NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL AND CLINICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Effective Date: April 14, 2003
We respect client confidentiality and only release confidential 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 at the Counseling Center of Lakeview.
Privacy Contact: If you have any questions about this policy or your rights, you may contact our Privacy Officer, Halley McCormack, at (773) 549-5886.
USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION
In order to effectively provide your care, there are times when we will need to share information about your care (also called Protected Health Information) with others outside CCLV. These times include:
Treatment: We may use or disclose clinical information about you to provide, coordinate, or manage your care or any related services, including sharing information with others outside CCLV with whom we are consulting or to whom we are referring you.
Payment: This agency may use and disclose your health information to others for the purposes of receiving payment for treatment and services that you receive. For example, a bill may be sent to you or a third-party payor, such as an insurance company or health plan. The information on the bill may contain information that identifies you, your diagnosis, and your treatment. We also have a right to verify that the payment information you are providing is correct.
Healthcare Operations: We may use information about you to coordinate our quality assurance activities. This may include setting up your appointments, reviewing your care, and 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 the immediate emergency you are facing.
Follow-up Appointments: We may leave appointment information on your home answering machine unless you tell us not to.
As Required by Law: We may disclose information about you in situations such as when we have a court order, or are mandated to provide public health information, such as communicable diseases or suspected abuse or neglect such as child abuse, elder abuse, or institutional abuse.
Governmental Requirements: We may disclose information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, and licensure. We may also 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 US Department of Health and Human Services to determine our compliance with federal laws related to health care and to Illinois state agencies that fund our services.
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.
Coroners: We are required to disclose information about the circumstances of a client death to a coroner who is investigating it.
PATIENT RIGHTS
You have the following rights under Illinois and federal law:
Copy of Record: You are entitled to inspect the clinical record CCLV has generated about you. We may charge you a reasonable fee for copying and mailing your record.
Release of Records: You may consent in writing to the release of your records to others, for any purpose you choose. This could include your attorney, employer, or others whom you wish to have knowledge of your care. You may revoke this consent at any time, but only to the extent no action has been taken by CCLV based upon your prior authorization.
Restriction on Record: You may ask us not to use or disclose part of the clinical information. This request must be in writing. The agency is not required to agree to your request if we believe it is in your best interest to permit use and disclosure of the information. Your request should be given to our Privacy Contact.
Contacting You: You may request that we send information to another address or by alternative means. We will honor such a request as long as it is reasonable and we are assured it is correct.
Amending Record: If you believe that something in your record is incorrect or incomplete, you may request we add an amendment to it. To make this request, contact the Privacy Contact, and ask for the Request to Amend Health Information form. In certain cases, we may deny your request. If we deny your request for an amendment, you have a right to file a statement that you disagree with us. Your request, our response, and your statement will be added to your record.
Accounting for Disclosures: You may request an accounting of any disclosures we have made related to your confidential information, except for information that we used for treatment, payment, or health care operations, or that we shared with you or your family, or information that you gave us specific consent to release. This accounting also excludes information we are required to release. To receive information regarding disclosures made for a specific time period no longer than six years and after April 14, 2003, please submit your request in writing to our Privacy Contact. We will notify you of the cost involved in preparing this list.
Questions and Complaints: If you have any questions, or wish a copy of this Policy, or have any complaints, you may contact our Privacy Contact in writing at our office for further information. You may also complain to the Secretary of the US Department of Health and Human Services Health and Human Services if you believe CCLV has violated your privacy rights. We will not retaliate against you for filing a complaint.
Changes in Policy: This agency reserves the right to change its Privacy Policy based on the needs of CCLV and changes in state and federal law. Revised notices will be posted in all agency facilities and copies made available upon request. |
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