Effective April 14, 2003
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.
This page describes the type of information we gather about you, with whom that information may be shared and the safeguards we have in place to protect it. You have the right to the confidentiality of your medical information and the right to approve or refuse the release of specific information except when the release is required by law. If the practices described in this brochure meet your expectations, there is nothing you need to do. If you prefer that we not share information we may honor your written request in certain circumstances described below. If you have any questions about this notice, please contact our Privacy Officer at the address below.
This Notice of Privacy Practices (the "Notice") describes Bethany Methodist practices regarding the use of your medical information and that of:
We understand that medical information about you and your health is personal. Protecting medical information about you is important. We create a record of the care and services you receive. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by Bethany Methodist whether made by health care professionals or other personnel.
This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.
We are required by law to:
The following categories describe different ways that we may use and disclose medical information. For each category of uses or disclosures we will provide examples. The examples provided are illustrative and are not intended to cover every circumstance under which we will make use of your medical information.
For Treatment. We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, training doctors, or other health care professionals who are involved in taking care of you. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In addition, the doctor may need to tell the dietitian if you have diabetes so that he/she can arrange for appropriate meals. Different health care professionals also may share medical information about you in order to coordinate the different things you need, such as prescriptions, lab work and x-rays. We also may disclose medical information about you to people outside the hospital who may be involved in your medical care after you leave the hospital or that provide services that are part of your care.
Notwithstanding the above, we will comply with Illinois law in the event that it is more stringent than the federal HIPAA Privacy Rule. For example, we will not use or disclose any information regarding HIV or AIDS status, mental health or developmental disabilities, or genetic testing results without your express written authorization, except to the extent such disclosures are permitted by the relevant Illinois law governing such disclosures.
For Payment. We may use and disclose medical information about you so that the treatment and services you receive may be billed to, and payment may be collected from, you, an insurance company or a third party. For example, your insurance may need to know about surgery you received so they will pay us or reimburse you for the surgery. We may also use and disclose medical information about you to obtain prior approval or to determine whether your insurance will cover the treatment.
For Health Care Operations. We may use and disclose medical information about you for health care operations. This is necessary to make sure that all of our patients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also disclose information to doctors, nurses, technicians, training doctors, medical students, and other hospital personnel for review and learning purposes. We may remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning who the specific patients are.
Appointment Reminders. We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care. Such appointment reminders will be left with household members or on telephone answering machines unless you restrict this practice by contacting our Privacy Officer in writing.
Treatment Alternatives. We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
Health-Related Benefits and Services. We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
Hospital Directory. We may include certain limited information about you in the hospital directory while you are a patient at the hospital. This information may include your name, location in the hospital, your general condition (e.g., fair, stable, etc.) and your religious affiliation. The directory information, except for your religious affiliation, may also be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy, such as a priest or rabbi, even if they don't ask for you by name. This is so your family, friends and clergy can visit you in the hospital and generally know how you are doing. Individuals
Involved in Your Care or Payment for Your Care. We may release medical information about you to a family member or to an individual who is involved in your medical care. We may also give information to someone who helps pay for your care. We may also tell your family or an individual who is involved in your care your condition and that you are in the hospital. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.
Business Associates. We will disclose your medical information to our business associates-those vendors with whom we contract to provide a service to Bethany Methodist. Examples of such business associates include our attorneys, auditors, certain health care providers, and other agencies. When services are contracted, we may disclose your medical information to our business associates so that they can perform the job that we ask them to do. To protect your medical information, however, we require our business associates to appropriately safeguard your medical information by requiring that they enter into an appropriate agreement with Bethany Methodist.
As Required By Law. We will disclose medical information about you when required to do so by federal, state or local law. For example, we may disclose your health information to the Food and Drug Administration (FDA) to report adverse events with food or drugs. We may also disclose information for law enforcement purposes as required by law or in response to a valid subpoena.
