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PERSONAL PRIVACY/ HIPAA
HIPAA (Health Insurance Portability and Accountability Act) --
Notice of Privacy Practices
NOTICE OF PRIVACY PRACTICES
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
You may also download Marklund's HIPAA policy
here.
I. Our Duty to
Safeguard Your Protected Health Information
We are committed to preserving the privacy and confidentiality of
your health information or the health information of your family
member, whether created by us or maintained on our premises. We are
required by certain state and federal regulations to implement
policies and procedures to safeguard the privacy of health
information. Copies of our privacy policies and procedures are
maintained in the business office. We are required by state and
federal regulations to abide by the privacy practices described in
this notice including any future revisions that we may make to the
notice as may become necessary or as authorized by law.
Individually
identifiable information about your past, present, or future health
or condition, the provisions of health care to you, or payment for
the health care treatment, or services you receive is considered
protected health information (PHI). We are required to provide you
with this Privacy Notice that contains information regarding our
privacy practices that explains how, when and why we may use or
disclose your protected health information and your rights and our
obligations regarding any such uses or disclosures.
Should you have
questions concerning our Privacy Notices, the names, addresses,
telephone numbers, website addresses, etc., of whom you should
contact are listed on the last page of this document.
II. How We May Use and
Disclose Your Protected Health Information
We have a limited right to use and/or disclose your health
information for purposes of treatment, payment, or for the
operations of our facility. For other uses, you must give us your
written authorization to release your protected health information
unless the law permits or requires us to make the use or disclosure
without your authorization.
Should it become
necessary to release your protected health information to an outside
party, we will require the party to have a signed agreement with us
that the party will extend the same degree of privacy protection to
your information as we do.
The privacy law
permits us to make some uses or disclosures of your protected health
information without your consent or authorization. The following
describes each of the different ways that we may use or disclose
your protected health information. Where appropriate, we have
included examples of the different types of uses or disclosures.
These include:
Use and Disclosures
Related to Treatment:
We may disclose your protected health information to those who are
involved in providing medical and nursing care services and
treatments to you. For example we may identify rooms by the first
name and last initial of the occupant, or release health information
about you to our nurses, nursing assistants, medication
aides/technicians, medical and nursing students, therapists,
pharmacists, medical records personnel, consultants, physicians,
etc. We may also disclose your protected health information to
outside entities performing other services relating to your
treatment: such as diagnostic laboratories, home health/hospice
agencies, family members, etc.
Use and Disclosures
Related to Payment:
We may use or disclose your protected health information to bill and
collect payment for services or treatments we provided to you. For
example, we may contact your insurance facility, health plan, or
another third party to obtain payment for services we provided to
you.
III. Uses and Disclosures of
Information That Do Not Require Your Consent or Authorization
State and federal law and regulations either require or permit us to
use or disclose your protected health information without your
consent or authorization. The uses or disclosures that we may make
without your consent or authorization include the following:
When Required by
Law:
We may disclose your protected health information with a federal,
state or local law requires that we report information about
suspected abuse, neglect, or domestic violence, reporting adverse
reactions to medications or injury from a health care product, or in
response to a court order or subpoena.
2. For Public
Health Activities for the Purpose of Preventing or Controlling
Disease, Injury or Disability:
We may disclose your protected health information when we are
required to collect information about diseases or injuries (e.g.,
your exposure to a disease or your risk for spreading or contracting
a communicable disease or condition, product recalls, or to report
vital statistics (e.g., births/deaths) to the public health
authority.
3. For Health
Oversight Activities:
We may disclose your protected health information to a health
oversight agency such as a protection and advocacy agency, the state
agency responsible for inspecting our facility or to other agencies
responsible for monitoring the health care system for such purposes
as reporting or investigation of unusual incidents or to ensure that
we are in compliance with applicable state and federal laws and
regulation and civil rights issues.
4. To Coroners,
Medical Examiners, Funeral Directors, Organ Procurement
Organizations or Tissue Banks:
We may disclose your protected health information to a coroner or
medical examiner for the purpose of identifying a deceased
individual or to determine the cause of death. We may also disclose
your health information to a funeral director for the purposes of
carrying out your wishes and/or for the funeral director to perform
his/her necessary duties.
