Notice of Privacy Practices

This notice explains how your medical information may be used and disclosed, and how you can access this information. Please review it carefully.

For More Information, Please Contact Us:

2250 Reed Station Pkwy

Carbondale, IL 62901, USA

Phone Number: 618-457-4999

Who We Are

This Notice outlines the privacy practices of Rubicon Healthcare, as well as the privacy practices of:

• All of our physicians, nurse practitioners, physician assistants, and other healthcare professionals who are authorized to document information in your medical record.
• All of our departments, such as medical records and billing.
• All of our healthcare facility locations.
• All of our employees, staff, volunteers, and other personnel who work for us or represent us.

Our Pledge

We recognize that your health information and the care you receive are personal, and we are dedicated to protecting that information. When you receive treatment or other healthcare services from us, we create a record of those services. This record is necessary to ensure you receive high-quality care and to meet legal obligations.

This notice applies to all records related to your care, whether created by our healthcare professionals or others working in our facilities. It explains how we may use and share your personal health information, outlines your rights regarding that information, and details our responsibilities when using or disclosing it.

We are legally required to:

• Ensure that any health information identifying you is kept private in accordance with applicable laws.

• Provide you with this notice outlining our legal responsibilities and privacy practices regarding your personal health information.

• Comply with the terms of the notice that is currently in effect for all of your personal health information.

How we May Use and Disclose Your Health Information

We may use and disclose your personal health information for the following purposes:

For Treatment. We may use your health information to provide you with medical treatment or services. This may include sharing your information with doctors, nurses, technicians, medical students, or others involved in your care. These individuals may be based at Rubicon Healthcare, at a hospital if you’re admitted under our care, or at another healthcare facility such as a specialist’s office, lab, pharmacy, or provider to whom we refer you for treatment, consultation, diagnostic tests, prescriptions, or other services.

This also includes healthcare professionals at or outside Rubicon Healthcare whom we consult regarding your treatment. For instance, we might consult a specialist affiliated with Rubicon Healthcare or share relevant health details with an emergency room physician treating you—for example, letting them know you have diabetes, as it could impact how your body heals.

For Payment. We may use and share your health information to bill and receive payment from you, your insurance provider—including Medicare or Medicaid—or any other third party responsible for covering the cost of your care. We may also share your information with other healthcare providers or your health plan to help arrange payment related to your treatment.

For example, if you have health insurance, we might need to provide details about your visit to your insurance company so they can pay us or reimburse you. Additionally, we may inform your health plan about a treatment you need in order to obtain prior authorization or confirm whether the service is covered under your plan.

For Health Care Operations. We may use and share your health information as part of our routine operations, and we may also share it with other healthcare providers involved in your care or with your health plan for their operational purposes. These uses and disclosures are important for running Rubicon Healthcare efficiently and ensuring that all patients receive high-quality care, while also helping other providers and plans improve their services.

For instance, we might use your information to review the care we’ve provided and to assess how well our staff is meeting your needs. We may also combine your health information with that of other patients to determine what services we should offer, evaluate which services are no longer necessary, examine the effectiveness of new treatments, or compare our performance with that of other organizations to identify areas for improvement. When doing so, we may remove any details that identify you, so the data can be used for research or evaluation purposes without revealing who you are.

Appointment Reminders. We may use and share your health information to remind you about upcoming appointments at Rubicon Healthcare.

Health-Related Services and Treatment Alternatives. We may use and share your health information to inform you about health-related services or to suggest treatment options or alternatives that may be of interest to you. If you prefer not to receive this type of information, or if you would like us to send it to a different address, please let us know.

Individuals Involved in Your Care or Payment for Your Care. We may share your health information with a friend or family member who is involved in your care or helping to pay for your treatment. Only the necessary medical information will be disclosed.

We may also use your information to inform family members or other responsible individuals about your location and general condition, or share it with organizations assisting in disaster relief efforts. If you are capable of making your own healthcare decisions, we will ask for your permission before sharing your medical information for these purposes. However, if you are unable to make such decisions, we may share relevant information with family or others involved in your care if we believe it’s in your best interest, based on our professional judgment. For example, we may provide limited information to a family member picking up a prescription or x-ray on your behalf.

Research. In certain cases, we may use or share your health information for research purposes. For example, a study might compare recovery outcomes between patients using different medications for the same condition. All research projects go through a special approval process that reviews how health information will be used and ensures a balance between research needs and your privacy. Before we use or disclose information for research, the project must be approved. In some cases, we may share information with researchers who are preparing a study, as long as the information stays within our facility. If a researcher will need access to details that identify you, such as your name or address, or will be involved in your care, we will almost always ask for your specific consent.

Organ and Tissue Donation. If you are an organ donor, we may share your health information with organizations involved in organ, eye, or tissue procurement or transplantation, as necessary to support the donation process.

