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.

Effective Date:  July 1, 2008 .

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 Chief Compliance Officer at 939-4444 ext. 220

USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION

In order to effectively provide you care, there are times when we will need to share your medical information with others beyond our practice.  This includes disclosures such as the following:

Treatment.  We may use or disclose medical information about you to provide, coordinate, or manage your care or any related services, including sharing information with others outside our practice that we are consulting with or referring you to.

Payment.  Information will be used to obtain payment for the treatment and services provided.  This will include contacting your health insurance company for prior approval of planned treatment or for billing purposes.

Healthcare Operations.  We may use information about you to coordinate our business activities.  This may include setting up your appointments, reviewing your care, 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 you are facing.

Follow Up Appointments/Care.  We will be contacting you to remind you of future appointments or information about treatment alternatives or other health-related benefits and services that may be of interest to you.  We will leave appointment information on your answering machine unless you tell us not to.

As Required by Law.   This would include situations where we have a subpoena, court order, or are mandated to provide public health information, such as communicable diseases or suspected abuse and neglect such as child abuse, elder abuse, or institutional abuse.

Coroners, Funeral Directors, and Organ Donation.  We are required to disclose information about the circumstances of your death to a coroner who is investigating it.

Governmental Requirements.  We may disclose information to a health oversight agency for activities authorized by law, such as audits, investigations inspections and licensure.  There also might be a need to share information with the Food and Drug Administration related to adverse events or product defects.  We are also required to share information, if requested with the Department of Health and Human Services to determine our compliance with federal laws related to health care.                                                  

Criminal Activity or Danger to Others.  If a crime is committed on our premises or against our personnel we may share information with law enforcement to apprehend the criminal.  We also have the right to involve law enforcement when we believe an immediate danger may occur to someone.

Fundraising.  As a not for profit provider of health care services we need assistance in raising money to carry out our mission.  We may contact you to seek a donation.