The Village of
Notice of Privacy Practices
IMPORTANT: 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.
As an essential part of
our commitment to you, The Village of Schiller Park maintains the privacy of
certain confidential health care information about you, known as Protected
Health Information or PHI. We are
required by law to protect your health care information and to provide you with
the attached Notice of Privacy Practices.
The
Notice outlines our legal duties and privacy practices respect to your
PHI. It not only describes our privacy
practices and your legal rights, but lets you know, among other things, how The
Village of Schiller Park is permitted to use and disclose PHI about you, how
you can access and copy that information, how you may request amendment of that
information, and how you may request restrictions on our use and disclosure of
your PHI.
The
Village of Schiller Park is also required to abide by the terms of the version
of this Notice currently in effect. In most situations we may use this
information as described in this Notice without your permission, but there are
some situations where we may use it only after we obtain your written
authorization, if we are required by law to do so.
We
respect your privacy, and treat all health care information about our patients
with care under strict policies of confidentiality that all of our staff is
committed to following at all times.
PLEASE
READ THE ATTACHED DETAILED NOTICE.
IF YOU HAVE ANY QUESTIONS ABOUT IT, PLEASE CONTACT:
RICHARD
J. NOSEK, OUR PRIVACY OFFICER, AT (847) 678-2550.
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.
Purpose of this Notice: The
Village of Schiller Park is required by law to maintain the privacy of certain
confidential health care information, known as Protected Health Information or
PHI, and to provide you with a notice of our legal duties and privacy practices
with respect to your PHI. This Notice describes your legal rights, advises you
of our privacy practices, and lets you know how The Village of Schiller Park is
permitted to use and disclose PHI about you.
The
Village of Schiller Park is also required to abide by the terms of the version
of this Notice currently in effect. In most situations we may use this
information as described in this Notice without your permission, but there are
some situations where we may use it only after we obtain your written
authorization, if we are required by law to do so.
Uses and Disclosures of PHI: The
Village of Schiller Park may use PHI
for the purposes of treatment, payment, and health care operations, in most
cases without your written permission.
Examples of our use of your PHI:
For treatment. This includes such things as verbal and
written information that we obtain about you and use pertaining to your medical
condition and treatment provided to you by us and other medical personnel
(including doctors and nurses who give orders to allow us to provide treatment
to you). It also includes information we give to other health care personnel to
whom we transfer your care and treatment, and includes transfer of PHI via
radio or telephone to the hospital or dispatch center as well as providing the
hospital with a copy of the written record we create in the course of providing
you with treatment and transport.
For payment. This includes any activities we must
undertake in order to get reimbursed for the services we provide to you,
including such things as organizing your PHI and submitting bills to insurance
companies (either directly or through a third party billing company), management
of billed claims for services rendered, medical necessity determinations and
reviews, utilization review, and collection of outstanding accounts.
For health care operations. This includes quality assurance activities,
licensing, and training programs to ensure that our personnel meet our
standards of care and follow established policies and procedures, obtaining
legal and financial services, conducting business planning, processing
grievances and complaints, creating reports that do not individually identify
you for data collection purposes.
Use and
Disclosure of PHI Without Your Authorization.
The Village of Schiller Park is permitted to use PHI without your
written authorization, or opportunity to object in certain situations,
including:
·
For
The Village of Schiller Park’s use in treating you or in obtaining payment for
services provided to you or in other health care operations;
·
For
the treatment activities of another health care provider;
·
To
another health care provider or entity for the payment activities of the
provider or entity that receives the information (such as your hospital or
insurance company);
·
To
another health care provider (such as the hospital to which you are
transported) for the health care operations activities of the entity that
receives the information as long as the entity receiving the information has or
has had a relationship with you and the PHI pertains to that relationship;
·
For
health care fraud and abuse detection or for activities related to compliance
with the law;
·
To
a family member, other relative, or close personal friend or other individual
involved in your care if we obtain your verbal agreement to do so or if we give
you an opportunity to object to such a disclosure and you do not raise an
objection. We may also disclose health
information to your family, relatives, or friends if we infer from the
circumstances that you would not object. For example, we may assume you agree
to our disclosure of your personal health information to your spouse when your
spouse has called the ambulance for you.
