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 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. 
2. 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. 
3. 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. 
4. 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. 
5. 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. 
6. 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.