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 CAREFULLY.
The Health Insurance Portability & Accountability Act of 1996
(HIPAA) requires all health care records and other individually identifiable
health information (protected health information) used or disclosed
to us in any form, whether electronically, on paper, or orally, be
kept confidential. This federal law gives you, the patient, significant
new rights to understand and control how your health information is
used. HIPAA provides penalties for covered entitles that misuse personal
health information. As required by HIPAA, we have prepared this explanation
of how we are required to maintain the privacy of your health information
and how we may use and disclose your health information.
Without specific written authorization, we are permitted to use and
disclose your health care records for the purposes of treatment, payment
and health care operations.
- Treatment means providing, coordinating, or managing health care
and related services by one or more health care providers. Examples
of treatment would include surgeries, follow-up care, administering
medication, etc.
- Payment means such activities as obtaining reimbursement for
services, confirming coverage, billing or collection activities,
and utilization review. An example of this would be billing your
medical health plan for your medical services.
- Health Care Operations include the business aspects of running
our practice, such as conducting quality assessment and improvement
activities. Auditing functions, cost-management analysis, and customer
service. An example would include a periodic assessment of our documentation
protocols, etc.
In addition, your confidential information may be used to remind
you of an appointment (by phone or mail) or provide you with information
about treatment options or other health-related services including
release of information to friends and family members that are directly
involved in your care who assist in taking care of you. We will use
and disclose your protected health information when we are required to do so by federal,
state or local law. We may disclose your protected health information
to public health authorities that are authorized by law to collect
information, to a health oversight agency for activities authorized
by law included but not limited to: response to a court or administrative
order, if you are involved in a lawsuit or similar proceeding, response
to a discovery request, subpoena, or other lawful process by another
party involved in the dispute, but only if we have made an effort
to inform you of the request or to obtain an order protecting the
information the party has requested. We will release your protected health information
if requested by a law enforcement official for
any circumstance required by law. We may release your protected health information
to a medical examiner or coroner to identify a deceased
individual or to identify the cause of death. If necessary, we also
may release information in order for funeral directions to perform
their jobs. We may release protected health information to organizations
that handle organ, eye or tissue procurement or transplantation, including
organ donation banks, as necessary to facilitate organ or tissue donation
and transplantation if you are an organ donor. We may use and disclose
your protected health information when necessary to reduce or prevent
a serious threat to your health and safety or the health and safety
of another individual or the public. Under these circumstances, we
will only make disclosures to a person or organization able to help
prevent the threat. We may disclose your protected health information
if you are a member of U.S. or foreign military forces (including
veterans) and if required by the appropriate authorities. We may disclose
your protected health information to federal officials for intelligence
and national security activities authorized by law. We may disclose
protected health information to federal officials in order to protect
the President, other officials or foreign heads of state, or to conduct
investigations. We may disclose protected health information to correctional
institutions or law enforcement officials if you are an inmate or
under the custody of law enforcement official. Disclosure for these
purposes would be necessary: (a) for the Institution to provide health
care services to you, (b) for the safety and security of the institution,
and/or (c) to protect your health and safety or the health and safety
of other individuals or the public. We may release your protected health information
for workers’ compensation and similar programs.
Any other uses and disclosures will be made only with your written
authorization. You may revoke such authorization in writing and we
are required to honor and abide by that written request, except to
the extent that we have already taken actions relying on your authorization.
You have certain rights in regards to your protected health information,
which you can exercise by presenting a written request to our Privacy
Officer at the practice address listed below:
- The right to request restrictions on certain uses and disclosures
of protected health information, including those related to disclosures
to family members, other relatives, close personal friends, or any
other person identified by you. We are, however, not required to
agree to a requested restriction. If we do agree to a restriction,
we must abide by it unless you agree in writing to remove it.
- The right to request to receive confidential communications of
protected health information from us by alternative means or at
alternative locations.
- The right to access, inspect and copy your protected health information.
- The right to request and amendment to your protected health information.
- The right to receive an accounting of disclosures of protected health information
outside of treatment, payment and health care operations.
- The right to obtain a paper copy of this notice from us upon
request.
We are required by law to maintain the privacy of your protected health information
and to provide you with notice of our legal duties
and privacy practices with respect to protected health information.
We are required to abide by the terms of the Notice of Privacy Practices
currently in effect. We reserve the right to change the terms of our
Notice of Privacy Practices and to make the new notice provisions
effective for all protected health information that we maintain. Revisions
to our Notice of Privacy Practices will be posted on the effective
date and you may request a written copy of the Revised Notice from
this office.
You have the right to file a formal, written complaint with us at
the address below, or with the Department of Health & Human Services,
Office of Civil Rights, in the event you feel your privacy rights
have been violated. We will not retaliate against you for filing a
complaint.
For more information about our Privacy Practices, please
contact:
Jim Kropp
1560 Sherman Ave. Suite 800
Evanston, IL 60201
(888) 517-4187
For more information about HIPAA or to file a complaint:
The U.S. Department of Health & Human Services
Office of Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
877-696-6775 (toll-free)