§ 5-37.3-3 - Definitions.
SECTION 5-37.3-3
§ 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 towaive the confidentiality, or to disclose or consent to the disclosure ofconfidential information, as established by this chapter. That person is not,except by explicit authorization, empowered to waive confidentiality or todisclose or consent to the disclosure of confidential information;
(ii) A guardian or conservator, if the person whose right toconfidentiality is protected under this chapter is incompetent to assert orwaive that right; or
(iii) If the patient/client is deceased, his or her personalrepresentative or, in the absence of that representative, his or herheirs-at-law.
(2) "Board of medical licensure and discipline" means theboard created under chapter 37 of this title.
(3) "Confidential health care communication" means acommunication of health care information by an individual to a health careprovider, including a transcription of any information, not intended to bedisclosed to third persons except if those persons are:
(A) Present to further the interest of the patient in theconsultation, examination or interview;
(B) Reasonably necessary for the transmission of thecommunication; or
(C) Participating in the diagnosis and treatment under thedirection of the health care provider, including members of the patient'sfamily.
(ii) "Confidential health care information" means allinformation relating to a patient's health care history, diagnosis, condition,treatment, or evaluation obtained from a health care provider who has treatedthe patient.
(4) "Health care provider" means any person licensed by thisstate to provide or lawfully providing health care services, including, but notlimited 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 his orher employment or agency related to or supportive of health services.
(5) "Health care services" means acts of diagnosis,treatment, medical evaluation, or counseling or any other acts that may bepermissible under the health care licensing statutes of this state.
(6) "Managed care contractor" means a person that:
(i) Establishes, operates, or maintains a network ofparticipating providers;
(ii) Conducts or arranges for utilization review activities;and
(iii) Contracts with an insurance company, a hospital ormedical service plan, an employer, an employee organization, or any otherentity providing coverage for health care services to operate a managed careplan.
(7) "Managed care entity" includes a licensed insurancecompany, hospital or medical service plan, health maintenance organization, anemployer or employee organization, or a managed care contractor as described insubdivision (6) of this section, that operates a managed care plan.
(8) "Managed care plan" means a plan operated by a managedcare entity as described in subdivision (7) of this section, that provides forthe financing and delivery of health care services to persons enrolled in theplan through:
(i) Arrangements with selected providers to furnish healthcare services;
(ii) Explicit standards for the selection of participatingproviders;
(iii) Organizational arrangements for ongoing qualityassurance, utilization review programs, and dispute resolution; and
(iv) Financial incentives for persons enrolled in the plan touse the participating providers and procedures provided for by the plan.
(9) "Medical peer review board" means a peer review boardunder chapter 37 of this title.
(10) "Nurse" means a registered nurse or licensed practicalnurse licensed to practice nursing in the state.
(11) "Participating provider" means a physician, hospital,pharmacy, laboratory, dentist, or other state licensed or other staterecognized provider of health care services or supplies, that has entered intoan agreement with a managed care entity to provide any services or supplies toa patient enrolled in a managed care plan.
(12) "Patient" means a person who receives health careservices from a health care provider.
(13) "Personally identifiable confidential health careinformation" means confidential health care information, which explicitly or byimplication identifies a particular patient.
(14) "Physician" means a person registered or licensed topractice allopathic or osteopathic medicine in this state under Rhode Islandgeneral laws.
(15) "Psychiatric social worker" means a person holding aMaster's or further advanced degree from a school of social work accredited bythe council of social work education.
(16) "Psychologist" means a certified psychologist underchapter 44 of this title.
(17) "Qualified personnel" means persons whose training andexperience are appropriate to the nature and level of the work in which theyare engaged and who, when working as part of an organization, are performingthat work with published and adequate administrative safeguards againstdisclosure unauthorized under this chapter.
(18) "Third party" means a person other than the patient towhom the confidential health care information relates and other than a healthcare provider.