If you are an organ donor, we may disclose your protected health
information to the organization that will handle your organ, eye or
tissue donation for the purposes of facilitation your organ or
tissue donation or transplantation.
5. For Research
Purposes:
We may disclose your protected health information for research
purposes only when a privacy board has approved the research
project. However, we may use or disclose your protected health
information to individuals preparing to conduct an approved research
project in order to assist such individuals in identifying persons
to be included in the research project. Researches identifying
persons to be included in the research project will be required to
conduct all activities onsite. If it becomes necessary to use or
disclose information about you that could be used to identify you by
name, we will obtain your written authorization before permitting
the researcher to use your information. Researchers will be required
to sign a Confidentiality and Non-Disclosure Agreement form before
being permitted access to health information for research purposes.
6. To Avert a
Serious Threat to Health or Safety:
We may disclose your protected health information to avoid a serious
threat to your health or safety or to the health or safety of
others. When such disclosure is necessary, information will only be
released to those law enforcement agencies or individuals who have
the ability or authority to prevent or lessen the threat of harm.
7. For Specific
Government Functions:
We may disclose protected health information of military personnel
and veterans, when requested by military command authorities, to
authorized federal authorities for the purposes of intelligence,
counterintelligence, and other national security activities (such as
protection of the President), or to correctional institutions.
8. For
Fund-raising:
We may use a limited amount of your protected health information
when raising money for our facility and its operations. We may also
disclose this information to a foundation related to the facility so
that the foundation may contact you to raise money on behalf of our
facility. The information we may use will be limited to your name,
address, telephone number, photograph, and dates for which you
received treatment or services at our facility. Tours of the
facility may take place from time to time. We may have these
individuals meet you. You may be photographed during special events
such as Summer Games, Holiday Open House, etc. Occasionally, there
may be media coverage. If you do not wish to be contacted for
participation in fund-raising activities or have this information
provided to our affiliated foundation, you must provide us with a
written notification. The name of the person to contact ad the
method of contacting him/her are listed on the last page of this
notice.
IV. Your Right
Regarding Your Protected Health Information
You have the following rights concerning the use or disclosure of
your protected health information that we create or that we may
maintain on our premises:
To Request
Restrictions on Uses and Disclosures of Your Protected Health
Information:
You have the right to request that we limit how we use or disclose
your protected health information 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 your care or services. For example,
you could request that we not disclose to family members or friends
information about a medical treatment you received.
Should you wish a
restriction placed on the use and disclosure of your protected
health information, you must submit such request in writing. The
name, address, and telephone number of the person to whom the
request is to be submitted is listed on the last page of this
document.
We are not required to agree to your restriction request. However,
should we agree, we will comply with your request not to release
such information unless the information is needed to provide
emergency care or treatment to you.
2. The Right to
Inspect and Copy Your Medical and Billing Records:
You have the right to inspect and copy your health information, such
as your medical and billing records that we use to make decisions
about your care and services. In order to inspect and/or copy your
health information you must submit a written request to us. If you
request a copy of your medical information, we may charges you a
reasonable fee for the paper, labor, mailing, and/or retrieval costs
involved in filing your request. We will provide you with
information concerning the cost of copying your health information
prior to performing such service. The name, address, and telephone
number of the person to whom you may file your request is listed on
the last page of this document.
We will respond
within thirty (30) days of receipt of such requests. Should we deny
your request to inspect and/or copy your health information, we will
provide you with written notice of our reasons of the denial and
your rights for requesting a review of our denial. If such review is
granted or is required by law, we will select a licensed health care
professional not involved in the original denial process to review
your request and our reasons for denial. We will abide by the
reviewer’s decision concerning your inspection/copy requests. You
may submit your denial review requests in writing.
