Notice of Privacy Practices at Cumberland Radiation Associates, LLC
NOTICE OF PRIVACY PRACTICES (NPP)
Cumberland Radiation Associates, LLC
This notice describes the privacy practices of Cumberland Radiation Associates, LLC, located in Tullahoma,
OUR PLEDGE REGARDING HEALTH INFORMATION
We understand that health information about patients is personal. We are committed to protecting the security of that
information, called protected health information (PHI), and to preventing its disclosure without your authorization.
We create a record of the care and services that patients receive from us. We need this record to provide patients with quality
care and to comply with certain legal requirements. This notice applies to all records of patient care generated by Cumberland Radiation Associates, LLC, whether made by a physician or by
others working in this practice. This notice tells you about the ways in which we may use and disclose our patients’ PHI. We also describe rights to the PHI that we keep about patients and explain
our obligations we have regarding the use and disclosure of our patients’ PHI.
By law, we are required to:
Make sure that health information that identifies our patients is kept private
Provide you with this notice of our legal duties and privacy practices with respect to PHI
Follow the terms of the notice that is currently in effect
Notify you if there is a security breach of protected health information (PHI) except when the PHI is encrypted and is disposed of
HOW WE MAY USE AND DISCLOSE YOUR PHI
The following categories describe different ways that we use and disclose health information. Within each category, we have
provided a list of examples.
For Treatment: We may use health information about our patients to provide them with health care treatment or services. We may disclose health information about our patients to
physicians, nurses, technicians, health students, or other personnel who are involved in the delivery of their care. These healthcare providers may work at our offices; at the hospital if patients
are hospitalized under our supervision; or at another physician’s office, lab, pharmacy, or other health care provider where we may have referred a patient for x-rays, laboratory tests,
prescriptions, or other treatment purposes. For example, a physician treating a patient for arthritis may need to know if that individual has diabetes because diabetes may impact the healing process.
In addition, the physician may need to tell the dietitian at the hospital if the patient has diabetes so that we can arrange for appropriate meals. We may also disclose health information about our
patients to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.
For Payment: We may use and disclose information about treatment and services we provide to patients for billing purposes. The information may include monies that we have received from
the individual who guarantees payment, from an insurance company, or from a third party. For example, we may need to give your health plan information about your office visit so the plan will either
pay us or reimburse you for the visit. We may also tell your health plan about a treatment before we provide it to you in order to obtain prior approval, if required, or to determine if your plan
will cover the treatment. If we provide a service to you for which you pay in full out-of-pocket and you request that we not send PHI to your insurance company, we are obligated to comply with your
request except when the information is needed to comply with the law.
For Health Care Operations: We may use and disclose protected health information about you for the operation of our health care practice. These uses and disclosures are necessary to run
our practice and to make sure that all our patients receive quality care. For example, we may use health information in a general review of our treatments and services or, more specifically, to
evaluate staff performance. We may also combine the health information of many patients to decide what improvement we could make, what additional services we should offer, what services are not
needed, or whether certain new treatments are effective. We may remove information that identifies you from this set of health information so others may use it to study health care delivery without
learning the identities of our specific patients.
Marketing: If applicable, we will seek and obtain your prior written authorization for all written communications to you regarding treatment and healthcare operations where we have
received financial remuneration from (or on behalf of) a third party in exchange for sending the communication; and the communication is intended to encourage purchase or use of a product or service
offered by the third party. This requirement may apply to appointment reminders, treatment reminders, alternative treatments, and healthcare products and services. The requirement does not apply to
face-to-face communications; promotional gifts of “nominal” value; prescription refill reminders or other communications about a drug or biologic that is being prescribed for you if the financial
remuneration received is reasonably related to our cost for making the communication; communications about general health; and communications about government or government-sponsored
Health-Related Services and Treatment Alternatives: We may use and disclose protected health information (PHI) to tell you about health-related services or recommend possible treatment
options or alternatives that may be of interest to you. Please let us know if you do not wish us to send you this information or if you wish us to send this information to a different
Appointment Reminders: We may use and disclose protected health information to contact you as a reminder of a scheduled appointment for you. We may also use it to notify you of a missed
appointment and how to contact us to reschedule. Please let us know if you do not wish to have us contact you for this purpose or if you wish us to contact you at a different
Fundraising Activities: From time to time we may use your protected health information (PHI) to contact you in an effort to raise money for our not-for-profit operations. We may
disclose health information to a business associate that may then contact you to raise money for our practice. We only will release contact information, such as your name, address, and phone number,
and the dates you received treatment or services from us. In these instances, we will give you the option to opt out of the fundraising communication.
Sale: From time to time we may sell your protected health information (PHI) for financial or other remuneration. For example, a researcher may pay us a fee that exceeds the reasonable
cost to prepare and transmit the PHI. We will obtain your prior authorization for the use and disclosure of protected health information (PHI) for sales purposes.
