PRIVACY NOTICE (Revision Date: August 31, 2014)
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
Each time you visit a hospital, doctor, or other health care provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, a plan for future care or treatment, and information needed for billing. This Notice of Privacy Practices (“Notice”) applies to all of the records of your care created by Saint Anthony Hospital, whether made by Saint Anthony Hospital personnel, agents of the hospital, or your personal doctor. Your personal doctor may have different policies or Notices for his/her use and disclosure of the medical information created in his/her office or clinic.
Saint Anthony Hospital takes the privacy of your health information seriously. We know that information about you and your health is personal. We are dedicated to protecting this information.
Other uses and disclosures of health information not covered by this Notice, or the laws that apply to us, will be made only with your written permission. If you give us permission to use or disclose health information about you, you may withdraw that permission, in writing, at any time. If you withdraw your permission, we will no longer use or disclose health information about you for the reasons covered by your written permission.
Saint Anthony Hospital, its workforce, and its medical staff members participate in an Organized Health Care Arrangement and are presenting you with this document as a joint Notice. Participants in the Organized Health Care Arrangement include:
Information will be shared among these participants as necessary to carry out treatment, payment, and health care operations. Doctors and other caregivers may have access to such health information in their offices to assist in reviewing past treatment, as it may affect current treatment.
The following describe examples of the ways we use and disclose health information about you. For each category we explain what we mean and give examples. Not every use or disclosure in a category will be listed. However, all of the ways that we are allowed to use and disclose health information will fall within one of the categories.
To You. We must disclose your health information to you, as described in the “Your Rights Regarding Your Health Information” section of this Notice.
For Treatment. We may use health information about you to give you treatment, health care, or other related services. We may share health information about you with doctors, nurses, aides, technicians, students, or other personnel who are involved in taking care of you. For example: our physicians, nurses and other health care personnel, including trainees, involved in your care use and disclose your health information to diagnose your condition and evaluate your needs. Different departments of the hospital also may share health information about you in order to coordinate the different services you may need, such as prescriptions, lab work, meals, and x-rays.
We also may use or disclose your health information to manage or coordinate your treatment, health care, or other related services. For example, we may give your primary doctor or other health care provider copies of various medical records that may assist him/her in treating you once you are discharged from this hospital.
For Payment. We may use and disclose your health information to bill and collect payment from you, your insurance company, or a third party payer, including a collection service. For example, we may need to give your insurance company information about your condition so they will pay us or reimburse you for the treatment. We also may tell your health plan about treatment to determine whether your plan will pay for the treatment.
For Health Care Operations. We may use and disclose health information to run the hospital. This is important to make sure that all patients receive quality care. For example, members of the medical staff and/or quality improvement team may use information about you to measure how well our staff takes care of you. We may combine health information about many patients to evaluate the need for new services or treatment. We may share information with doctors, nurses, and students so that they can learn about how to care for people like you. We may combine health information we have with that of other hospitals to see how we are doing and what we can do better. We also may disclose your health information to various government or accreditation agencies to maintain our license and accreditation.
As Required by Law. We will disclose your health information when required to do so by federal, state, or local law. We may disclose your health information as authorized by and to the extent necessary to comply with workers’ compensation laws or laws relating to similar programs.
For Public Health and Safety. We may disclose your health information for public health activities or when there is an imminent threat to your health or safety or the health or safety of others. There may be other examples, but public health and safety activities generally include the following:
Judicial or Administrative Purposes. We may disclose your health information in response to a court or administrative order. We also may disclose your health information in response to a subpoena, discovery request, or other lawful process by someone else involved in a dispute.
Law Enforcement. We may disclose health information if asked to do so by a law enforcement official, if such disclosure is:
Coroners, Medical Examiners and Funeral Directors. In certain circumstances, we may disclose health information to a coroner, medical examiner, or funeral director. This may be necessary for example, to identify a deceased person or determine the cause of death.
Organ and Tissue Donation. We may disclose your health 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.
Research. Under certain circumstances, we may use and disclose health information about you for research purposes. Before we use or disclose health information for research, the project will be approved through a special process. Most of the time, however, we will ask for your specific permission for the researcher to have access to your name, address or other information that reveals who you are, or to be involved in your care.
Military and National Security. We may disclose to military authorities the health information of armed services personnel under certain circumstances. We may disclose your health information to authorized federal officials for lawful intelligence, counterintelligence, and other national security activities authorized by law. We may disclose health information required for lawful intelligence, counterintelligence, and other national security activities. We may disclose health information to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or for the conduct of special investigations.
Custodial Situations. If you are an inmate in a correctional institution and if the correctional institution or law enforcement authority makes certain representations to us, we may disclose your health information to a correctional institution or law enforcement official.
Treatment, Alternatives, Appointment, Reminders and Health-Related Benefits. We may use and disclose your health information to provide you with appointment reminders and tell you about or recommend possible treatment alternatives or health-related benefits or services or agencies that may be of interest to you. If you do not wish us to contact you about treatment alternatives, health-related benefits, or appointment reminders, you must notify us in writing, and state from which of those activities you wish to be excluded.
