RT Medical LLC Notice of Privacy Practices
Effective Date: October 23, 2025
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.
If you have any questions about this Notice, please contact our main office with questions 615-469-7299.
RT Medical LLC is a durable medical equipment provider located in Tennessee. This Notice of Privacy Practices describes how we may use and disclose your Protected Health Information (PHI) to carry out treatment, payment, or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your PHI. PHI is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health or condition and related health care services.
We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice at any time. The new notice will be effective for all PHI that we maintain at that time. Any revision to this Notice of Privacy Practices will be posted on our website at www.rtmedical.com/privacy and available at our office location. You may also contact us and request that a revised copy be sent to you in the mail or ask for one at the time of your next visit.
I. Uses and Disclosures of PHI
A. Uses and Disclosures of PHI Based Upon Your Written Consent
You will be asked to sign a consent form. Once you have consented to the use and disclosure of your PHI for treatment, payment, and health care operations by signing the consent form, RT Medical LLC will use or disclose your PHI as described in this Section I. Your PHI may be used and disclosed by your healthcare provider, our staff, and others outside of our organization that are involved in your care and treatment for the purpose of providing health care services to you. Your PHI may also be used and disclosed to pay your health care bills and to support the operation of our organization.
Following are examples of the types of uses and disclosures of your protected health information that we are permitted to make once you have signed our consent form. These
examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our organization once you have provided consent.
1. Treatment: We will use and disclose your PHI to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party that has already obtained your permission to have access to your PHI. For example, we would disclose PHI to physicians who may be treating you when we have the necessary permission from you to disclose your PHI. Your PHI may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you. In addition, we may disclose your PHI from time to time to another healthcare provider (e.g., a specialist or laboratory) who, at the request of your physician, becomes involved in your care by providing assistance with your health care diagnosis or treatment.
2. Payment: Your PHI will be used, as needed, to obtain payment for your health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for health care services, such as making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, obtaining approval for a service may require that your relevant PHI be disclosed to the health plan.
3. Healthcare Operations: We may use or disclose, as needed, your PHI in order to support the business activities of our organization. These activities include, but are not limited to, quality assessment activities, employee review activities, licensing, marketing, and conducting or arranging for other business activities. For example, we may ask for your name and date of birth upon arrival. We may also call you by name when you are ready to be seen. We may use or disclose your PHI, as necessary, to contact you to remind you of an appointment, including via secure text messaging through our compliant communication platform (e.g., for appointment reminders, health notifications, or instructions). We will share your PHI with third-party “business associates” that perform various activities (e.g., billing services or communication platforms like RingCentral) for our organization. Whenever an arrangement between us and a business associate involves the use or disclosure of your PHI, we will have a written contract (such as a Business Associate Agreement) that contains terms to protect the privacy of your PHI. We may use or disclose your PHI, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you. We may also use and disclose your PHI for other marketing activities. For example, your name and address may be used to send you a newsletter about our services. You may contact our Privacy Officer to request that these materials not be sent to you.
B. Uses and Disclosures of PHI Based Upon Your Written Authorization
Other uses and disclosures of your PHI will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke this authorization at
any time, in writing, except to the extent that we have taken an action in reliance on the use or disclosure indicated in the authorization. For example, we require your authorization for most uses and disclosures of psychotherapy notes, uses and disclosures for marketing purposes (except as permitted by law), and disclosures that constitute a sale of PHI.
C. Other Permitted and Required Uses and Disclosures That May Be Made With Your Consent, Authorization, or Opportunity to Object
We may use and disclose your PHI in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your PHI. If you are not present or able to agree or object, your healthcare provider may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the PHI that is relevant to your health care will be disclosed.
1. Others Involved in Your Healthcare: Unless you object, we may disclose to a member of your family, a relative, a close friend, or any other person you identify, your PHI that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose your PHI to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.
2. Emergencies: We may use or disclose your PHI in an emergency treatment situation. If this happens, your healthcare provider shall try to obtain your consent as soon as reasonably practicable after the delivery of treatment. If your healthcare provider is required by law to treat you and has attempted to obtain your consent but is unable to do so, they may still use or disclose your PHI to treat you.
3. Communication Barriers: We may use or disclose your PHI if your healthcare provider attempts to obtain consent from you but is unable to do so due to substantial communication barriers and determines, using professional judgment, that you intend to consent to use or disclosure under the circumstances.
D. Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent, Authorization, or Opportunity to Object
We may use and disclose your PHI in the following situations without your consent or authorization. These situations include:
1. Required By Law: We may use or disclose your PHI to the extent that the use or disclosure is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of any such uses or disclosures.