Research: Under certain circumstances we may use and disclose health information for research purposes. For example, a research project may involve comparing the health and recovery of
all patients who received one medication to those who received another medication for the same condition. The practice owner(s) must approve all research projects. They evaluate all potential
projects and select those that will be of direct or indirect benefit to our patients and/or community. Their review process also evaluates a proposed research project’s use of health information,
trying to balance the needs of the research community with patients’ need for privacy. We will obtain your written authorization to use your PHI for research purposes except when our practice owner
has determined that the use or disclosure involves no more than a minimal risk to your privacy based on the following:
An adequate plan to protect the identifying information from improper use and disclosure;
An adequate plan to destroy the identifying information at the earliest opportunity consistent with the research (unless there is a
health or research justification for retaining the identifiers or such retention is otherwise required by law);
Adequate written assurances that the PHI will not be reused or disclosed to any other person or entity (except as required by law for
authorized oversight of the research study, or for other research for which the use or disclosure would otherwise be permitted);
The research could not practically be conducted without the waiver; and
The research could not practically be conducted without access to and use of the PHI.
Before we use or disclose health information for research, the project will have been approved through our practice’s research
approval process. However, we may disclose health information about you to people preparing to conduct a research project. For example, we may help potential researchers look for patients with
specific health needs, as long as the health information they review does not leave our facility.
Organ and Tissue Donation: If you are an organ donor, we may release health information to an organ donation bank or to organizations that handle organ procurement or organ, eye, or
tissue transplantation, as necessary to facilitate organ or tissue donation and transplantation.
As Required by Law: We will disclose health information about you when required to do so by federal, state, or local law.
To Avert a Serious Threat to Health or Safety: We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety, or the health
and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
Military and Veterans: If you are a member of the armed forces or separated or discharged from military services, we may release health information about you as required by military
command authorities or the Department of Veterans’ Affairs as may be applicable. We may also release health information about foreign military personnel to the appropriate foreign military
Workers’ Compensation: We may release health information about you for Workers’ Compensation or similar programs. These programs provide benefits for work-related injuries or
Public Health Risks: We may disclose health information about you for public health activities. These activities generally include the following:
The prevention or control of disease, injury, or disability
The reporting of births and deaths
The reporting of child abuse or neglect
The reporting of reactions to medications or problems with products
The notification of people about recalls of products they may be using
The notification of a person or organization required to receive information on Food and Drug Administration–regulated
The notification of a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or
The notification of the appropriate government authority, if we believe a patient has been the victim of abuse, neglect, or domestic
violence (we will only make this disclosure if you agree or when required or authorized by law)
Health Oversight Activities: We may disclose health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits,
investigations, inspections, and licensure. These activities are necessary for the government to monitor the healthcare system, government programs, and compliance with civil rights
Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose your health information in response to a court or administrative order. We may also disclose health
information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute but only if efforts have been made to tell you about the request or
to obtain an order protecting the information requested.
Law Enforcement: We may release health information if requested to do so by a law enforcement official:
In reporting certain injuries, as required by law: gunshot wounds, burns, dog bites, and injuries to perpetrators of
In response to a court order, subpoena, warrant, summons, or similar process
To identify or locate a suspect, fugitive, material witness, or missing person (name and address, date of birth or place of birth,
social security number, blood type or Rh factor, type of injury, date and time of treatment and/or death, if applicable, and a description of distinguishing physical
About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s
About a death we believe may be the result of criminal conduct
About criminal conduct at our facility
In emergency circumstances to report a crime; the location of a crime or victims; or the identity, description, or location of a
person who committed a crime
Coroners, Health Examiners, and Funeral Directors: We may release health information to a coroner or health examiner. This may be necessary, for example, to identify a deceased person
or determine the cause of death. We may also release health information about patients to funeral directors as necessary to carry out their duties.
National Security and Intelligence Activities: We may release health information about you to authorized federal officials for intelligence, counterintelligence, and other national
security activities authorized by law.
Protective Services for the President and Others: We may disclose health information about you to authorized federal officials so they may conduct special investigations or provide
protection to the President, other authorized persons, or foreign heads of state.
Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release health information about you to the correctional
institution or law enforcement official. This release would be necessary (1) for the institution to provide health care; (2) to protect your health and safety or the health and safety of others; or
(3) for the safety and security of the correctional institution.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
You have the following rights regarding health information we maintain about you:
Right to Inspect and Copy: You have the right to inspect and copy health information such as medical and billing records that may be used to make decisions about your
In order to request inspection and copying of health information that may be used to make decisions about you, submit a written
request to Cumberland Radiation Associates, LLC, Privacy Official, 2114 N Jackson
St., Tullahoma, TN 37388. If you request a copy of the
information, we may charge a fee for the costs of copying, mailing, or other supplies and services associated with your request.
We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to health
information, you may request that the denial be reviewed. This review will be conducted by another licensed healthcare professional chosen by our practice. The person conducting the review will not
be the person who denied your request. This practice will comply with the outcome of the review.
