for public health activities and purposed to a public health authority that is permitted by law to collect or receive such information. For example, a disclosure may be made for the purpose of preventing or controlling disease, injury or disability.
Communicable Diseases. We may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
Abuse, Neglect, or Domestic Violence. We may disclose PHI to proper government authorities if we reasonably believe that you (or others) have been or may be a victim of domestic violence, abuse, or neglect.
Health Oversight. We may disclose PHI to a health oversight agency for oversight activities including, for example, audits, investigations, inspections, licensure and disciplinary activities and other activities conducted by health oversight agencies to monitor the health care system, government benefit programs, and other government regulatory programs and civil rights laws.
Food and Drug Administration. We may disclose your protected health information to a person or company required by the Food and Drug Administration for the purpose of quality, safety, or effectiveness of FDA-regulated products or activities including, to report adverse events, product defects or problems, biologic product deviations, to track products; to enable product recalls; to make repairs or replacements, or to conduct post marketing surveillance, as required.
Legal Proceedings. We may disclose your protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), or in certain conditions in response to a subpoena, discovery request or other lawful process when we receive satisfactory assurances that efforts have been made to advise you of the request or to obtain an order protecting the information requested.
Law Enforcement. We may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include (1) legal processes and otherwise required by law, (2) limited information requests for the identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of our practice, and (6) medical emergency (not on our practice’s premises) and it is likely that a crime has occurred.
Coroners, Medical Examiners or Funeral Directors. We may disclose PHI regarding decedents to a coroner, medical examiner or funeral director so that they may carry out their jobs.
Organ Donation. We may disclose PHI to organizations that help procure, locate, and transplant organs in order to facilitate organ, eye, or tissue donation and transplantation.
Threat to Health or Safety. In limited circumstances, we may disclose PHI when we have a good faith belief that the disclosure is necessary to prevent a serious and imminent threat to the health or safety of a person or to the public.
Specialized Government Functions. We may disclose PHI for certain specialized government functions, such as military and veteran activities, national security and intelligence activities, protective services for the president and others, medical suitability determinations, and for certain correctional institutions or in other law enforcement custodial purposes.
Compliance Review. We are required to disclose PHI to the Secretary of the United States Department of Health and Human Services when requested by the Secretary to review our compliance with the HIPAA Privacy Rule.
Workers’ Compensation. We may disclose PHI in order to comply with laws relating to workers’ compensation or other similar programs.
Research. For research purposes under certain limited circumstances for research projects that have been evaluated and approved through an approval process that takes into account your need for privacy. We must obtain a written authorization to use and disclose PHI about you for research purposes except in situations where a research project meets specific, detailed criteria established by the HIPAA Privacy Rule to ensure the privacy of PHI.
Emergencies. We may use or disclose your PHI in an emergency treatment situation in compliance with applicable laws and regulations.
With Your Written Authorization. Your written authorization generally will be obtained before we use or disclose psychotherapy notes about you that may be in our possession. Psychotherapy notes are separately filed notes about your conversations with a mental health professional during a counseling session; summary information about your mental health treatment does not constitute psychotherapy notes. In addition, your written authorization will be obtained for uses and disclosures of PHI for marketing purposes and disclosures that constitute a sale of PHI, unless use and disclosure is permitted without your authorization. Except as described in this Notice, all other uses and disclosures of your PHI will be made only with your written authorization. If you have authorized us to use or disclose PHI about you, you may revoke your authorization at any time, except to the extent we have taken action based on the authorization (e.g., you cannot revoke with respect to disclosures that have already been made).
Limited Data Set/Minimum Necessary. The amount of health information used or disclosed in accordance with the above provisions will be limited, to the extent practicable, to a limited data set, or if needed by Re-new Institute, to the minimum necessary to accomplish the intended purpose of the use, disclosure or request, respectively.
Other Permitted and Required Uses and Disclosure That Require Providing You the Opportunity to Agree or Object
We may use and disclose your protected health information in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your protected health information. If you are not present or able to agree or object to the use or disclosure of protected health information, then your physician may, using professional judgement, determine whether the disclosure is in your best interest.
Others Involved in Your Health Care of Payment for your Care. Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person(s) you identify, your protected health information that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgement. 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 of your location, general condition or death. Lastly, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.
YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
The HIPAA Privacy Rule gives you several rights with regard to your protected health information (PHI). These rights include:
- Right to Request Restrictions: You have the right to request a restriction or limitation on the PHI we use or disclose about you for treatment, payment or health care operations, or that we disclose to those who may be involved in your care or payment for your care. In the instances where you have paid for health care items or services out-of-pocket in-full, we are required upon request to restrict disclosures of PHI to your health plan. In all other instances, while we will consider a patient’s restriction request, we are not required to agree to it. If we do agree to your request, we will comply with your request except as required by law or for emergency treatment. To request restrictions, you must make your request in writing on our Request for Additional Restrictions on Communication Form to our Privacy Officer at the address listed on the last page of this Notice.
- Right to Receive Confidential Communications: You have the right to request that you receive communications regarding PHI in a certain manner or at a certain location. For example, you may request that we contact you at home, rather than at work. You must make your request in writing by submitting our Request for Alternative Communication Form specifying how you would like to be contacted (for example, by regular mail to your post office box and not your home) to our Privacy Officer. We will accommodate all reasonable requests.
- Right to Inspect and Copy: You have the right to inspect and receive a copy of your PHI contained in records we maintain that may be used to make decisions about your care. These records usually include your medical and billing records that we may maintain, but do not include psychotherapy notes, information gathered or prepared for a civil, criminal, or administrative proceeding, or PHI that is subject to law that prohibits access. To inspect and copy your PHI, you must make your request on our Request for Access form to our Privacy Officer at the address listed below. If you request a copy of PHI about you, we may charge you a reasonable fee for the copying, postage, labor and supplies used in meeting your request. If and only to the extent that Re-new Institute uses or maintains your PHI in an Electronic Health Record (“EHR”), as of the date required by the Health Information Technology for Clinical and Economic Health Act (“HITECH Act”), Re-new Institute will provide you with a copy of your PHI in electronic format and, upon your request, will transmit such copy directly to an entity or individual of your designation, provided that such designation is made clear, conspicuous and specific. We may charge you a fee for providing your PHI in electronic form equal to our labor costs incurred in responding to your request. We may deny your request to inspect and copy PHI only under limited circumstances, and in some cases, a denial of access may be reviewable.
- Right to Amend: If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information for as long as such information is kept by or for us. You must submit your request to amend in writing on our Request for Amendment of Patient Information Form to our Privacy Officer and give us a reason for your request. We may deny your request in certain cases. If your request is denied, you may submit a written statement disagreeing with the denial, which we will keep on file and distribute with all future disclosures of the information to which it relates.
- Right to Receive an Accounting of Disclosures: You have the right to request a list of certain disclosures of PHI made by us during a specified period of up to six years prior to the request, except disclosures: (i) for treatment, payment or health care operations, unless, as of the date required by the HITECH Act and only to the extent that Re-new Institute uses or maintains an EHR for you, such disclosures are made through your EHR (in which case the list of disclosures will be limited to those made in the three years prior to the date of your request, subject to certain restrictions); (ii) made to you; (iii) to persons involved in your care or for the purpose of notifying your family or friends of your whereabouts; (iv) for national security or intelligence purposes; (v) made pursuant to your written authorization; (vi) incidental to another permissible use or disclosure; (vii) for certain notification purposes (including national security, intelligence, correctional, and law enforcement purposes); or (viii) made before April 14, 2003. If you wish to make such a request, please contact our Privacy Officer. The first accounting that you request in a 12-month period will be free, but we may charge you for our reasonable costs of providing additional lists in the same 12-month period. We will tell you about these costs, and you may choose to cancel your request at any time before costs are incurred.
- Right to a Paper Copy of this Notice: You have a right to receive a paper copy of this Notice at any time. You are entitled to a paper copy of this Notice even if you have previously agreed to receive this Notice electronically. To obtain a paper copy of this Notice, please contact our Privacy Officer.
- The Right to Be Notified of a Breach of Unsecured PHI: We are required by law to maintain the privacy of your PHI and to notify you if a breach of your unsecured PHI occurs.
If you believe your privacy rights have been violated, you may file a complaint with us, or the Secretary of the United States, Department of Health and Human Services. To file a complaint with our office, please contact our Privacy Officer. We will not take action against you or retaliate against you in any way for filing a complaint.
If you have any questions or need additional information about this Notice, please contact our Privacy Officer.
You may contact our Privacy Officer at the following address and phone number:
18324 Cheyenne Rd.
Omaha, Nebraska 68136
EFFECTIVE DATE: The form of this notice was published and first became effective on November 1, 2020.