The Right to an Accounting of the Disclosures of Protected Health Information. You have the right to an accounting of how we have disclosed your protected health information we have made in the six-year period prior to the date of your request for the accounting.
We are not required to account for uses and disclosures of your protected health information by us: to carry out treatment, payment or health care operations performed by us or our business associates; to other health care providers to provide treatment to you; to other covered entities or health care providers for payment activities of said persons; to other covered entities which have had a treatment relationship with you for certain health care operations purposes of said entities; to you pursuant to your rights to access your protected health information; made pursuant to an authorization signed by you; to friends and family involved in your care and treatment or payment for your care and treatment, or for certain notification purposes; for national security or intelligence purposes; to correctional authorities with respect to persons in custody; that occurred prior to April 14, 2003; or incident to a use or disclosure otherwise permitted or required by law.
Your request for an accounting must be made in writing to our Privacy Contact at 455 South Roselle Rd., #206, Schaumburg, IL. 60193. Your first request in any twelve (12) month period will be provided to you at no charge, however, additional requests will be charged to you based on our cost to conduct the accounting. We will inform you of the fee for the additional accountings prior to our conducting the accounting so that you may consider whether to modify or withdraw your request before you incur any fees.
Right to Receive Paper Notice. If you have agreed to receive this notice electronically, you have the right to receive a paper copy of this notice at our office at 455 South Roselle Rd., #206, Schaumburg, IL. 60193.
If you believe your privacy rights have been violated or that we have not complied with this Notice of Privacy Practices, you may file a written complaint with our Privacy Contact at 455 South Roselle Rd., #206, Schaumburg, IL. 60193, or with the Secretary of the U.S. Department of Health and Human Services. Our Privacy Contact can also be reached by calling 847-352-2822. We will not penalize or charge you for filing a complaint with our Privacy Contact.
This Notice of Privacy Practices has been prepared to reflect your rights under the Health Insurance Portability and Accountability Act. If state law provides you with greater access to information, or provides greater protection to that information, than as described in this policy, then we shall follow the provisions of state law. Examples of such state laws are the Mental Health and Developmental Disabilities Confidentiality Act, the AIDS Confidentiality Act and the Genetic Information Privacy Act. In addition, if a Federal law creates greater protection for the information described in this Policy, the Provider shall follow the provisions of such federal law. An example of such a Federal law is the Federal Drug Abuse, Prevention, Treatment and Comprehensive Alcohol Abuse and Alcoholism Prevention Treatment, and Rehabilitation Act of 1970.
This Notice of Privacy Practices is effective as of March 31, 2003.
We will share your protected health information with third party “business associates” that perform various activities (e.g., billing, transcription services) for the practice.
We may disclose your protected health information to another entity for: health care fraud and abuse detection or compliance, conducting quality assessment and improvement activities, population-based activities relating to improving health or reducing health care costs, protocol development, case management and care coordination, contacting of health care providers and patients with information about treatment alternatives, and related functions that do not include treatment, reviewing the competence of health care professionals, conducting training programs, accreditation, certification, licensing, credentialing or other similar activities. Disclosures described in the preceding sentence will only be made if the other entity has or had a relationship with you.
We may disclose your protected health information to an organized health care arrangement in which we participate for any health care operation activities of said organized health care arrangement. An example of an organized health care arrangement is a hospital and its medical staff.
II. Uses and Disclosures of Protected Health Information Based upon Your Written
Other uses and disclosures of your protected health information for purposes other than treatment, payment and health care operations will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke an authorization at any time in writing, except to the extent that we have taken an action in reliance on the use or disclosure indicated in the authorization.
DI. Uses and Disclosures for Which You Have the Opportunity to Agree or Object.
We may use or disclose your protected health information in the circumstances described in this Section III, without seeking an authorization, provided we first give you an opportunity to object to such use or disclosure. If you are present, we may provide you with an opportunity to object and accept your failure to object as your agreement, or we may reasonably infer from the circumstances that you do not object. If you are not present or are unable to agree or object to such use or disclosure of your protected health information, we may use our professional judgement to determine whether the use or disclosure of your protected health information is in your best interest. All communications described in this Section III may be done orally. For example, unless you object, we may disclose your protected health information to your family member, other relative or close personal friend or any other individual identified by you as being a person who is directly involved with your care or payment relating to your care or treatment. IV. Uses and Disclosures of Protected Health Information Which Do Not Require Your
Authorization or Opportunity to Object.
We are permitted under certain circumstances to make the following uses and disclosures of your protected health information without having to obtain your authorization, or give you an opportunity to object: uses and disclosures required by law; uses and disclosures for public health activities, such as reporting of disease, child abuse, injury, or vital events such as birth or death; disclosure to an employer if you are a member of the employer’s workforce and we have been requested by the employer to conduct an evaluation relating to medical surveillance of the workplace or to evaluate whether you have a work-related illness or injury; disclosure to a governmental authority if we reasonably believe that you are a victim of abuse, neglect or domestic violence; disclosure to health oversight agencies (e.g., the U.S. Department of Health and Human Services) for oversight activities authorized by law; disclosures for legal proceedings; disclosures for law enforcement purposes; disclosures concerning decedents; uses and disclosures for cadaveric organ, eye or tissue donation purposes; uses and disclosures for research purposes; uses and disclosures to avert a serious threat to health or safety; disclosures regarding protected health information of members of the armed forces to appropriate military command authorities; national security and intelligence activities; disclosures to correctional authorities regarding protected health information of persons in custody; and disclosures as authorized to comply with workers’ compensation laws.
V. Your Rights
The Right to Request Restriction of Uses and Disclosures. You have the right to request that we restrict the uses or disclosures of your protected health information to carry out treatment, payment or health care operations and to family members, other relatives or persons directly involved in your care or payment. We are not required to agree to any such restrictions, but if we do, we must comply with such restrictions, other than in an emergency or certain other circumstances permitted or required by law.
The Right to Confidential Communications. You have the right to submit a written request to our Privacy Contact that we provide you with an alternative means of communication in the event you tell us that our customary methods of communication may not preserve the confidentiality of your information. You may request that we send such communications to you to alternative locations. We will attempt to accommodate all reasonable requests.
The Right to Access Protected Health Information. You have a right to submit a written request to our Privacy Contact to inspect and copy your protected health information. Under certain circumstances, we may deny your request to inspect and copy your protected health information.
We may charge a fee for the cost of copying, postage or other items or services involved with your request. You may not remove our records from the premises.
The Right to Amend Protected Health Information. You have the right to submit a written request to our Privacy Contact that we amend your protected health information in our custody, and you must explain the basis for your request. We may deny your request to amend your protected health information if a) we did not create the information unless the individual or entity that created the information is no longer available to make the requested amendment, b) the information is not maintained by or in our custody, c) you do not have the right to access such information, or d) we have determined that such information is accurate and complete.