THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THE INFORMATION. PLEASE REVIEW IT CAREFULLY.
Effective Date: April 14, 2003.
We respect patient confidentiality and only release medical information about you in accordance with the Illinois and federal law. This notice describes our policies related to the use of the records of your care generated by this practice.
Privacy Contact: If you have any questions about this policy or your rights contact the Medical Records Coordinator at 815-432-5241.
Use and Disclosure of Protected Health Information
In order to effectively provide care, we may need to share your medical information with others. This includes:
Treatment: The Center may use or disclose treatment information about you to provide, coordinate, or manage your care or related services.
Payment: With your written consent, information will be used to obtain payment for the treatment and services provided.
Healthcare Operations: The Center may use information about you to coordinate services. This may include setting up your appointments, reviewing your care, and/or training staff.
Information Disclosed Without Your Consent: Under Illinois and federal law, information about you may be disclosed without your consent in the following circumstances:
Emergencies: Sufficient information may be shared to address an immediate emergency.
Follow Up Appointments/Care: The Center will be contacting you to remind you of future appointments or information about treatment. The Center will leave appointment information on your answering machine unless directed otherwise.
As Required by Law: This would include situations where IMHC has a subpoena, court order, or are mandated to provide public health information.
Coroners: We are required to disclose treatment information about the circumstances of your death to a coroner.
Government Requirements: IMHC may disclose information for activities authorized by law, such as audits, investigations, inspections and licensure.
Criminal Activity or Danger to Others: If a crime is committed on our premises or against our personnel IMHC is required to share information with law enforcement. IMHC has the right to involve law enforcement when staff believes an immediate danger may occur.
You have the following rights under Illinois and federal law:
Copy of Your Record: You are entitled to inspect your consumer record. IMHC may charge you a reasonable fee for copying and mailing your record.
Release of Records: You may consent, in writing, to release your records to others. This could include your attorney, employer, or others. You may revoke this consent, in writing, at any time, but only to the extent no action has been taken.
Restriction on Record: You may request, in writing, that IMHC not use or disclose part of the clinical information. The Center is not required to agree to your request. The request should be given to the Medical Records Co-ordinator.
Contacting You: You may request that The Center send information to another address or by alternative means. We will honor such requests as long as they are reasonable. We have a right to verify that the payment information you are providing is correct.
Amending Record: If you believe that something in your record is incorrect or incomplete, you may request we amend it. To do this contact the Director of Operations and ask for the Request to Amend Health Information form. In certain cases, IMHC may deny your request. If your request is denied, you have the right to file a statement that you disagree with this decision. Your statement and IMHC’s response will be filed in your record.
Accounting for Disclosures: You may request an accounting of any disclosures that have been made related to your confidential information. To receive information regarding disclosures, submit your request in writing to the Privacy Officer. We will notify you of the cost involved in preparing this list.
Questions and Complaints: If you have questions or complaints, you may contact the Privacy Officer in writing. You also may complain to the Secretary of Health and Human Services if you believe our Center has violated your privacy rights. The Center will not retaliate against you for filing a complaint.