Fox Prairie Medical Group
Notice of Privacy Practices
This Notice of Privacy Practices has been created by Fox Prairie Medical Group (“Provider”) to inform you of how we may use your information for treatment, payment and health care operations purposes and as otherwise permitted by law. We are required by law to maintain the privacy of your protected health information and to provide you with notice of our privacy practices with regard to accessing, amending, and controlling the use of your protected health information. By reading this notice and signing the acknowledgement form, you are allowing Fox Prairie Medical Group to use, access, and disclose your health information for treatment, payment and health operations.
We will abide by the terms of the Notice of Privacy Practices at any time as it applies to all protected health information in our custody without providing any notice of such change. At your request, upon the occurrence of any revision of the terms of the Notice of Privacy Practices currently in effect, you may obtain a revised copy of this Notice of Privacy Practices from our administrative personnel at our office located at 2560 Foxfield Rd., Suite 160, St. Charles, IL 60174. The privacy contact for the Provider is Andrea Dailey. Please direct all questions to the privacy contact at the address above.
I. Treatment, Payment and Healthcare Operations
Following are examples of some, but not all, of the types of uses and disclosures of your information that we are permitted to make.
Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with another health care provider; For example, we would disclose your information as necessary to hospitals or specialists providing care to you.
Payment: Your information will be used, as necessary, to obtain payment for our health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you, such as determining eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. We will disclose to your health insurance company information about the goods and services rendered to you in order to obtain payment. We may also disclose your information to another entity so that it may seek payment.
Operations: We may use or disclose, as necessary, your information in order to support our business activities. These activities include, but are not limited to, quality assessment, employee review, face-to-face marketing activities, and conducting or arranging for other business activities. To protect your health information, we require the business associates to appropriately safeguard your information.
We may use or disclose your information as necessary to contact you to remind you of appointments. We may use or disclose information to notify or assist in notifying a family member, personal representative, or other person responsible for your care. Health care professionals, using their best judgment, may disclose to a family member, other relative, close personal friend, or any other person you identify, health information relevant to that person’s involvement with your care or payment related to that care. We may contact you to provide you with information about treatment alternatives or other health-related benefits and services which may be of interest to you. We will follow Illinois state law as it relates to “personal representatives” or non-emancipated minors.
We will share your protected health information with third party “business associates” that perform activities (e.g., transcription, information technology support, and billing) for the practice.
We may disclose your protected health information to another entity for health care fraud and abuse detection or compliance, conducting quality improvement activities, population-based activities relating to improving health or reducing health care costs, protocol development, case management and care coordination, contacting of health care providers and patients with information about treatment alternatives, and related functions that do not include treatment, reviewing the competence of health care professionals, conducting training programs, accreditations, certification, licensing, credentialing or other similar activities. Disclosures described in the preceding paragraph will only be made if the other entity has or had a relationship with you.
We may disclose your protected health information to an organized health care arrangement in which we participate for any health care operation activities of said organized health care arrangement. An example of an organized health care arrangement is a hospital and its medical staff. We may disclose information to researchers when there are established protocols or where we have obtained a waiver from an institutional review board.
II. Uses and Disclosures of Protected Health Information Based upon Your Written Authorization
Other uses and disclosures of your protected health information for purposes other than treatment, payment and health care operations will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke an authorization at any time in writing, except to the extent that we have taken an action in reliance on the use or disclosure indicated in the authorization.
III. Uses and Disclosures for Which You Have Consent Opportunity
We may use or disclose your protected health information in the circumstances described in Section III, without seeking an authorization, provided we first give you an opportunity to object to such use or discloser. If you are present, we may provide you with an opportunity to object and accept your failure to object as your agreement, or we may reasonably infer from the circumstances that you do not object. If you are not present or are unable to agree or object to such use or disclosure of your protected health discloser of your protected health information is in your best interest. All communications described in Section III may be done orally.
IV. Uses and Disclosures of Protected Health Information Which Do Not Require Your Authorization or Opportunity to Object.