Fundraising Activities. We may use your health information to contact you for fundraising purposes to support our non-profit operations. If you prefer not to receive these communications, you can contact us using the information at the end of this Notice. Each fundraising message will clearly explain how to opt out of future contact.

Health Information Exchange. We may take part in one or more Health Information Exchanges (HIEs), which allow us to share your health information electronically with other participating providers for treatment, payment, and healthcare operations.

As Required By Law. We will disclose your health information when required to do so by international, federal, state, or local law.

To Avert a Serious Threat to Health or Safety. We may use or disclose your information when it’s necessary to prevent a serious threat to your health or safety, or to the health or safety of others. Any such disclosure would only be made to someone in a position to help prevent the threat.

Military and Veterans. If you are currently serving in the armed forces or have been discharged, we may release your health information as required by military command authorities or the Department of Veterans Affairs, when applicable. We may also disclose information about members of foreign military forces to the appropriate foreign military authorities.

Workers’ Compensation. We may disclose your health information as needed for workers’ compensation or similar programs that provide benefits for work-related injuries or illnesses.

Public Health Activities. In certain situations, we are required to report your health information for public health purposes. These activities typically include:

• Preventing or controlling disease, injury, or disability.

• Reporting births and deaths.

• Reporting cases of child abuse or neglect.

• Reporting adverse reactions to medications or problems with medical products.

• Notifying individuals about product recalls.

• Informing people who may have been exposed to a communicable disease or may be at risk of spreading it.

• Notifying the appropriate government authority if we believe a patient has been a victim of abuse, neglect, or domestic violence—this will only be done with your agreement or when required or authorized by law.

Health Oversight Activities. We may share your health information with health oversight agencies for activities permitted by law. These activities can include audits, investigations, inspections, and licensing processes. Such oversight is necessary for the government to monitor the healthcare system, public programs, and compliance with civil rights and regulatory laws.

Business Associates. We may disclose your health information to third-party service providers, known as business associates, who perform tasks or services on our behalf—such as billing or data processing—if the information is necessary for them to do their work. All business associates are required by contract to protect your privacy and are not allowed to use or share your information for any purpose other than what is outlined in the agreement.

Lawsuits and Disputes. If you are involved in a legal proceeding, we may release your health information in response to a court or administrative order. We may also respond to subpoenas, discovery requests, or other legal processes that are not accompanied by a formal order, but only if efforts have been made to notify you of the request or to secure a protective order for the requested information.

Law Enforcement. We may disclose your health information to law enforcement officials in the following situations:

• In response to a court order, subpoena, warrant, summons, or similar legal process

• To help identify or locate a suspect, fugitive, material witness, or missing person

• Under certain limited conditions, about a crime victim

• When we believe a death may have resulted from criminal activity

• Regarding criminal conduct that occurs at Rubicon Healthcare

• In emergency situations, to report a crime, the location of the crime or victims, or the identity, description, or location of the person believed to have committed the crime

Coroners, Medical Examiners, and Funeral Directors. We may provide health information to a coroner or medical examiner when needed, for example, to identify a deceased individual or determine the cause of death. We may also share relevant health information with funeral directors as required for them to perform their duties.

National Security and Intelligence Activities. We may disclose your health information to authorized federal officials for activities related to intelligence, counterintelligence, and national security, as permitted by law.

Protective Services for the President and Others. We may release your health information to authorized federal officials to assist in providing protection for the President, other designated individuals, or foreign heads of state, as well as for conducting authorized special investigations.

Inmates. If you are an inmate in a correctional facility or under the custody of a law enforcement official, we may release your health information to the facility or official if it is necessary for your care, to ensure your safety or the safety of others, or to maintain the safety and security of the correctional institution.

The following uses and disclosures of your Protected Health Information will only be made with your written authorization:

• Most uses and disclosures of psychotherapy notes, if those notes were created by Rubicon Healthcare

• Uses and disclosures of your information for marketing purposes

• Disclosures that involve the sale of your Protected Health Information

• Any other disclosures not outlined in this Notice of Privacy Practices

If you provide written authorization for us to use or disclose your health information, you may revoke that authorization at any time in writing. Once we receive your written revocation, we will stop using or disclosing your information for the purposes covered by the authorization. Please note, we cannot undo any disclosures already made under your previous authorization, and we are still required to maintain records of the care we have provided.

You have specific rights regarding your personal health information. This section of the notice explains those rights and how to exercise them:

Right to Inspect and Copy. You have the right to inspect and obtain a copy of your personal health information contained in your medical and billing records, or in any other records we use to make healthcare decisions about you. This right does not extend to psychotherapy notes, although, upon request and payment of any applicable fee, we may provide you with a summary of those notes.

