Privacy Policy

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.

Effective Date

This notice is effective as of June 21, 2024.

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Obtain a Copy of This Notice

• You can request a paper or electronic copy of this notice from any RTI staff member.
• We will provide you with a copy promptly upon request.
• You can view this notice any time by visiting https://restorative-therapies.com/privacy-policy/.

Obtain Your Medical Record

• You can request an electronic or paper copy of your medical record by submitting an Authorization to Release or Obtain PHI form to the Health Information Management department.
• We will provide a copy or summary of your health information within 30 days.
• We may charge a reasonable, cost-based fee.

Correct Your Medical Record

• You can request that we correct health information about you that you think is incorrect or incomplete by submitting a Request to Amend or Restrict PHI form to the Health Information Management department.
• We may deny your request, but we will provide a written explanation within 60 days.
• We cannot make any changes to documents not created by us. For example, we cannot make any changes to medical records obtained from another provider.

Limit the Information We Share

• You can request that we not share certain information for treatment, payment, or operations.
• For example, if you pay for a product or service out-of-pocket in full, you can request that we do not share that information for the purpose of payment or operations with your health plan.
• We are not required to honor your request and may deny it if the requested restriction would affect your care.
• If we agree to honor your request, the restriction will remain in effect until you submit a written request to terminate it.
• You can request a restriction by submitting a Request to Restrict PHI form to the Health Information Management department.
• You can request to terminate a restriction by submitting a Request to Revoke Authorization or Restriction of PHI form to the Health Information Management department.

Obtain a List of Those with Whom We’ve Shared Information

• You can request a list (“accounting”) of the times we have shared your health information by submitting a Request for Accounting of Disclosures of PHI form to the Health Information Management department.
• We will include all disclosures made for up to six (6) years prior to the date of your request except for routine disclosures regarding treatment, payment, and health care operations, and certain other disclosures (such as any completed at your request).
• We will provide one accounting per year at no cost but may charge a reasonable, cost-based fee for any additional accounting provided within twelve (12) months.

Confidential Communications

• You can request that we contact you in a specific way. For example, you can request that we only call or text a specific phone number or send mail to a different address.
• We will honor all reasonable requests.

Choose Someone to Act For You

• If you have given someone medical Power of Attorney (“POA”) or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
• We will confirm that this person has the authority to act for you before we take any action.

File a Complaint if You Feel Your Rights are Violated

• You can complain if you feel we have violated your rights by contacting the Health Information Management department.
• You can file a complaint with 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 certain health information, you can tell us your choices about what we share.

Sharing Information With Others Involved in Your Care

• We may discuss your health information with your family, friends, or other individuals involved in your care, if you have given us permission to do so.
• You can list the individuals that we have permission to communicate with on the Authorization for Disclosure of PHI form.
• You can make changes by submitting a new Authorization for Disclosure of PHI form to the Health Information Management department.

Marketing and Communications

• We will never share your health information for marketing purposes unless you have given us written permission to do so.
• You can request additional information about marketing by contacting the Health Information Management department or the Marketing and Communications department.

Our Uses & Disclosures

We typically use or share your health information for purposes of treatment (providing products or services), payment (billing for products or services), and health care operations (managing our business). We may also share your health information in ways that contribute to the public good, such as public health and research, or if required by law. For more information, please visit https://www.hhs.gov/hipaa/for-individuals/