HIPAA COMPLIANT STATEMENT

 

As  required  by  the  Privacy  Regulations  Promulgated  Pursuant  to  the Health  Insurance  Portability  and  Accountability  Act  of  1996  (HIPAA) 

 

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 Notice of Privacy Practices describes how  we may use and disclose your protected health information (PHI) to carry out treatment, payment or health care operations (TPO) and for other purposes that are permitted or required by law.  It also describes your  rights to  access and control your protected health information.  “Protected health information” is information about  you, including demographic information, that may identify you and that relates to your  past, present or future physical or mental health or condition and related

 health care services. 

 

Uses  and  Disclosures  of  Protected  Health  Information:  Your  protected  health  information  may  be  used  and disclosed  by  our  organization,  our  office  staff  and  others  outside  of  our office  that  are  involved  in  your  care  and treatment  for  the  purpose  of  providing  health  care  services  to  you,  to  pay  your  health  care  bills,  to  support  the operation  of  the  

organization,  and  any  other  use  required  by  law. 

 

Treatment:  We  will  use  and  disclose  your  protected  health  information  to  provide,  coordinate,  or  manage  your health  care  and  any  related  services.  This  includes  the  coordination  or  management  of  your  health  care  with  a third  party.  For  example,  we  would  disclose  your  protected  health  information,  as  necessary,  to  a  home  health agency  that  provides  

care  to  you.  For  example,  your  protected  health  information  may  be  provided  to  a  physician to  whom you have been referred  to  ensure  that  the  physician  has  the  necessary  

information  to  diagnose  or  treat you. 

 

Payment:  Your  protected  health  information  will  be  used,  as  needed,  to  obtain  payment  for  your  health  care services.  For  example,  obtaining  approval  for  equipment  or  supplies  

coverage  may  require  that  your  relevant protected  health  information  be  disclosed  to  the  health  plan  to  obtain  approval  for  coverage. 

 

Healthcare Operations: We may use or disclose, as needed, your protected health information in order to support the  business  activities  of  our  organization.  These  activities  include,  but  are  not  limited  to,  quality  assessment activities,  

employee  review  activities,  accreditation  activities,  and  conducting  or  arranging  for  other  business activities.  For  example,  we  may  disclose  your  protected  health  information  to  

accrediting  agencies  as  part  of  an accreditation  survey.  We  may  also  call  you  by  name  while  you  are  at  our  facility.  We  may  use  or  disclose  your protected  health  information,  

as  necessary,  to  contact  you  to  check  the  status  of  your  equipment. 

 

We  may  use  or  disclose  your  protected  health  information  in  the  following  situations  without  your authorization:  as  Required  By  Law,  Public  Health  issues  as  required  by  law,  

Communicable  Diseases,  Health Oversight,  Abuse  or  Neglect,  Food  and  Drug  Administration  requirements,  Legal  Proceedings,  Law  Enforcement, Criminal  Activity,  Inmates,  Military  

Activity,  National  Security,  and  Workers’  Compensation.  Required  Uses  and Disclosures:  Under  the  law,  we  must  make  disclosures  to  you  and  when  required  by  the  Secretary  of  

the Department  of  Health  and  Human  Services  to  investigate  or  determine  our  compliance  with  the  requirements  of Section  164.500. 

 

Other  Permitted  and  Required  Uses  and  Disclosures  Will  Be  Made  Only  with  Your  Consent,  Authorization  or Opportunity  to  Object,  unless  required  by  law. 

 

You  may  revoke  this  authorization,  at  any  time,  in  writing,  except  to  the  extent  that  your  physician  or  this organization  has  taken  an  action  in  reliance  on  the  use  or  disclosure 

indicated  in  the  authorization. 

 

Your  Rights:  Following  is  a  statement  of  your  rights  with  respect  to  your  protected  health  information. 

 

You have the right  to  inspect  and copy  your protected health  information.  Under  federal  law,  however,  you  may not  inspect  or  copy  the  following  records;  psychotherapy  notes;  

information  compiled  in  reasonable  anticipation of,  or  use  in,  a  civil,  criminal,  or  administrative  action  or  proceeding,  and  protected  health  information  that  is subject  to  law  that  

prohibits  access  to  protected  health  information. 

 

You  have the  right  to  request  a  restriction  of  your  protected  health  information.  This  means  you  may  ask  us  not to  use  or  disclose  any  part  of  your  protected  health  information  for  the  purposes  of  treatment,  payment  or healthcare  operations.  You  may  also  request  that  any  part  of  your  protected  health  information  not  be  disclosed to  family  members  or  friends  who  may  be  involved  in  your  care  or  for  notification  purposes  as  described  in  this Notice  of  Privacy  Practices.  Your  request  must  state  the  specific  restriction  requested  

and  to  whom  you  want  the restriction  to  apply. 

 

Our  organization  is  not  required  to  agree  to  a  restriction  that  you  may  request.  If  our  organization  believes  it  is  in your  best  interest  to  permit  use  and  disclosure  of  your  

protected  health  information,  your  protected  health information  will  not  be  restricted. 

 

You  then  have  the  right  to  use  another  Healthcare  Professional. You  have  the  right  to  request  to  receive  confidential  communications  from  us  by  alternative  means  or  at  an 

alternative  location.   You  have  the  right  to  obtain  a  paper  copy  of  this  notice  from  us,  upon  request,  even  if  you have  agreed  to  accept  this  notice  alternatively,  e.g.,  electronically. 

 

You  may  have  the  right  to  have  our  organization  amend  your  protected  health  information.  If  we  deny  your request  for  amendment,  you  have  the  right  to  file  a  statement  of  

disagreement  with  us  and  we  may  prepare  a rebuttal  to  your  statement  and  will  provide  you  with  a  copy  of  any  such  rebuttal. 

 

You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. 

 

We reserve  the right  to  change  the  terms  of  this  notice  and  will  inform  you  by  mail  of  any  changes.  You  then  have the  right  to  object  or  withdraw  as  provided  in  this  notice. 

 

Complaints:  You  may  complain  to  us  or  to  the  Secretary  of  Health  and  Human  Services  if  you  believe  your  privacy rights  have  been  violated  by  us.  You  may  file  a  complaint  with  us  by  notifying  our  privacy  contact  of  your complaint.  We  will  not  retaliate  against  you  for  filing  a  complaint. 

 

We are required by law to maintain the  privacy of, and provide individuals  with,  this  notice  of  our  legal  duties  and privacy  practices  with  respect  to  protected  health  information,  if  you  have  any  questions  concerning  or  objections to  this  form,  please  ask  to  speak  with  our  Vice President  in  person  or  by  phone  at   815.277.9505.  

 

Associated  companies  with  whom  we  may  do  business,  such  as  an  answering  service  or  delivery  service,  are given  only  enough  information  to  provide  the  necessary  service  to  

you.  No  medical  information  is  provided. 

 

We welcome  your  comments:   Please  feel  free  to  call  us  if  you  have  any  questions  about  how  we  protect  your privacy.  Our  goal  is  always  to  provide  you  with  the  highest  quality  services.