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Notice of privacy practices for individuals we serve |
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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. Anixter Center’s privacy policies are in compliance with the Illinois law, Mental Health and Developmental Disabilities Confidentiality Act 740 ILCS 110, and with the federal Health Insurance Portability and Accountability Act of 1996, commonly known as HIPAA. Effective Date: April 14, 2003 We respect client confidentiality and only release medical information about you in accordance with Illinois and federal law. This notice describes our polices related to the use of the records of your care generated by Anixter Center. Privacy Contact: If you have any questions about this policy or your rights contact:
Privacy Officer USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION In order to effectively provide you care, there are times when we will need to share your medical information with others beyond Anixter Center after obtaining written authorization from you. This includes for: Treatment: We may use or disclose medical information about you to provide, coordinate or manage your care or any related services, including sharing information with others outside Anixter Center that we are consulting with or referring you to. Payment: Information will be used to obtain payment for the treatment and services provided, including contacting your health insurance company for prior approval of planned treatment or for billing purposes. Health Care Operations: We may use information about you to coordinate our business 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. As required by law: This requirement includes situations in which we have a subpoena, court order or are mandated to provide public health information; for example, when there are questions regarding communicable disease or suspected abuse and neglect including child abuse, elder abuse or institutional abused. Other scenarios include: 1. If you applied for financial benefits and are not able or not available to give out the information needed. 2. If a staff member learns that you are violating court supervision, parole or probation. 3. If information is needed by the Secret Service in order to protect the life of a person under their protection. 4. If the Illinois Department of Law Enforcement needs information to determine whether or not you can obtain a firearm owner’s identification card. Coroners, Funeral Directors, and Organ Donation: We may disclose medical information to a coroner or medical examiner and funeral directors for the purposes of carrying out their duties. When organs are donated sufficient information will be provided to the program as necessary to facilitate the organ or tissue donation. Governmental Requirements: We may disclose information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections and licensure. There also might be a 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 Department of Health and Human Services to determine our compliance with federal laws related to health care. Criminal Activity or Danger to Self or 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 or to property. CLIENT RIGHTS You have the following rights under Illinois and federal law: Copy of Record: You are entitled to inspect the client record Anixter Center generated about you. We may charge you a reasonable fee for copying and mailing your record. Guide: $20 handling charge for processing records and a charge of 75 cents per page for pages 1-25 and 50 cents per page for pages 26-50 and 25 cents for pages in excess of 50 pages. For copies made from microfilm or microfiche the charge will not exceed $1.25 per page. Release of Records: You may consent in writing to release your records to others, for any purpose you choose. This could include your attorney, employer, or anyone 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 with your prior authorization. Restriction of Record: You may ask us not to use or disclose part of the medical information. This request must be in writing. Anixter Center is not required to agree to your request if we believe it is in your best interest to permit use of disclosure of the information. This request should be given to the Director of the program and the 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. We have a right to verify that the payment information you are providing is correct. Amending Records: If you believe that something in your file is incorrect or incomplete you may request we amend it. To do this, contact the Director of the program 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. We will then file our response and your statement and our response will be added to your record. Accounting for Disclosures: You may request an accounting of any disclosures we have made related to your medical information except for information we used for treatment, payment or health care operations purposes or that we shared with you or your family or information that you gave us specific consent to release. It also excludes information we were required to release. To receive information regarding disclosure 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 to have a copy of this policy or have any complaints, you may contact our Privacy Contact in writing for further information. You also may complain to the Secretary of Health and Human Services if you believe Anixter Center has violated your privacy rights. We will not retaliate against you for filing a complaint. Changes in Policy: The agency reserves the right to change its privacy policy based on the needs of the agency and changes in state and federal law. 4/03 HIPAA |
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