3. The Right to
Amend or Correct Your Health Information:
You have the right to request that your health information be
amended or corrected if you have reason to believe that certain
information is incomplete or incorrect. You have the right to make
such requests of us for as long as we maintain/retain your health
information. Your requests must be submitted to us in writing. We
will respond within sixty (60) days of receiving the written
request. If we approve your request, we will make such
amendments/corrections and notify those with a need to know of such
amendments/corrections.
We may deny your request if:
a. Your request
is not submitted in writing;
b. Your written request does not contain a reason to support
your request;
c. The information was not created by us, unless the person or
entity that related the information is no longer available to
make that amendment;
d. It is not a part of the health information kept by our for
our facility;
e. It is not part of the information which you would be
permitted to inspect and copy; and/or
f. The information is already accurate and complete.
If your request is
denied, we will provide you with a written notification of the
reason(s) of such denial and your rights to have the request, the
denial, and any written response you may have relative to the
information and denial process appended to your health information.
The name, address, and telephone number of the person to whom you
may file your request is listed on the last page of this document.
The Right to
Request Confidential Communication:
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 may request that we not send any health information
about you to a family member’s address. We will agree to your
request, as long it is reasonably easy for us to do so. You are not
required to reveal nor will we ask the reason for your request. To
request confidential communications you must:
a. Notify us in
writing;
b. Indicate what information you wish to limit;
c. Indicate whether or not you wish to limit or restrict our use
or disclosure of such information; and
d. Identify to whom the restrictions apply (e.g., which family
member(s), agency, etc.).
The name, address
and telephone number of the person to whom you may file your request
is listed on the last page of this document.
The Right to
Request an Accounting of Disclosures of Protected Health
Information:
You have the right to request that we provide you with a listing of
when, to whom, for what purpose, and what content of your protected
health information we have released over a specified period of time.
This accounting will not include any information we have made for
the purposes of treatment, payment, or health care operations or
information released to you, your family, or the facility directory,
disclosures made for national security purposes, or any releases
pursuant to your authorization.
Your request must
be submitted in writing and must indicate the time period for which
you wish the information (e.g., May 1, 2003 through August 31,
2005). Your request may not include releases for more than six (6)
years prior to the date of your request and may not include releases
prior to April 14, 2003. Your request must indicate in what form
(e.g., printed copy or E-mail) you wish to receive this information.
We will respond to your request within sixty (60) days of the
receipt of your written request. Should additional time be needed to
reply, you will be notified of such extension. However, in no case
will such extension exceed thirty (30) days. The first accounting
you request during a twelve (12) month period will be free. There
may be a reasonable fee for additional requests during the twelve
(12) month period. 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.
The name, address,
and telephone number of the person to whom you may file your request
is listed on the last page of this document.
The Right to
Receive a Paper Copy of This Notice:
You have the right to receive a paper copy of this notice even
though you may have agree to receive an electronic copy of this
notice. You may request a paper copy of this notice at anytime or
you may obtain a copy of this information from our website (as
applicable). The name, address, and telephone number of the person
to whom you may obtain a paper copy of this notice is listed on the
last page of this document.
V. How to File a
Complaint About our Privacy Practices
If you have reason to believe that we have violated your privacy
rights, violated our privacy polices and procedures, or you disagree
with a decision we made concerning access to your protected health
information, etc., you have the right to file a complaint with us or
the Secretary of the Department of Health and Human Services.
Complaints may be filed without fear of retaliation in any form.
To file a complaint
with us, contact us by phone or by mail:
Our Designee: Irene Kasnicka,
QA Coordinator, 164 S. Prairie Avenue, Bloomingdale, IL 60108,
630.529.2871, ext. 3230
To file a complaint
with the United States Secretary of Health and Human Services, send
your compliant to him or her in care of:
Office of Civil Rights, U.S.
Department of Health and Human Services, 200 Independence Avenue,
SW, Washington, D.C. 20201
To ask questions or
request information, contact us by phone or mail. If you have any
questions or want more information about this Notice of Privacy
Practices, please contact: Our Designee: Irene Kasnicka, QA
Coordinator, 164 S. Prairie Avenue, Bloomingdale, IL 60108,
630.529.2871, ext. 3230
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