We are permitted under certain circumstances to make the following uses and disclosures of your protected health information without having to obtain your authorization, or give you an opportunity to object: uses and disclosures required by law: uses and disclosures for public health activities, such as reporting of diseases, child or elder abuse, injury, or vital events such as birth and death; disclosure to an employer if you are a member of the employer’s workforce and we have been requested by the employer to conduct an evaluation relating to medical surveillance of the workplace or to evaluate whether you have a work-related illness or injury; discloser to a governmental authority if we reasonably believe that you are a victim of abuse, neglect, or domestic violence; disclosure to health oversight agencies (e.g., the U.S. Department of Health and Human Services) for oversight activities authorized by law; disclosures for legal proceedings; disclosures for law enforcement purposes; disclosures concerning decedents; uses and disclosures for cadaver organ, eye, or tissue donation purposes; uses and disclosures for research purposes; uses and disclosures to avert a serious threat to health or safety; disclosures regarding protected health information of members of the armed forces to appropriate military command authorities; national security and intelligence activities; disclosures to correctional authorities regarding protected health information of persons in custody; and disclosures as authorized to comply with workers’ compensation laws.
V. Your Rights
The Right to Request Restriction of Uses and Disclosures. You have the right to request that we restrict the uses or disclosures of your protected health information to carry out treatment, payment or health care operations and to facility members, other relatives or persons directly involved in your care or payment. We are not required to agree to any such restriction, but if we do, we must comply with such restrictions, other than in an emergency or certain circumstances permitted or required by law.
The Right to Confidential Communications. You have the right to submit a written request to our privacy contact that we provide you with an alternative means of communication in the event you tell us that our customary methods of communication may not preserve the confidentiality of your information. We will attempt to accommodate all reasonable requests.
The Right to Access Protected Health Information. You have a right to submit a written request to our privacy contact that we amend your protected health information in our custody, and you must explain the basis for your request. We may deny your request to amend your protected health information if a) we did not create the information unless the individual or entity that created the information is no longer available to make the requested amendment, b) the information is maintained by or in our custody, c) you do not have the right to access such information, or d) we have determined that such is accurate and complete.
The Right to an Accounting of the Disclosures of Protected Health Information. You have a right to an accounting of how we have disclosed your protected health information we have made in the six-year period prior to the date of your request for the accounting.
We are not required to account for uses and disclosures of your protected health information by us to carry out treatment, payment or health care operations performed by us or our business associates; to other health care providers to provide treatment to you; to other covered entities or health care providers for payment activities of said person; to other covered entities which have had a treatment relationship with you for certain health care operations purposes of said entities; to you pursuant to your right to access your protected health information; made pursuant to an authorization signed by you; to friends and family involved in your care and treatment or payment for your care and treatment, or for certain notification purposes; for national security or intelligence purposes; to correctional authorities with respect to persons in custody; or that occurred prior to April 14, 2003; or incident to a use or disclosure otherwise permitted or required by law.
Your request for an accounting must be made in writing to our privacy contact at 2560 Foxfield Rd., Suite 160, St. Charles, IL, 60174. We will inform you of the fee for accounting services prior to the accounting.
VI. Further Information
If you have questions and would like additional information, you may contact the privacy contact by calling (630)513-8734. If you believe your privacy rights have been violated, you can file a complaint with our privacy contact at 2560 Foxfield Rd., Suite 160, St. Charles, IL, 60174, or with the U.S. Department of Health and Human Services.
VII. Additional Rights; Effective Date
This Notice of Privacy Practices has been prepared to reflect your rights under the Health Insurance Portability and Accountability Act. If state law provides you with greater access to information, or provides greater protection to that information, than is described in this policy, then we shall follow the provisions of state law. Examples of such state laws are the Mental Health and Developmental Disabilities Confidentiality Act, The AIDS Confidentiality Act and the Genetic Information Privacy Act. In addition, if a federal law creates greater protection for the information described in this policy, the Provider shall follow the provisions of such federal law. An example of such a federal law if the Federal Drug Abuse, Prevention, Treatment and Comprehensive Alcohol Abuse and Alcoholism prevention Treatment, and Rehabilitation Act of 1970.
This Notice of Privacy Practices is effective as of April 14, 2003.