2. Public Health: We may disclose your PHI for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The
disclosure will be made for the purpose of controlling disease, injury, or disability. We may also disclose your PHI, if directed by the public health authority, to a foreign government agency that is collaborating with the public health authority.
3. Health Oversight: We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs, and civil rights laws.
4. Abuse or Neglect: We may disclose your PHI to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your PHI if we believe that you have been a victim of abuse, neglect, or domestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.
5. Food and Drug Administration: We may disclose your PHI to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, track products; to enable product recalls; to make repairs or replacements; or to conduct post-marketing surveillance, as required.
6. Legal Proceedings: We may disclose PHI in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request, or other lawful process.
7. Law Enforcement: We may also disclose PHI, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include (1) legal processes and otherwise required by law, (2) limited information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on our premises, and (6) medical emergency (not on our premises) and it is likely that a crime has occurred.
8. Criminal Activity: Consistent with applicable federal and state laws, we may disclose your PHI if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose PHI if it is necessary for law enforcement authorities to identify or apprehend an individual.
9. Workers’ Compensation: Your PHI may be disclosed by us as authorized to comply with workers’ compensation laws and other similar legally established programs.
10. Inmates: We may use or disclose your PHI if you are an inmate of a correctional facility and we created or received your PHI in the course of providing care to you.
11. Required Uses and Disclosures: Under the law, we must make disclosures to you and, when required by the Secretary of the Department of Health and Human Services, to investigate or determine our compliance with the requirements of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule.
II. Your Rights
Following is a statement of your rights with respect to your PHI and a brief description of how you may exercise these rights.
A. You have the right to inspect and copy your PHI. This means you may inspect and obtain a copy of PHI about you that is contained in a designated record set for as long as we maintain the PHI. A “designated record set” contains treatment and billing records and any other records that we use for making decisions about you. Under federal law, however, you may not inspect or copy the following records: information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and PHI that is subject to law that prohibits access to PHI. Depending on the circumstances, a decision to deny access may be reviewed. In some circumstances, you may have a right to have this decision reviewed. Please contact our Privacy Officer if you have questions about access to your medical record.
B. You have the right to request a restriction of your PHI. This means you may ask us not to use or disclose any part of your PHI for the purposes of treatment, payment, or healthcare operations. You may also request that any part of your PHI not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice. Your request must state the specific restriction requested and to whom you want the restriction to apply. We are not required to agree to a restriction that you may request, except for requests to restrict disclosures to your health plan for payment or health care operations purposes if you have paid for the item or service out of pocket in full. If we agree to the requested restriction, we may not use or disclose your PHI in violation of that restriction unless it is needed to provide emergency treatment. Please discuss any restriction you wish to request with your healthcare provider. You may request a restriction by contacting the Privacy Officer.
C. You have the right to request to receive confidential communications from us by alternative means or at an alternative location. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact (e.g., secure text messaging). We will not request an explanation from you as to the basis for the request. Please make this request in writing to our Privacy Officer.
D. You may have the right to have your healthcare provider amend your PHI. This means you may request an amendment of PHI about you in a designated record set for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request, you have the right to file a statement of disagreement with us, and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact our Privacy Officer if you have questions about amending your medical record.
E. You have the right to receive an accounting of certain disclosures we have made, if any, of your PHI. This right applies to disclosures for purposes other than treatment, payment, or healthcare operations as described in this Notice. It excludes disclosures we may have made to you, to family members or friends involved in your care, or for notification purposes. You have
the right to receive specific information regarding these disclosures that occurred after April 14, 2003. You may request a shorter timeframe. The right to receive this information is subject to certain exceptions, restrictions, and limitations.
F. You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically.
G. You have the right to be notified following a breach of unsecured PHI. We will notify you if your unsecured PHI has been breached.
III. Complaints
You may complain to us or to the Secretary of the Department of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our Privacy Officer of your complaint. We will not retaliate against you for filing a complaint.
This Notice was published and becomes effective on the date listed above.
Important Note: This is a sample Notice of Privacy Practices based on standard HIPAA templates and guidelines. It is not intended to serve as legal advice. RT Medical LLC should consult with a qualified healthcare attorney to customize this document to your specific operations, ensure full compliance with HIPAA and any applicable state laws (such as those in Tennessee), and review any Business Associate Agreements with vendors like RingCentral. For texting patients, ensure you obtain patient consent, use secure platforms, and limit PHI in messages as per HIPAA requirements.