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.
THIS NOTICE APPLIES TO ALL OF THE RECORDS OF YOUR CARE
GENERATED BY REGENERATIVE MEDICINE INSTITUTE (“COMPANY”) WHETHER MADE BY THE COMPANY OR AN ASSOCIATED FACILITY.
Uses and Disclosures
Treatment. Your health information may be used by staff members or
disclosed to other health care professionals for the purpose of evaluating your
health, diagnosing medical conditions, and providing treatment. For example,
results of laboratory tests and procedures will be available in your medical
record to all health professionals who may provide treatment or who may be
consulted by staff members.
Payment. Your health information may be used to seek payment from your
health plan and from other sources such credit card companies that you may use
to pay for services. For example, your health plan may request and receive
information on dates of service, the services provided, and the medical
condition being treated.
Health care operations. Your health information may be used as necessary
to support the day-to-day activities and management of our Company. For
example, information on the services you received may be used to support
budgeting and financial reporting, and activities to evaluate and promote
quality.
Law enforcement. Your health information may be disclosed to law
enforcement agencies to support government audits and inspections, to
facilitate law-enforcement investigations, and to comply with government
mandated reporting.
Public health reporting. Your health information may be disclosed to
public health agencies as required by law. For example, we are required to
report certain communicable diseases to the state’s public health department.
Other uses and disclosures require your authorization. Disclosure of your
health information or its use for any purpose other than those listed above
requires your specific written authorization. If you change your mind after
authorizing a use or disclosure of your information you may submit a written
revocation of the authorization. However, your decision to revoke the
authorization will not affect or undo any use or disclosure of information that
occurred before you notified us of your decision to revoke your authorization.
Additional Uses of Information
Appointment reminders. Your health information may be used by our staff
to send you appointment reminders.
Information about treatments. Your health information may be used to
send you information that you may find interesting on the treatment and
management of your medical condition. We may also send you information
describing other health-related products and services that we believe may
interest you.
Fund raising. Unless you request us not to, we may use your name and
address to support our fund-raising efforts, if any. If you do not want to
participate in fund-raising efforts, please contact us.
Individual Rights
You have certain rights under the federal privacy standards. These include the
following and are explained in greater detail in the PATIENT RIGHTS section of
this notice:
-
the right to request restrictions on the use and disclosure of your protected
health information
- the right to receive confidential communications
concerning your medical condition
- the right to inspect and copy your
protected health information
- the right to amend or submit corrections to
your protected health information
-
the right to receive an accounting of how and to whom your protected health
information has been disclosed
-
the right to receive a printed copy of this notice
Duties of the Company
We are required by law to maintain the privacy of your protected health
information and to provide you with this notice of privacy practices. We also
are required to abide by the privacy policies and practices that are outlined
in this notice.
Right to Revise Privacy Practices
As permitted by law, we reserve the right to amend or modify our privacy
policies and practices. Changes in our policies and practices may be required
by changes in federal and state laws and regulations. Upon request, we will
provide you with the most recently revised notice on any office visit. The
revised policies and practices will be applied to all protected health
information we maintain.
Requests to Inspect Protected Health Information You may generally
inspect or copy the protected health information that we maintain. As permitted
by federal regulation, we require that requests to inspect or copy protected
health information be submitted in writing. You may obtain a form to request
access to your records by contacting our receptionist or privacy officer. Your
request will be reviewed and will generally be approved unless there are legal
or medical reasons to deny the request.
Complaints
If you would like to submit a comment or complaint about our privacy practices,
you can do so by sending a letter outlining your concerns to:
Privacy Officer
Regenerative Medicine Institute
3121 S. Maryland Parkway, Suite 206
Las Vegas, Nevada 89109
If you believe that your privacy rights have been violated, you should call the
matter to our attention by sending a letter describing the cause of your
concern to the same address. You will not be penalized or otherwise retaliated
against for filing a complaint.
Contact Person
The name and address of the person you can contact for further information
concerning our privacy practices is as noted above. You may call us at 877-RMI-LAB6.
Effective Date
This Notice is effective on or after July 1, 2005.
PATIENT RIGHTS
THIS SECTION DESCRIBES YOUR RIGHTS AND THE OBLIGATIONS OF THIS COMPANY REGARDING
THE USE AND DISCLOSURE OF YOUR MEDICAL INFORMATION.
You have the following rights regarding medical information we maintain about
you:
Right to Inspect and Copy
You have the right to inspect and copy medical information that may be used to
make decisions about your care. This includes your own medical and billing
records, but does not include psychotherapy notes. Upon proof of an appropriate
legal relationship, records of others related to you or under your care
(guardian or custodial) may also be disclosed. To inspect and copy your medical
record, you must submit your request in writing to our Privacy Officer. If you
request a copy of the information, we may charge a fee for the costs of
copying, mailing or other supplies (tapes, disks, etc.) associated with your
request. We may deny your request to inspect and copy in certain very limited
circumstances. If you are denied access to medical information, you may request
that our denial be reviewed. Another licensed health care professional chosen
by the Company will review your request and the denial. The person conducting
the review will not be the person who denied your request. We will comply with
the outcome and recommendations from that review.
Right to Amend
If you feel that the medical information we have about you in your record is
incorrect or incomplete, then you may ask us to amend the information by
following the procedure below.
You have the right to request an amendment for as long as the Company maintains
your medical record.
To request an amendment, your request must be submitted in writing, along with
your intended amendment and a reason that supports your request to amend. The
amendment must be dated and signed by you and notarized.
We may deny your request for an amendment if it is not in writing or does not
include a reason to support the request. In addition, we may deny your request
if you ask us to amend information that:
-
Was not created by us, unless the person or entity that created the information
is no longer available to make the amendment;
- Is not part of the medical
information kept by or for the Company;
- Is not part of the information which
you would be permitted to inspect and copy; or
- Is inaccurate and incomplete.
Right to an Accounting of Disclosures
You have the right to request an "accounting of disclosures." This is a list of
the disclosures we made of medical information about you, to others. To request
this list, you must submit your request in writing. Your request must state a
time period not longer than six (6) years back and may not include dates before
July 1, 2005 (or the actual implementation date of the HIPAA Privacy
Regulations). Your request should indicate in what form you want the list (for
example, on paper or electronically). We will notify you of the cost involved
and you may choose to withdraw or modify your request at that time before any
costs are incurred.
Right to Request Restrictions You have the right to request a
restriction or limitation on the medical information we use or disclose about
you for treatment, payment or health care operations. You also have the right
to request a limit on the medical information we disclose about you to someone
who is involved in your care or the payment for your care (a family member or
friend). For example, you could ask that we not use or disclose information
about a particular treatment you received.
We are not required to agree to your request and we may not be able to comply
with your request. If we do agree, we will comply with your request
except that we shall not comply, even with a written request, if the
information is excepted from the consent requirement or we are otherwise
required to disclose the information by law.
To request restrictions, you must make your request in writing and your request
must indicate:
-
what information you want to limit;
-
whether you want to limit our use, disclosure or both; and
- to whom you want the
limits to apply, (e.g., disclosures to your children, parents, spouse, etc.)
Right to Request Confidential Communications
You have the right to request that we communicate with you about medical
matters in a certain way or at a certain location. For example, you can ask
that we only contact you at work or by mail, that we not leave voice mail or
e-mail, or the like.
To request confidential communications, you must make your request in writing.
We will not ask you the reason for your request. We will accommodate all reasonable
requests. Your request must specify how or where you wish us to contact you.
Right to a Paper Copy of This Notice
You have the right to a paper copy of this notice. You may ask us to give you a
copy of this notice at any time. Even if you have agreed to receive this notice
electronically, you are still entitled to a paper copy of this notice.
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