Title 5
Businesses and Professions

Chapter 37.3
Confidentiality of Health Care Communications and Information Act

§ 5-37.3-3. Definitions.

As used in this chapter:

(1) “Authorized representative” means:

(i) A person empowered by the patient/client to assert or to waive the confidentiality, or to disclose or consent to the disclosure of confidential information, as established by this chapter. That person is not, except by explicit authorization, empowered to waive confidentiality or to disclose or consent to the disclosure of confidential information;

(ii) A guardian or conservator, if the person whose right to confidentiality is protected under this chapter is incompetent to assert or waive that right;

(iii) If the patient/client is deceased, their personal representative or, in the absence of that representative, any heir-at-law; or

(iv) A patient’s attorney.

(2) “Board of medical licensure and discipline” means the board created under chapter 37 of this title.

(3)(i) “Confidential healthcare communication” means a communication of healthcare information by an individual to a healthcare provider, including a transcription of any information, not intended to be disclosed to third persons except if those persons are:

(A) Present to further the interest of the patient in the consultation, examination, or interview;

(B) Reasonably necessary for the transmission of the communication; or

(C) Participating in the diagnosis and treatment under the direction of the healthcare provider, including members of the patient’s family.

(ii) “Confidential healthcare information” means all information relating to a patient’s healthcare history, diagnosis, condition, treatment, or evaluation obtained from a healthcare provider who has treated the patient.

(4) “Healthcare provider” means any person licensed by this state to provide or lawfully providing healthcare services, including, but not limited to, a physician, hospital, intermediate-care facility or other healthcare facility, dentist, nurse, optometrist, podiatrist, physical therapist, psychiatric social worker, pharmacist, or psychologist, and any officer, employee, or agent of that provider acting in the course and scope of their employment or agency related to or supportive of health services.

(5) “Healthcare services” means acts of diagnosis, treatment, medical evaluation, or counseling or any other acts that may be permissible under the healthcare licensing statutes of this state.

(6) “Managed-care contractor” means a person that:

(i) Establishes, operates, or maintains a network of participating providers;

(ii) Conducts or arranges for utilization review activities; and

(iii) Contracts with an insurance company, a hospital or medical service plan, an employer, an employee organization, or any other entity providing coverage for healthcare services to operate a managed-care plan.

(7) “Managed-care entity” includes a licensed insurance company, hospital, or medical service plan, health maintenance organization, an employer or employee organization, or a managed-care contractor as described in subsection (6) of this section, that operates a managed-care plan.

(8) “Managed-care plan” means a plan operated by a managed-care entity as described in subsection (7), that provides for the financing and delivery of healthcare services to persons enrolled in the plan through:

(i) Arrangements with selected providers to furnish healthcare services;

(ii) Explicit standards for the selection of participating providers;

(iii) Organizational arrangements for ongoing quality assurance, utilization-review programs, and dispute resolution; and

(iv) Financial incentives for persons enrolled in the plan to use the participating providers and procedures provided for by the plan.

(9) “Medical peer-review board” means a peer-review board under chapter 37 of this title.

(10) “Nurse” means a registered nurse or licensed practical nurse licensed to practice nursing in the state.

(11) “Participating provider” means a physician, hospital, pharmacy, laboratory, dentist, or other state-licensed or other state-recognized provider of healthcare services or supplies, that has entered into an agreement with a managed-care entity to provide any services or supplies to a patient enrolled in a managed-care plan.

(12) “Patient” means a person who receives healthcare services from a healthcare provider.

(13) “Personally identifiable confidential healthcare information” means confidential healthcare information, which explicitly or by implication identifies a particular patient.

(14) “Physician” means a person registered or licensed to practice allopathic or osteopathic medicine in this state under Rhode Island general laws.

(15) “Psychiatric social worker” means a person holding a master’s or further-advanced degree from a school of social work accredited by the council of social work education.

(16) “Psychologist” means a certified psychologist under chapter 44 of this title.

(17) “Qualified personnel” means persons whose training and experience are appropriate to the nature and level of the work in which they are engaged and who, when working as part of an organization, are performing that work with published and adequate administrative safeguards against disclosure unauthorized under this chapter.

(18) “Third party” means a person other than the patient to whom the confidential healthcare information relates and other than a healthcare provider.

(19) “Third-party requestor” means any person or entity presenting a patient-signed Health Insurance Portability and Accountability Act (HIPAA)-compliant authorization allowing them to obtain a copy of the patient’s medical records or reports.