| |
 |
Notice
of Privacy Practices
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.
Arlington Pediatrics, Ltd. creates a
medical record of your health information in order to
treat you, receive payment for services
delivered, and to comply with certain policies and
laws. We are also required by law to
provide you with this Notice of our legal duties and
privacy practices. In addition, the law
requires us to ask you to sign an Acknowledgment
that you received this Notice.
We are
required by federal and state law to maintain the privacy of
your medical
information. Medical information is also
called “protected health information” or “PHI”.
This is
a list of some of the types of uses and disclosures of PHI
that may occur:
- Treatment:
We obtain health information, or PHI, about you to treat
you. Your PHI is
used by us and others to treat
you. We may also send your PHI to another physician,
facility or counselor to which
we refer you for treatment, care, procedures, or testing.
We may also use your PHI to
contact you to tell you about alternative treatments, or
other health-related benefits
we offer. If you have a friend or family member involved in
your care, we may give them PHI
about you.
-
Payment:
We use your PHI to obtain payment for the services that we
render. For
example, we send PHI to your
insurance plan to obtain payment for our services.
-
Health
Care Operations:
We use your PHI for our operations. For example, we may
use your PHI in determining
whether we are giving adequate treatment to our patients.
On occasion, we may use your
PHI to contact you to remind you of an appointment.
Legal
Requirements:
We may use and disclose your PHI as required or authorized
by law. For example, we may use or
disclose your PHI for the following reasons:
-
Public
Health:
We may disclose your health information to prevent / control
disease,
injury or disability, to report
births and deaths, to report reactions to medicines or
medical devices or to report
suspected cases of abuse or neglect.
-
Health
Oversight Activities:
We may use
and disclose your PHI to stat agencies
and federal government
authorities when required to do so. We may use and disclose
your health information in
order to assist others in determining your eligibility for
public
benefit programs and to
coordinate delivery of those programs. For example, we must
give PHI to the Secretary of
Health and Human Services in an investigation into our
compliance with the federal
privacy rule.
-
Judicial
and Administrative Proceedings:
We may use and disclose your PHI in
judicial and administrative
proceedings. Efforts may be made to contact you prior to a
disclosure of your PHI to the
party seeking the information.
-
Law
Enforcement: We
may use and disclose your PHI in order to comply with
requests pursuant to a court
order, warrant, subpoena, summons, or similar process.
We may use and disclose PHI to
locate someone who is missing, to identify a crime
victim, to report a death, to
report criminal activity at our offices, or in an emergency.
-
Avert a
Serious Threat to Health or Safety:
We may use or disclose your PHI to
stop you or someone else from
getting hurt.
-
Work-Related Injuries:
We may use or disclose PHI to an employer if the employer
is conducting medical workplace
surveillance or to evaluation work-related injuries.
-
Coroners, Medical Examiners, and Funeral Directors:
We
may use or disclose
PHI to a coroner or medical
examiner in some situations. For example, PHI may be
needed to identify a deceased
person or determine a cause of death. Funeral directors
may need PHI to carry out their
duties.
-
Armed
Forces:
We may
use or disclose the PHI of Armed Forces personnel to the
military for proper execution
of a military mission. We may also use and disclose PHI
to the Department of Veterans
Affairs to determine eligibility for benefits.
-
National
Security and Intelligence:
We may
use or disclose PHI to maintain the
safety of the President or
other protected officials. We may use or disclose PHI for
the conduct of national
intelligence activities.
-
Research:
You will
need to sign an Authorization form before we use or disclose
PHI
for research purposes except in
limited situations. For example, if you want to
participate in research or a
clinical study, an Authorization form must be signed.
-
Fundraising:
If we
undertake any fundraising activities, we may contact you
about
the fundraising activity. We do
not engage in marketing activities, and need your
authorization to do so.
Illinois
Law:
Illinois
law has certain requirements that govern the use or
disclosure of
your PHI. In order for us to release
information about mental health treatment, genetic
information, your AIDS/HIV status, and
alcohol or drug abuse treatment, you will be
required to sign an Authorization form
unless state law allows to make the specific type
of use or disclosure without your
authorization.
Your
Rights:
You have
certain rights under federal and state laws relating to your
PHI.
Some of these rights are described below:
-
Restrictions:
You have
a right to request restrictions on how your PHI is used for
purposes of treatment, payment
and health care operations. We are not required to
accommodate your request.
-
Communications:
You have
a right to receive confidential communications about
your PHI. For example, you may
request that we only call you at home. If your
request is reasonable, it may
be accepted.
-
Inspect
and Access:
You have
a right to inspect your health information. This
information includes billing
and medical record information. You may not inspect your
record in some cases. If your
request to inspect your record is denied, we will send
you a letter letting you know
why and explaining your options.
You may have a copy of your PHI
in most situations. If you request a copy of your
PHI, we may charge you a fee
for making the copies and mailing them to you, if you
ask us to mail them.
-
Amendments of Your Records:
If you believe there is an error in your PHI, you have
a right to request that we
amend your PHI. We are not required to agree with your
request to amend.
-
Accounting of Disclosures:
You have
a right to receive an accounting of disclosures
that we have made of your PHI
for purposes other than treatment, payment, and health
care operations, or release
made pursuant to your authorization.
-
Copy of
Notice:
You have
a right to obtain a paper copy of this Notice, even if you
originally received the Notice
electronically. We have also posted this Notice at our
office.
-
Complaints:
If you
feel that your privacy rights have been violated, you may
file a
complaint with us by calling
our Privacy Officer at 847-398-0400. We will not retaliate
against you for filing a
complaint. You may also file a complaint with the Secretary
of
Health and Human Services in
Washington, DC if you feel your privacy rights have
been violated.
We are required to abide with terms of the
Notice currently in effect; however, we may
change this Notice. If we materially change
this Notice, you can get a revised Notice by
stopping by our office to pick up a
copy. Changes to the Notice are applicable to the
health information we already have.
^
Top of page
|
|
|
|
|