To Avert a Serious Threat to Health or Safety. We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
Fundraising Activities. We may use medical information about you in an effort to raise money for the Bethany Methodist and its operations. We may disclose medical information to a foundation related to the hospital so that the foundation may raise money for the hospital. We only would release contact information, such as your name, address and phone number. If you do not want the Bethany Methodist to contact you for fundraising efforts, you must notify our Privacy Officer in writing at the address below.
Organ and Tissue Donation. If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
Military and Veterans. If you are a member of the armed forces, we may release medical information about you as required by military command authorities.
Workers' Compensation. We may release medical information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.
Public Health Risks. We may disclose medical information about you for public health activities. These activities generally include the following:
Health Oversight Activities. We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes. We may disclose medical information about you in response to a subpoena, discovery request, or other lawful order from a court.
Law Enforcement. We may release medical information if asked to do so by a law enforcement official as part of law enforcement activities; in investigations of criminal conduct or of victims of crime; in response to court orders; in emergency circumstances; or when required to do so by law.
Coroners, Medical Examiners and Funeral Directors. We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients of the hospital to funeral directors as necessary to carry out their duties.
Protective Services for the President, National Security and Intelligence Activities. We may release medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations, or for intelligence, counterintelligence, and other national security activities authorized by law.
Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
You have the following rights regarding medical information we maintain about you:
Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes.
To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to our Privacy Officer at the address below. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.
We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to your medical information, in many circumstances, you may request that the denial be reviewed. If a review is applicable, another licensed health care professional chosen by Bethany Methodist will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review. Please note, however, that under certain limited circumstances, there is no opportunity for a review of denial of access to your medical information.
Right to Amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept. Any amendment to your medical record will be disseminated to anyone who received the original information.
To request an amendment, your request must be made in writing and submitted to our Privacy Officer. In addition, you must provide a reason that supports your request.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
In the event that we are unable to agree to a request for amendment, we will provide you with written notification.
Right to an Accounting of Disclosures. You have the right to request an "accounting of disclosures." This is a list of the disclosures of your medical information that we have made to third parties. Such an accounting shall not include disclosures made for treatment, payment or health care operations; for national security interests; to comply with authorized requests of law enforcement or correctional institution officials; or to you to inform you of the content of your medical records. In addition, an accounting will not include disclosures that you expressly have authorized, disclosures made to persons involved in your care, or disclosures made to maintain the facility's directory.
All requests for accountings shall be submitted in writing and directed to our Privacy Officer. Your request must state a time period that may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper, electronically). The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. 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.
Right to Request Restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend.
We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. In the event that we are unable to agree to your request for restrictions on the use or disclosure of your medical information, we will provide you with written notice.
All requests for restrictions shall be in writing and shall be directed to our Privacy Officer at the address below. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply. Please note that you will be required to bear any additional costs associated with your request (i.e., additional postage, etc.).
Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
To request confidential communications, you must make your request in writing to our Privacy Officer. We will not ask you the reason for your request and we will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.
To obtain a paper copy of this notice, please request one in writing from our Privacy Officer at the address below. We will provide a copy of the current notice to any individual upon request.
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in paper form in prominent locations throughout Bethany Methodist. We will also post a copy of our current notice on our web site, at http://www.bethanymethodist.org. The notice will contain the effective date in the header of the first page and on the last page.
If you believe your privacy rights have been violated, you may file a complaint with Bethany Methodist or with the Secretary of the Department of Health and Human Services. To file a complaint with Bethany Methodist, contact our Privacy Officer at the address and phone number below. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written authorization. If you authorize us to use or disclose medical information about you, you may revoke your authorization, in writing, at any time. If you revoke your authorization, thereafter, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have made in reliance upon your authorization, and that we are required to retain our records of the care that we provided to you.
Name: Jim Brady, LNHA
5015
N. Paulina Avenue
Chicago, IL. 60640
(773) 989-1521 or (773) 989-1357
Effective April 14, 2003
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