To access or receive copies of your health information, you must submit a written request to one of our designated privacy contacts listed on the first page of this notice. If you request a copy, we may charge a reasonable fee to cover copying, mailing, and any other associated costs. However, we will not charge a fee if the information is needed to support a claim for benefits under the Social Security Act or other state or federal needs-based programs.

In rare cases, we may deny your request to inspect or copy your records. If this happens, you have the right to request a review of the denial. A licensed healthcare professional, not involved in the original decision, will be assigned to review your request. We will follow the outcome of that review. Note that certain denials, such as those involving psychotherapy notes, are not subject to review.

Right to Amend. If you believe that the health information we have about you is incorrect or incomplete, you have the right to request that we amend it. This applies to any records we maintain that are used to make decisions about your care.

To request an amendment, you must submit your request in writing to one of our privacy contacts listed on the first page of this notice. The request must be on a single sheet of paper, either clearly handwritten or typed, and must include a reason supporting your request for the change.

We may deny your request if it:

• Is not submitted in writing or does not include a valid reason,

• Refers to information that was not created by us (unless the originator is no longer available to make the correction),

• Is not part of the records we maintain,

• Is part of records you are not allowed to inspect or copy, or

• Is already accurate and complete.

If we do approve an amendment, we will inform the healthcare providers involved in your care and others as needed to ensure the updated information is used appropriately for treatment, payment, or healthcare operations, as described in this notice.

Right to Receive an Accounting of Disclosures. You have the right to request an accounting of certain disclosures of your health information that we have made. This accounting will not include all types of disclosures. For example, it will not include disclosures:

• Made for treatment, payment, or healthcare operations, as previously described in this notice

• Made with your written authorization

• Made to a family member, relative, or personal friend involved in your care or the payment for your care, when you have given permission

• Made to law enforcement officials

To request an accounting, you must submit a written request to one of our privacy contacts listed on the first page of this notice. Your request must specify a time period, which may not be more than six (6) years.

The first list you request within a 12-month period will be provided at no cost. For any additional requests within that same period, we may charge a reasonable fee for the cost of providing the list. We will inform you of any charges in advance, and you may choose to withdraw or modify your request to avoid or reduce the cost.

You will receive the accounting in paper form within 30 days of your request, or we will notify you if additional time is needed. In that case, the list will be provided no later than 60 days from the date of your original request.

Right to Request Restrictions. You have the right to ask us to limit how we use or disclose your health information for treatment, payment, or healthcare operations. You can also request that we restrict the information we share with someone involved in your care or in paying for your care, such as a family member or friend. For example, you might ask us not to share information with a specific doctor or not to inform your spouse about a certain treatment. Additionally, you may request that we do not disclose your health information to your health plan for specific services, provided you have paid for those services out-of-pocket in full.

We are not required to agree to most restriction requests if doing so is not feasible or if it would interfere with your care, except for the case involving out-of-pocket payments as mentioned above. If we do agree to a restriction, we will follow it unless the information is needed to provide emergency care. All requests for restrictions must be submitted in writing to one of our privacy contact persons listed on the first page of this notice. Your request must clearly describe what information you want to limit and to whom the limits should apply.

Right to Receive Confidential Communications. You have the right to request that we communicate with you in a specific way about your health information. For instance, you may ask that we contact you only at work or send mail to a particular address.

To make this request, please submit it in writing to one of our privacy contact persons listed on the first page of this notice. We won’t ask you to explain the reason for your request, but you must tell us how and where you want to be contacted. We will honor all reasonable requests.

Right to Notice in the Event of a Breach. We are legally required to protect the privacy of your protected health information. If there is ever a breach involving your unsecured health information, we will notify you promptly.

Right to a Paper Copy of This Notice. You have the right to receive a paper copy of this Notice of Privacy Practices at any time. To request a copy, contact one of our privacy contact persons listed on the first page of this notice. You may also access a copy online at our website: www.rubiconhealthcenter.org

 

We reserve the right to change this notice and to make the revised notice effective for all health information we maintain about you—both past and future. A copy of the current notice will be posted at our facility, and the effective date will be shown in the top right-hand corner of the first page. You may request a copy of the current notice at any time.

Complaints:

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. You can submit your complaint to us by mailing a written description, speaking with us in person, or calling us directly:

         2250 Reed Station Pkwy

         Carbondale, IL 62901, USA

         Phone Number: 618-457-4999

Please include a description of what happened, along with the dates and names of any individuals involved. Also, be sure to provide your contact information so we can follow up with you regarding your complaint. You will not be penalized in any way for filing a complaint.

Acknowledgment of Receipt of this Notice:

We will ask you to sign a separate form or notice to confirm that you have received a copy of this notice. If you choose not to sign or are unable to do so, a staff member will document the date and sign on your behalf. This acknowledgment will be kept in your records.