Right to Request Information in a Form of Your Choosing: You have the right to request the provision of protected health information (PHI) in a form of your choice such as paper or
electronic. We will grant or deny the request within 30 days, and we may at times request a 30-day extension period. If any of the protected health information (PHI) is stored off-site, we will
respond to your request within 60 days. We may charge you a reasonable, cost-based fee for preparing the information that you request.
Right to Request that We Send Information to Other Designated Parties: You have the right to request that we send copies of the protected health information (PHI) to other designated
parties, provided that you submit a written signed request, designating the name, identity, and correct address of the designated recipient.
Right to Amend: If you believe that our health information about you is either incorrect or incomplete, you may ask us to amend the information. You have the right to request an
amendment for as long as we keep the information. To request an amendment, your request must be made in writing on the Request for Correction/Amendment of Protected Health Information form and
submitted to this office’s Medical Records Department. On the form you must include information supporting and the reasons for your request.
We may deny your request for an amendment if it is not in writing or does not include a reason for the request. In addition, we
may deny your request if you ask us to amend information that:
Was not created by us, unless the person or entity that created the information is no longer available to make the
Is not part of the health information kept by or for our practice
Is not part of the information that you would be permitted to inspect and copy
Is accurate and complete
ANY AMENDMENT WE MAKE TO YOUR HEALTH INFORMATION WILL BE DISCLOSED TO THOSE WITH WHOM WE DISCLOSE INFORMATION AS PREVIOUSLY
Right to an Accounting of Disclosures: You have the right to request a list of the disclosures of your protected health information (PHI) we have made, except for uses and disclosures
for treatment, payment, and healthcare operations, as previously described.
To request this list of disclosures, you must submit your request in writing to Cumberland Radiation Associates, LLC,
Privacy Official, 2114 N Jackson St.,Tullahoma, TN 37388. Your request must state a time period that may not be
longer than 6 years and may not include dates before April 14, 2003. The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of
providing the list. We will notify you of the cost involved, and you may choose to withdraw or modify your request at that time before any costs are incurred. We will mail you a list of disclosures
in writing within 30 days of your request. If we are unable to provide you with this information within 30 days, we will notify you of that fact and inform you of the date by which we can supply the
list. This date will not be more than 60 days from the date you made the request.
Right to Request Restrictions: You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment, or health care
operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for care, such as a family member or
friend. We are not required to agree to your request for restrictions if it is not feasible for us to ensure our compliance or believe it will negatively affect the care we provide
If we do agree, we will comply with your request, unless the information is needed to provide emergency treatment. To request a
restriction, you must make your request in writing to this office’s Medical Records Department on the To Request Restrictions on the Use and Disclosure of PHI form. In your request, you must tell us
what information you want to limit and to whom you want the limits to apply.
Right to Request Confidential Communications: You have the right to request that we communicate with you about your health matters in a certain way or at a certain location. For
example, you can ask that we only contact you at work or by mail to a post office box.
To request confidential communications, you must make your request in writing to this office’s Medical Records Department on
the To Request Confidential Handling of Specified Health Information form. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how
or where you wish us to contact you.
Right to Request Withholding of Disclosures to Health Plans: If you pay out-of-pocket in full for a service that we provide to you, you may request that we withhold from the payer
disclosure of information on that service. We are obligated to comply with that request unless disclosure is otherwise required by law.
Right to Request Withholding of Use and Disclosure of Psychotherapy Notes: You may request that we withhold use and disclosure of psychotherapy notes related to care that we provide for
Right to Be Notified Should There Be a Breach: You have the right to receive notice from us regarding a breach in disclosure of protected health information (PHI).
Right to a Paper Copy of This Notice: You have the right to obtain a paper copy of this notice at any time. To obtain a copy, please contact Cumberland Radiation Associates,
LLC, Privacy Official, 2114 N Jackson St., Tullahoma, TN
CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for health
information we already have about you as well as any information we receive in the future. We will post a copy of the current notice at each of our sites and on our website. The notice will contain
on the first page, at the top, the effective date. You may request a copy of our most current notice at any time.
If you believe that 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 in Washington, DC. To file a complaint with us, complete our Patient Comment and Privacy Complaint form. All complaints must be submitted in writing to
Cumberland Radiation Associates, LLC, Privacy Official, 2114 N
Jackson St., Tullahoma, TN 37388. You will not be penalized for filing a complaint.
OTHER USES OF HEALTH INFORMATION
Other uses and disclosures of health information not covered by this notice or the laws that apply to us will be made only with
your written permission. If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will
no longer use or disclose protected health information (PHI) about you for the reasons covered by your written authorization. We cannot revoke any disclosures that we have already made with your
permission. We are required to retain our records of the care that we provided to you.
ACKNOWLEDGMENT OF RECEIPT OF THIS NOTICE
We will request that you sign a separate form acknowledging that you have received a copy of this notice. If you choose, or are
not able to sign, a staff member will sign his or her name and date. This acknowledgment will be filed with your records.