CHC Wellbeing 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.
OUR LEGAL DUTY
CHC Wellbeing is required by applicable federal and state law to maintain privacy of your protected health information (“PHI”), as defined by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). We are also required to give you this notice about our privacy practices, our legal duties, and your rights concerning your PHI. We must follow the privacy practices that are described in this notice while it is in effect. This notice takes effect (July __, 2010), and will remain in effect until we replace it. We reserve the right to change our privacy practices and the terms of this notice at any time, provided such changes are permitted by applicable law.
We reserve the right to make the changes in our privacy practices and the new terms of our notice effective for all PHI that we maintain, including PHI we created or received before we made the changes. Before we make a significant change in our privacy practices, we will change this notice and provide you with a revised copy of this notice.
We are also required to notify you if we become aware of a breach of any of your PHI that is not secured in accordance with federal guidelines. We will also notify you if we are unable to agree to restriction on our use and/or disclosure of your PHI that you request.
You may request a copy of our notice at any time. For more information about our privacy practices, or additional copies of this notice, please contact the CHC Wellbeing Privacy Officer using the information listed at the end of this notice.
USES AND DISCLOSURES OF HEALTH INFORMATION WITHOUT YOUR AUTHORIZATION
We may disclose your PHI for the purpose of treatment, payment, or health care/wellness operations. Examples of these types of disclosures are provided below:
Treatment purposes. Example: Information obtained by CHC Wellbeing or by another member of your health care team will be recorded in your health record and used to assess and monitor your health status, determine the appropriate care and treatment for you, and prescribe treatments and medications for you, as necessary. These treatment determinations often require us to share your health information with your physician or other health care providers involved in your treatment.
Payment purposes. Example: A bill may be sent to you or to a third party payor. The information on the bill or accompanying the bill may include information that identifies you, your diagnosis, the treatments rendered to you, and the medications, supplies and equipment used to perform the treatments.
Health care operations. Example: Employees of CHC Wellbeing and its staff may use information in your health record to assess the quality of the care and treatment they provide to you. The information will then be used in an effort to continually improve the quality and effectiveness of the health care and services that we provide to all of our patients.
We may disclose your PHI in order to inform you of treatment alternatives, or other health-related benefits.
We may contact you to provide appointment reminders. In some instances, as required by law, we may seek your consent prior to providing you with certain materials.
We may disclose your PHI for the purpose of research.
We will only disclose your PHI for research purposes without your express authorization if the research protocol has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.
We may disclose your PHI to public health officials.
We may disclose your PHI to law enforcement officials for law enforcement purposes.
We may disclose your PHI to an appropriate governmental authority if we reasonably believe that you may be a victim of abuse, neglect, or domestic violence.
If we believe it is necessary to avert a serious threat to the health or safety of yourself or the public, we may disclose your PHI to a person or persons who we believe are reasonably able to prevent or lessen the threat. We may disclose your PHI as a source of data for business planning and for certain marketing purposes. Except as provided by 45 C.F.R. § 164.508, we will not use your PHI for marketing communications without your written authorization.
We may use your PHI as a tool for quality assurance and continuous quality improvement. We may disclose your PHI as required by federal and state laws and regulations.
We may disclose your PHI to a health oversight agency, such as the Illinois Department of Health, the Illinois Department of Financial and Professional Regulation or the United States Department of Health and Human Services for purposes relating to the oversight of the health care system and government benefit programs such as Medicare or Medicaid.
We may disclose your PHI in the course of a judicial or administrative proceeding in response to a court order, subpoena, discovery request or other lawful process.
We may disclose your PHI to a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death, or other purposes as authorized by law.
We may also disclose your PHI to funeral directors as necessary to carry out their duties.
We may disclose your PHI to organizations involved in the procurement, banking, or transplantation of cadaveric organs, eyes or tissue, for the purpose of facilitating organ and tissue donation where applicable.
If you are a member of the United States or foreign Armed Forces, we may disclose your PHI for activities that are deemed necessary by appropriate military command authorities to assure the proper execution of a military mission.
We may disclose your PHI to authorized federal officials for the conduct of lawful intelligence, counter-intelligence and other national security functions authorized by law, or for the purpose of providing protective services to the President or foreign heads of state.