In situations where you are not capable of objecting (because you are
not present or due to your incapacity or medical emergency), we may, in our
professional judgment, determine that a disclosure to your family member,
relative, or friend is in your best interest. In that situation, we will
disclose only health information relevant to that person's involvement in your
care. For example, we may inform the person who accompanied you in the
ambulance that you have certain symptoms and we may give that person an update
on your vital signs and treatment that is being administered by our ambulance
crew;
·
To
a public health authority in certain situations (such as reporting a birth, death
or disease as required by law, as part of a public health investigation, to
report child or adult abuse or neglect or domestic violence, to report adverse
events such as product defects, or to notify a person about exposure to a
possible communicable disease as required by law;
·
For
health oversight activities including audits or government investigations,
inspections, disciplinary proceedings, and other administrative or judicial
actions undertaken by the government (or their contractors) by law to oversee
the health care system;
·
For
judicial and administrative proceedings as required by a court or
administrative order, or in some cases in response to a subpoena or other legal
process;
·
For
law enforcement activities in limited situations, such as when there is a
warrant for the request, or when the information is needed to locate a suspect
or stop a crime;
·
For
military, national defense and security and other special government functions;
·
To
avert a serious threat to the health and safety of a person or the public at
large;
·
For
workers’ compensation purposes, and in compliance with workers’ compensation
laws;
·
To
coroners, medical examiners, and funeral directors for identifying a deceased
person, determining cause of death, or carrying on their duties as authorized
by law;
·
If
you are an organ donor, we may release 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 donation and transplantation;
·
For
research projects, but this will be subject to strict oversight and approvals
and health information will be released only when there is a minimal risk to
your privacy and adequate safeguards are in place in accordance with the law;
·
We
may use or disclose health information about you in a way that does not
personally identify you or reveal who you are.
Any other use or disclosure of PHI, other than
those listed above will only be made with your written authorization, (the
authorization must specifically identify the information we seek to use or
disclose, as well as when and how we seek to use or disclose it).
You may revoke your authorization at any time, in
writing, except to the extent that we have already used or disclosed medical
information in reliance on that authorization.
Patient Rights: As a patient, you have a number of rights
with respect to the protection of your PHI, including:
The right to access, copy or inspect your PHI.
This means you may come to our offices and inspect and copy most of the
medical information about you that we maintain.
We will normally provide you with access to this information within 30
days of your request. We may also charge
you a reasonable fee for you to copy any medical information that you have the
right to access. In limited
circumstances, we may deny you access to your medical information, and you may
appeal certain types of denials.
We have available forms to
request access to your PHI and we will provide a written response if we deny
you access and let you know your appeal rights.
If you wish to inspect and copy your medical information, you should
contact the privacy officer listed at the end of this Notice.
The right to amend your PHI.
You have the right to ask us to amend written medical information that
we may have about you. We will generally
amend your information within 60 days of your request and will notify you when
we have amended the information. We are
permitted by law to deny your request to amend your medical information only in
certain circumstances, like when we believe the information you have asked us
to amend is correct. If you wish to
request that we amend the medical information that we have about you, you
should contact the privacy officer listed at the end of this Notice.
The right to request an accounting of our use and
disclosure of your PHI.
You may request an accounting from us of certain disclosures of your
medical information that we have made in the last six years prior to the date
of your request. We are not required to
give you an accounting of information we have used or disclosed for purposes of
treatment, payment or health care operations, or when we share your health
information with our business associates, like our billing company or a medical
facility from/to which we have transported you.
We are also not required
to give you an accounting of our uses of protected health information for which
you have already given us written authorization. If you wish to request an accounting of the
medical information about you that we have used or disclosed that is not
exempted from the accounting requirement, you should contact the privacy
officer listed at the end of this Notice.
The right to request that we restrict the uses and
disclosures of your PHI. You have the right to request that we restrict how we use and
disclose your medical information that we have about you for treatment, payment
or health care operations, or to restrict the information that is provided to
family, friends and other individuals involved in your health care. But if you request a restriction and the
information you asked us to restrict is needed to provide you with emergency
treatment, then we may use the PHI or disclose the PHI to a health care
provider to provide you with emergency treatment. The Village of Schiller Park is not required
to agree to any restrictions you request, but any restrictions agreed to by The
Village of Schiller Park are binding on The Village of Schiller Park.
Internet, Electronic Mail, and the Right to Obtain Copy
of Paper Notice on Request. If we maintain a web site, we
will prominently post a copy of this Notice on our web site and make the Notice
available electronically through the web site.
If you allow us, we will forward you this Notice by electronic mail
instead of on paper and you may always request a paper copy of the Notice.
Revisions to the Notice: The Village of Schiller Park reserves the
right to change the terms of this Notice at any time, and the changes will be
effective immediately and will apply to all protected health information that
we maintain. Any material changes to the
Notice will be promptly posted in our facilities and posted to our web site, if
we maintain one. You can get a copy of
the latest version of this Notice by contacting the Privacy Officer identified
below.
Your Legal Rights and Complaints: You also have the right to
complain to us, or to the Secretary of the United States Department of Health
and Human Services if you believe your privacy rights have been violated. You
will not be retaliated against in any way for filing a complaint with us or to
the government. Should you have any
questions, comments or complaints you may direct all inquiries to the privacy
officer listed at the end of this Notice.
Individuals will not be retaliated against for filing a complaint.
If you have any questions or if you wish to file a
complaint or exercise any rights listed in this Notice, please contact:
Richard J. Nosek, Privacy Officer
The
9526
(847) 678-2550
Or via e-mail: rnosek@villageofschillerpark.com
Effective Date of the Notice: