Privacy policy

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.

USE AND DISCLOSURE OF YOUR PERSONAL HEALTH INFORMATION (PHI)

Northern Illinois Hospice and Grief Center (NIH) may use your PHI for purposes of providing your treatment, obtaining payment for your care and conducting health care operations. Your PHI is defined in the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 and NIH has established policies to safeguard unnecessary disclosure.

THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH YOUR PHI MAY BE USED AND DISCLOSED:

To provide treatment.

NIH may use your PHI to coordinate care within our organization, and with others such as, physicians, pharmacists, medical suppliers, family members and other professionals who are involved in your care.

To obtain payment.

For example, NIH may be required by your insurance company to provide PHI so that they can reimburse you or NIH.

To conduct health care operations.

NIH may use and disclose your PHI to facilitate our functions and to provide quality care to all our patients. Some examples for this use and disclosure would include: Training programs including those in which students, trainees, volunteers or practitioners in health care learn under supervision; sharing your PHI with our licensing and certification entities or for use in our internal audits and nursing homes and hospitals where we provide service.

THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH YOUR PHI MAY ALSO BE USED AND DISCLOSED.

When legally required.

NIH will disclose your PHI when required by any Federal, State or local law or for public activities and purposes in order to: Prevent or control disease, report disease or injury, notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease.

To report abuse, neglect or domestic violence.

NIH is allowed to notify government authorities if we believe a patient is the victim of abuse, neglect or domestic violence. We will make this disclosure only when specifically required or authorized by law or when the patient agrees to the disclosure.

In connection with judicial and administrative proceedings.

NIH may disclose your health information in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order or in response to a subpoena, discovery request or other lawful process, but only when NIH makes reasonable efforts to either notify you about the request or to obtain an order protecting your PHI.

For law enforcement purposes.

As permitted or required by State law, NIH may disclose your PHI to law enforcement officials for specific purposes. Some of those officials include: Coroners and Medical Examiners, Funeral Directors, Organ, Eye or Tissue Donation, Worker's Compensation.

AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION

Other than is stated above, NIH will not disclose your PHI other than with your written authorization. If you or your representative authorizes NIH to use or disclose your PHI, you may revoke that authorization in writing at any time.

YOUR RIGHTS WITH RESPECT TO YOUR PHI

You have the following rights regarding your health information that NIH maintains:

Right to request restrictions.

You may request restrictions on certain uses and disclosures of your PHI. You have the right to request a limit on NIH’s disclosure of your PHI to someone who is involved in your care or the payment of your care. However, we are not required to agree to your request. If you wish to make a request for restrictions, please contact our Privacy Officer.

Right to receive confidential communications.

You have the right to request that NIH communicate with you in a certain way. For example, you may ask that we only conduct communications pertaining to your health information with you privately with no other family members present. If you wish to receive confidential communications, please contact our Privacy Officer. NIH will not request that you provide any reasons for your request and will attempt to honor your reasonable requests for confidential communications.

Right to inspect and copy your health information.

You have the right to inspect and copy your PHI, including billing records. A request to inspect and copy records containing your health information may be made to our Privacy Officer. If you request a copy of your PHI, NIH may charge a reasonable fee for copying and assembling costs associated with your request.

Right to amend health care information.

If you believe your PHI is incorrect or incomplete, you or your representative have the right to request that NIH amend them. That request may be made as long as the information is maintained by us. A request for an amendment of records must be made in writing to our Privacy Officer. NIH may deny the request if it is not in writing or does not include a reason for the amendment. The request also may be denied if your PHI records were not created by us, if the records are not part of our records, if the health information you wish to amend is not part of the health information you or your representative are permitted to inspect and copy, or if, in our opinion, the records containing your health information are accurate and complete.

Right to an accounting.

You or your representative have the right to request an accounting of disclosures of your PHI made by NIH for certain reasons, including those related to public purposes authorized by law and certain research. The request for an accounting must be made in writing to our Privacy Officer, and the request should specify the time period for the accounting starting on or after April 14, 2003. Accounting requests may not be made for periods of time in excess of six (6) years. NIH will provide the first accounting you request during any 12-month period without charge. Subsequent accounting requests may be subject to a reasonable cost-based fee.

Right to a paper copy of this notice.

You or your representative have a right to a separate paper copy of this Notice at any time even if you or your representative have received this Notice previously. To obtain a separate paper copy, please contact our Privacy Officer or obtain a copy of the current version at our website, www.northernillinoishospice.org.

NIH’s DUTIES

NIH is required by law to maintain the privacy of your PHI and to provide you and your representative this Notice of its Duties and Privacy Practices and to abide by the terms of this Notice as may be amended from time to time. NIH reserves the right to change the terms of its Notice and to make the new Notice provisions effective for all Personal Health Information it maintains. If we change our Notice, we will provide a copy of the revised Notice to you or your representative. You or your representative have the right to express complaints to us and to the Secretary of DHHS if you or your representative believe your privacy rights have been violated. Any complaints to NIH should be made in writing to our Privacy Officer. NIH encourages you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way for filing a complaint.

CONTACT PERSON

For all issues regarding patient privacy, your rights under the Federal Privacy Standards, and questions regarding this notice, contact our Clinical Care Director/Privacy Officer by phone, 815-398-0500; by fax 815-398-0588; or in person at Northern Illinois Hospice and Grief Center, 4215 Newburg Road, Rockford, IL 61108.

For Fund Raising Activities.

NIH may use information about you, including your name, address and phone number, to contact you to raise funds which help support our organization. If you do not wish us to do so, please contact our Privacy Officer in writing.

EFFECTIVE DATE - This Notice is effective April 14, 2003.