We may disclose your PHI to a correctional institution or a law enforcement official having lawful custody of you.
We may disclose your PHI as authorized by, and in compliance with, laws relating to workers’ compensation and similar programs established by law that provide benefits for work-related illnesses and injuries without regard to fault.
OTHER PERMISSIBLE OR REQUIRED USED OR DISCLOSURES
Notifying or Communicating with Persons Involved in your Care: We may use or disclose health information to notify, or to assist in notification of (including identifying or locating) a family member, your personal repre-sentative or another person responsible for your care of your location and general condition. If you are present, then prior to use or disclosure of your health information, we will provide you with an opportunity to object to such uses or disclosures. In the event of your incapacity or emergency circumstances, we will disclose health information based on a determination using our judgment disclosing only health information that is directly relevant to the person’s involvement in your healthcare. CHC Wellbeing will not disclose your PHI to your family members, personal representative or any other person as described in this paragraph if you object to such disclosure. Please notify the CHC Wellbeing Privacy Officer at the number provided below if you object to such disclosures.
Business associates: Some activities of CHC Wellbeing are provided on our behalf through contracts with business associates. Examples of when we may use a business associate include coding and claims submission performed by a third party billing company, consulting and quality assurance activities provided by an outside consultant, billing and coding audits performed by an outside auditor, and other legal and consulting services provided in response to billing and reimbursement issues which may arise from time to time. When we enter into contracts to obtain these services, we may need to disclose your health information to our business associate so that the associate may perform the job which we have requested. To protect your health information, however, we require our business associate to appropriately safeguard your information.
Any use or disclosure of your PHI that is not listed above will be made only with your written authorization. You may revoke such authorization at any time, as provided by 45 C.F.R. § 164.508(b)(5).
You have the right to:
Inspect and copy all or any part of your medical or health record, as provided by federal regulations. If you request a paper copy of your medical or health record from us, we may charge you a copying and/or postage fee, as allowable under applicable state law.
Request restrictions on the use and disclosure of your PHI. However, we are not required to agree to the restriction, except if you pay for a service entirely out-of-pocket. If you pay for a service entirely out-of-pocket, you may request that information regarding the service be withheld and not provided to a third party payor. We are obligated by law to abide by such restriction. If you wish to request a restriction on the use and disclosure of your PHI, please provide a written request describing your requested disclosure to the Privacy Officer. We will notify you of our decision regarding the requested restriction.
Request that we amend your medical record, to the extent that such amendments are permissible under federal regulations.
Request and receive an accounting of disclosures made of your health information, except for disclosures made for the purpose of treatment, payment, health care operations and certain other purposes if such disclosures were made through a paper record or other health record that is not electronic, as set forth in federal regulations. On or after January 1, 2011, if you request an accounting of disclosures of your PHI, the accounting may include disclosures made for the purpose of treatment, payment and health care operations to the extent that disclosures are made through an electronic health record.
Receive communications regarding your health information by alternative means or have such communications addressed to an alternative location. For example, at your request, we will mail items to a post office box instead of your residence.
Receive notification if your unsecured (i.e. identifiable) PHI has been accessed by unauthorized individuals if we determine that there is a potential risk of harm as a result of the unauthorized access.
If you execute any authorization(s) for the use and disclosure of your health information, you have the right to revoke such authorization(s), except to the extent that action has already been taken in reliance on such authorization.
Request and receive an electronic copy of your PHI if CHC Wellbeing maintains your PHI in an electronic health record. We may charge you a reasonable fee to cover our costs for this service.
Refuse to undergo a genetic test or other genetic service requested by your health insurer or offered by CHC Wellbeing.
QUESTIONS AND COMPLAINTS
If you want more information about our privacy practices or have questions or concerns, please contact the CHC Wellbeing Privacy Office by writing to:
CHC Wellbeing, Inc.
Attn: Privacy Office
5440 N. Cumberland Ave. Suite #225
Chicago, IL 60656
If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made about access to your health information or in response to a request you made to amend or restrict the use of your health information, you may complain to us using the contact information listed at the end of this notice. You also may submit a written complaint to the U.S. Department of Health and Human services. We support your right to the privacy of your PHI. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.