Notice of privacy practices

Your rights

You have rights regarding the medical information we keep about you. We will respond to a request in accordance with applicable law. To make a request, contact us using the information in the Contact section. We may ask you to submit a request in writing and to verify your identity.

• Get a copy of your record. You may ask to inspect or receive a copy of your medical record and other health information we maintain about you. You may request an electronic copy when the record is maintained electronically. We usually provide a copy within 30 days of your request. If we need additional time as allowed by law, we will explain the reason and the expected date in writing. We may charge a reasonable, cost-based fee for copying, mailing, or preparing the copy as permitted by law.
• Ask us to correct your record. You may ask us to amend health information you believe is incorrect or incomplete. Make the request in writing and explain why the information should be changed. We may deny a request in certain circumstances, such as when the information is accurate and complete or was not created by us. If we deny your request, we will provide a written explanation and tell you how to submit a statement of disagreement.
• Request confidential communications. You may ask us to contact you in a specific way or at a different address or phone number. For example, you may ask us to call a particular number or send mail to a different address. We will accommodate reasonable requests and will not require you to explain the reason for your request.
• Ask us to limit what we use or share. You may ask us not to use or disclose certain health information for treatment, payment, or health care operations, or not to share it with someone involved in your care or payment. We are not required to agree to every request. However, if you or someone on your behalf pays in full out of pocket for a health care item or service and asks us not to disclose information about that item or service to your health plan for payment or health care operations, we must agree unless a law requires the disclosure.
• Get a list of disclosures. You may ask for an accounting of certain disclosures of your health information made during the six years before the date of your request. The accounting will not include all disclosures; for example, it generally does not include disclosures for treatment, payment, and health care operations or disclosures you authorized. You may receive one accounting in any 12-month period at no charge. We may charge a reasonable, cost-based fee for additional accountings in that period, and we will tell you about the fee so you can withdraw or modify your request.
• Get a paper copy of this notice. You may request a paper copy at any time, even if you agreed to receive this notice electronically. You may also read or print the notice from our website.
• Choose someone to act for you. If you have given someone medical power of attorney or if someone is your legal guardian or personal representative, that person may exercise your rights and make choices about your health information to the extent allowed by law. We will verify the person's authority before acting on a request.
• File a complaint. If you believe we have violated your privacy rights, you may complain to us or to the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.

Your choices

For some health information, you can tell us your preferences about what we share. If you have a clear preference in a situation described below, tell your care team or contact our Privacy Officer. We will follow your direction when the law allows us to do so.

• People involved in your care or payment. We may share relevant information with a family member, close friend, or another person you identify as involved in your care or payment for your care. We may also share information with someone helping in a disaster relief effort. If you are present, we will ask whether you agree, give you an opportunity to object, or reasonably infer from the circumstances that you do not object. If you are not able to express a preference, we may use our professional judgment and share information that is directly relevant to the person's involvement, when permitted by law.
• Fundraising communications. If we contact you about fundraising, you may opt out of future fundraising communications at any time. We will explain how to make that choice in the communication.

We do not use or disclose your information for marketing, sell your health information, or disclose psychotherapy notes without your written permission, except where the law specifically permits or requires a disclosure. If you give written permission for a use or disclosure that requires authorization, you may revoke it in writing at any time. A revocation does not undo actions already taken in reliance on your authorization.

How we typically use or share your information

We may use and disclose your health information for treatment, payment, and health care operations without a separate written authorization when allowed by law. These are common and necessary parts of providing care and operating a medical practice.

• Treat you. We use information to provide, coordinate, or manage your health care and related services. For example, a physician may review your history and share relevant information with another clinician involved in your care so they can coordinate a referral or follow-up.
• Run our organization. We use information to operate and improve our practice, support quality and safety activities, train staff, review care, and manage our services. For example, authorized staff may review a record to confirm that care was documented and coordinated appropriately.
• Bill for your services. We use and share information to bill and receive payment from you, an insurer, or another responsible party. For example, we may send an insurer information about a service so it can determine coverage and pay a claim.

We may also contact you about appointments, care instructions, treatment alternatives, or health-related services that may be relevant to you. We may share information with business associates that perform services for us, such as billing or information technology support. These partners must agree in writing to safeguard the information and use it only as permitted for their work.

Other ways we may use or share your information

We may use or disclose health information for the purposes below when the legal conditions for the disclosure are met. We limit disclosures to what the law permits or requires.

• Help with public health and safety issues. This may include reporting certain diseases, injuries, births, or deaths; helping with product recalls; reporting adverse reactions to medications; preventing or reducing a serious threat to someone's health or safety; and reporting suspected abuse, neglect, or domestic violence when authorized or required by law.
• Do research. We may use or disclose information for health research when the required privacy protections and approvals are in place. Where required, we will ask for your written permission before information that identifies you is used for research.
• Comply with the law. We will share information when federal, state, or local law requires us to do so, including disclosures to health oversight agencies that are authorized to inspect or investigate health care activities.
• Respond to organ and tissue donation requests. We may share information with organizations that coordinate organ, eye, or tissue donation and transplantation when permitted by law.
• Work with a medical examiner or funeral director. We may share information with a coroner, medical examiner, or funeral director as needed for their duties and as permitted by law.
• Address workers' compensation and similar programs. We may use or disclose information for workers' compensation claims or other programs that provide benefits for work-related injuries or illness.
• Respond to law enforcement and other government requests. We may disclose information to law enforcement officials, correctional institutions, military authorities, national security officials, or other government agencies in circumstances allowed by law. We may also disclose information in response to a valid legal process or to a government agency conducting oversight.
• Respond to lawsuits and legal actions. We may disclose information in response to a court or administrative order, subpoena, or other lawful process when the legal requirements are met.

Our responsibilities

We are required by law to protect the privacy and security of your health information, provide you with this notice of our legal duties and privacy practices, and follow the terms of the notice currently in effect. We will notify you promptly if a breach occurs that may have compromised the privacy or security of your information, as required by law.

We will not use or share your information other than as described in this notice unless you tell us in writing that we may do so. If you give us written permission, you may change your mind at any time by notifying us in writing. Your change will apply to future uses and disclosures; it cannot reverse actions we have already taken in reliance on your permission.

For more information about your rights or our privacy practices, contact our Privacy Officer using the details at the end of this notice.

Changes to the terms of this notice

We may change the terms of this notice, and the changes will apply to all health information we have about you. The current notice will be available on our website and in our offices. The effective date at the top of the notice identifies the version currently in effect. You may request a paper copy at any time.

Contact

To exercise your rights, request a paper copy, ask a question, or file a complaint with us, contact our Privacy Officer at the address and phone number below.

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. Write to 200 Independence Avenue S.W., Washington, D.C. 20201; call 1-877-696-6775; or visit hhs.gov/ocr/privacy/hipaa/complaints. We will not retaliate against you for filing a complaint with us or with the Office for Civil Rights.

Riverbend Medical Group
Attn: Privacy Officer
655 N High Street, Suite 210
Columbus, OH 43215
(614) 938-2740