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.
UNDERSTANDING YOUR HEALTH RECORD/INFORMATION
This notice describes the practices of RenewMe Medspawith respect to your protected health information created while you are a patient of RenewMe. RenewMe and personnel authorized to have access to your medical chart are subject to this notice.
We create a record of the care and services you receive from RenewMe. We understand that medical information about you and your health is personal. The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) is a federal statute that requires that all protected health information used or disclosed by RenewMe in any form, whether electronically, on paper, or orally, are kept confidential. We are committed to protecting medical information about you. This notice applies to all of the records of your care by RenewMe.
This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.
YOUR HEALTH INFORMATION RIGHTS
Although your health record is the physical property of RenewMe, the information belongs to you. You have the right to:
- Inspect and request a paper or electronic copy of your health record as provided by law;
- Request that we amend your health record as provided by law. We will notify you if we are unable to grant your request to amend your health record;
- Request communication of your health information by alternative means or at alternative locations. We will accommodate reasonable requests;
- Request a restriction on certain uses and disclosures of your information for treatment, payment, health care operations and as to disclosures permitted to persons, including family members involved with your care and as provided by law. However, we are not required by law to agree to a requested restriction, unless the request relates to a restriction on disclosures to your health insurer regarding health care items or services for which you have paid out-of-pocket and in-full;
- Obtain an accounting of disclosures of your health information as provided by law;
- Obtain a paper copy of this notice of information practices; and
- Choose someone to act for you if you have given someone medical power of attorney or if someone is your legal guardian. We will verify the person’s authority before we take action.
You may exercise your rights set forth in this notice by providing a written request to RenewMe at firstname.lastname@example.org.
In addition to the responsibilities set forth above, we are also required to:
- Maintain the privacy of your health information;
- Subject to certain exceptions under the law, provide notice of any unauthorized acquisition, access, use or disclosure of your protected health information to the extent it was not otherwise secured;
- Provide you with a notice as to our legal duties and privacy practices with respect to information we maintain about you;
- Abide by the terms of this notice; and
- Notify you if we are unable to agree to a requested restriction on certain uses and disclosures.
USES AND DISCLOSURES OF MEDICAL INFORMATION THAT DO NOT REQUIRE YOUR AUTHORIZATION
The following categories describe different ways that we may use and disclose medical information without your authorization. For each category of uses or disclosures we will explain what we mean, but not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information without your authorization should fall within one of the categories.
We will use your health information for treatment.
For example: We may disclose medical information about you to doctors, nurses, technicians, medical students, or other personnel who are involved in taking care of you. We may share medical information about you in order to coordinate different treatments, such as prescriptions, lab work and x-rays. We may also provide your physician or a subsequent healthcare provider with copies of various reports to assist in treating you once you are discharged from care by RenewMe.
We will use your health information for payment.
For example: Abill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.
We will use your health information for regular health care operations.
For example: We may use the information in your health record to assess the care and outcome in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the health care and services we provide.
We will use and disclose your health information as otherwise allowed by law. Examples of those uses and disclosures follow:
Business associates: There are some services provided in our organization through agreements with business associates. Examples include answering services and copy services. To protect your health information, however, we require business associates to appropriately safeguard your information.
Notification: Unless you object, we may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care about your location and general condition.
Individuals involved in your care: Unless you object, we may disclose to a family member, other relative, a close personal friend or other person you identify the health information that is directly relevant to that person’s involvement in your health care or payment for your health care. If you are not able to agree or object to such disclosure, we may disclose the information as necessary if we determine it is in your best interest in our professional judgment.
Disaster relief: We may use or disclose your health information to public or private disaster relief organizations to coordinate your care or to notify your family or friends of your location or condition in a disaster. We will provide you with an opportunity to agree or object to these disclosures when practical.
Research: We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to protect the privacy of your health
Communications regarding treatment alternatives and appointment reminders: We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, medications, devices, supplements, product and product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacement.
Worker’s compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to worker’s compensation or other similar programs established by law.
Public health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
Abuse, neglect or domestic violence: As required by law, we may disclose health information to a governmental authority authorized by law to receive reports of abuse, neglect, or domestic violence.
Judicial, administrative and law enforcement purposes: Consistent with applicable law, we may disclose health information about you for judicial, administrative and law enforcement purposes.
Health oversight activities: We may disclose health information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections and licensure.
Threats to health or safety: We may use or disclose health information as allowed by law if we believe in good faith that it is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public or for law enforcement authorities to identify or apprehend an individual involved in a crime.
Special government functions: We may disclose health information to authorized federal officials for intelligence, counter-intelligence and other national security activities authorized by law, or for protective services to the President of the United States or certain other government officials. If you are a member of the military, we may disclose health information to military authorities under some circumstances. If you are an inmate of a jail, prison or other correctional facility or in the custody of law enforcement personnel, we may disclose health information necessary for your health and the health and safety of others.
Required or allowed by law: We will disclose medical information about you when required or allowed to do so by federal, state or local law.
Electronic Health Information Exchange: We use a third party to maintain our electronic medical records (“EMR”), and stores electronic health information about you in the EMR. We monitor who can view your EMR and limit access to the personnel with an actual need to access your information.
WHEN WE NEED YOUR WRITTEN AUTHORIZATION
Any uses or disclosures outside the scope described above will be made only with your written authorization. Most uses or disclosures of psychotherapy notes, and of protected health information for marketing purposes and the sale of protected health information require an authorization. You may revoke such authorization in writing at any time and RenewMe is required to honor and abide by that revocation, except to the extent that it has already taken actions relying on your authorization.
FOR MORE INFORMATION OR TO REPORT A PROBLEM
If you have questions and would like additional information, you may contact RenewMe at (213) 866-3747.
If you believe your privacy rights have been violated, you can send a complaint to RenewMe at email@example.com. You may also contact RenewMe directly by telephone. For all complaints, please ask for or direct attention to the Privacy Officer. You can also send a complaint to U.S. Department of Health and Human Services, Office for Civil Rights, Centralized Case Management Operations, 200 Independence Ave., S.W. Suite 515F, HHH Building, Washington, D.C. 20201, by calling the Customer Response Center at: (800) 368-1019, by facsimile at: (202) 619-3818, by calling TDD: (800) 537-7697, or by email at: firstname.lastname@example.org, or by visiting https://www.hhs.gov/hipaa/filing-a-complaint/index.html.
There will be no retaliation against you for filing a complaint.
THIS NOTICE OF PRIVACY PRACTICES IS EFFECTIVE AS OF SEPTEMBER 8, 2021.
We may change our policies and this notice at any time and have those revised policies apply to all the protected health information we maintain. RenewMe will periodically post from time to time, and you may request a written copy of, any updated versions of this notice.