Fundraising Activities. We and our related foundations may use your health information to contact you in an effort to raise money for Saint Anthony Hospital and its operations. In these cases, we would disclose only limited information about you including: your demographic information (name, address, other contact information, age, gender, and date of birth); dates of health care provided to you; department of service; your treating physician; whether you had a positive or negative outcome; and your health insurance status. If you do not want us to contact you for fundraising efforts, you have the right to opt-out of receiving such communications.
Facility Directory. We may include certain limited information about you in our inpatient facility directory. The directory includes your name, location in the hospital, general condition (e.g., fair, stable, etc.) and your religious affiliation. The directory information, except for your religious affiliation, also may be disclosed 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 minister, even if they do not ask for you by name. If you do not wish to be included in the facility directory, please notify us at the time of admission.
Family and Friends. We may disclose health information about you to a family member, other relative, or any other person identified by you who is involved in your health care. We also may give information to someone who helps pay for your care. In addition, we may tell your family, friends, personal representative or other person responsible for your health care your condition and that you are at the Hospital.
Third Parties. We may disclose your health information to third parties with whom we contract to perform services on our behalf. If we disclose your information to these entities, we will have an agreement with them to safeguard your information.
Other uses and disclosures of health information not covered by this Notice or the laws that apply to us will be made only with your written authorization (permission), including (1) most uses and disclosures of psychotherapy notes; (2) most uses and disclosures of your health information for marketing purposes; and (3) disclosures that constitute the sale of your health information. If you provide us with permission to use or disclose your health information, you may revoke (cancel) that permission, in writing, at any time. If you cancel your permission, we will no longer use or disclose health information about you for the reasons covered by your written permission. We are unable to take back any disclosures we have already made under the permission, and we are required to retain our records of the care that we provided to you.
You have the following rights regarding health information that we maintain about you:
Right to Access and Copy. You have the right to inspect and receive a copy of health 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 receive a copy of your health information, you may submit your request in writing to: Director, Health Information Management (Medical Records) at 2875 West 19th Street, Chicago, IL 60623. If you did not receive care at Saint Anthony Hospital, you will need to contact the Office Manager of the location where you received services. If you ask for a copy of the information, we may charge a fee to cover the costs of copying, mailing or other supplies associated with your request.
We may deny your request to inspect and copy your health information in certain very limited circumstances. In some cases, if you are denied access to your health information, you may ask that the denial be reviewed. Another licensed health care professional chosen by Saint Anthony Hospital will review your request and the denial. The person conducting the review will not be the person who denied your request. We will abide by the outcome of the review.
Right to Amend. If you feel that medical information we have about you is not correct or incomplete, you may ask us to make corrections to the information. You have the right to request a correction for as long as the information is kept by or for us. We may deny your request for a correction, and if this occurs, you will be notified of the reason for the denial.
To ask for an amendment, your request must be made in writing and submitted to the Privacy Officer, Department of Medical and Legal Services at 2875 West 19th Street, Chicago, IL 60623. 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:
Right to an Accounting of Disclosures. You have the right to ask for a list of certain disclosures that we have made of your health information. This is a list of when, what, to whom, and why we disclosed health information about you that was required or permitted by law, but did not require your written permission.
To ask for this list of disclosures, you must submit your request in writing to the Privacy Officer, Department of Medical and Legal Services at 2875 West 19th Street, Chicago, IL 60623. Your request must state a time period for the accounting that must be within the six years immediately preceding the date of your request. Your request should indicate in what form you want the list (for example, in hand copy or via e-mail). The first list you request within a twelve-month period will be provided free of charge. However, if you make additional requests in the same twelve-month period, you may be charged a reasonable, cost-based fee. 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 ask for 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 health information we disclose about you or someone who is involved in your care or the payment for your care.
We are not required to agree to your request, except if you request that we not disclose information to a health plan for payment or health care operations activities when you have paid for the services that are the subject of the information out-of-pocket in full. If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment.
To ask for restrictions, you must make your request in writing to the Privacy Officer, Department of Medical and Legal Services at 2875 West 19th Street, Chicago, IL 60623. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclose, or both; and (3) to who you want the limits to apply.
Right to Request Confidential Communications. You have the right to ask that we communicate with you or your responsible party about your health care in a certain way or at a certain location. For example, you may ask that we use an address other than your home address for billing purposes, or that we do not leave a message on your telephone voice mail. We will not ask you the reason for your request and we will accommodate all reasonable requests.
To request confidential communications, you must make your request in writing to your health care provider at the location where you received services. 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 receive a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time. We are required to ask you to acknowledge, in writing, your receipt of this Notice.
We reserve the right to change this Notice. The revised Notice will include the effective date and will be effective for 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 a prominent location to which you have access. The Notice also is available to you upon request. In addition, if we revise the Notice, we will offer you a copy of the Notice currently in effect.
If you have any questions about this Notice or would like more information, please contact the Saint Anthony Hospital Privacy Officer at 773.484.4471.
This Notice was published on or about September 21, 2012 and becomes effective on: October 1, 2012. Revision date: July 12, 2011; August 31, 2014.