Your Information. Your Rights. Our Responsibilities.
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.
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
|Get an electronic or paper copy of your medical record||You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.|
|We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.|
|Ask us to correct your medical record||You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.|
|We may say “no” to your request, but we’ll tell you why in writing within 60 days.|
|Request confidential communications||You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.|
|We will say “yes” to all reasonable requests.|
|Ask us to limit what we use or share||You can ask us not to use or share certain health information for treatment, payment, or our operations.|
|We are not required to agree to your request, and we may say “no” if it would affect your care.|
|If you pay for a service or healthcare item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer.|
|We will say “yes” unless a law requires us to share that information.|
|Get a list of those with whom we’ve shared information||You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.|
|We will include all the disclosures except for those about treatment, payment, and healthcare operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.|
|Get a copy of this privacy notice||You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.|
|Choose someone to act for you||If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.|
|We will make sure the person has this authority and can act for you before we take any action.|
|File a complaint if you feel your rights are violated||You can complain if you feel we have violated your rights by contacting us using the information provided near the bottom of this page.|
|You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.|
|We will not retaliate against you for filing a complaint.|
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
|In these cases, you have both the right and choice to tell us to:||Share information with your family, close friends, or others involved in your care|
|Share information in a disaster relief situation|
|Include your information in a hospital directory|
|Contact you for fundraising efforts|
|If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.|
|In these cases we never share your information unless you give us written permission:||Marketing purposes|
|Sale of your information|
|Most sharing of psychotherapy notes|
|In the case of fundraising:||We may contact you for fundraising efforts, but you can tell us not to contact you again.|
Our Uses and Disclosures
How do we typically use or share your health information? We typically use or share your health information in the following ways:
|Treat you||We can use your health information and share it with other professionals who are treating you.||Example: A doctor treating you for an injury asks another doctor about your overall health condition.|
|Run our organization||We can use and share your health information to run our practice, improve your care, and contact you when necessary.||Example: We use health information about you to manage your treatment and services.|
|Bill for your services||We can use and share your health information to bill and get payment from health plans or other entities.||Example: We give information about you to your health insurance plan so it will pay for your services.|
How else can we use or share your health information? We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
|Help with public health and safety issues||We can share health information about you for certain situations such as:|
|Helping with product recalls|
|Reporting adverse reactions to medications|
|Reporting suspected abuse, neglect, or domestic violence|
|Preventing or reducing a serious threat to anyone’s health or safety|
|Do research||We can use or share your information for health research|
|Comply with the law||We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law|
|Respond to organ and tissue donation requests||We can share health information about you with organ procurement organizations|
|Work with a medical examiner or funeral director||We can share health information with a coroner, medical examiner, or funeral director when an individual dies|
|Address workers’ compensation, law enforcement, and other government requests||We can share health information with a coroner, medical examiner, or funeral director when an individual dies|
|For workers’ compensation claims|
|For law enforcement purposes or with a law enforcement official|
|With health oversight agencies for activities authorized by law|
|For special government functions such as military, national security, and presidential protective services|
|Respond to lawsuits and legal actions||We can share health information about you in response to a court or administrative order, or in response to a subpoena|
Special privacy protections apply to HIV-related information, alcohol and substance abuse, mental health and genetic information. Unless required by law, Shawnee Health Service (SHS) will not release this information unless you provide written consent. SHS will only use this information internally as needed for quality improvement, billing, and information systems/information technology purposes.
SHS participates in the Southern Illinois Health Information Exchange (SIHIE) and exchanges health information with other local hospitals. This allows SHS to share your health information with other healthcare providers involved in your care. If you would like to opt-out, please complete the form located at www.sihie.org or request the Opt-Out form from us.
SHS shares your health and treatment information as needed with the Illinois Comprehensive Automatized Immunization Registry Exchange (ICARE). If you would like to opt-out, please request the Opt-Out form from us.
- We are required by law to maintain the privacy and security of your protected health information.
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
- We must follow the duties and privacy practices described in this notice and give you a copy of it.
- We will not use or share your information other than as described here unless you tell us we can in
writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you
change your mind.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
Changes to the Terms of This Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.
Effective Date: April 14, 2003, Revised October 17, 2018
This Notice of Privacy Practices applies to the following organizations.
All Shawnee Health Service sites. If you would like a list of locations, please ask us.
Privacy Officer: Connie Favreau
Shawnee Health Service, 109 California Street, PO Box 577, Carterville, IL 62918-0577
Email: firstname.lastname@example.org Phone: (618) 956-8221 Fax: (618) 985-6860