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THIS NOTICE BECAME EFFECTIVE ON APRIL 14, 2003.
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.
UNDERSTANDING YOUR HEALTH INFORMATION AND MEDICAL RECORD
Each time you visit a hospital, physician, or other healthcare
provider, they document information about you and your visit.
Typically, this record is referred to as your medical record and
contains your name, symptoms, health history and exam, test results,
diagnoses, treatment given and a plan for future care or treatment
(“Health Information”). This medical record is used to plan your care
and treatment and be a source of your health information as described
below.
YOUR HEALTH INFORMATION RIGHTS
Your medical record is the physical property of the Mercy Hospital and
Medical Center site, however the information within your medical record
belongs to you. Federal, including the Health Information Portability
and Accountability Act (HIPAA), and Illinois Laws provide you with the
following rights regarding your health information that is contained in
the medical record that Mercy Hospital and Medical Center keeps about
you.
• Right to obtain a copy of this Notice of Privacy Practices.
• Right to request certain restrictions on the uses and disclosures of your health information.
• Right to inspect or receive a copy of your health record.
• Right to request an amendment to your health record if you believe it contains an error.
• Right to obtain a list of all the people and companies to which Mercy
Hospital and Medical Center has released your health information (an
“accounting” of disclosures).
• Right to request that we communicate with you about your health care at a confidential phone number or address.
• Right to revoke your written consent/authorization to use or disclose
your health information except when the use or disclosure has already
happened.
Federal
and Illinois laws also provide you with the right to be informed about
and give your written authorization before any health information,
including highly confidential information, is disclosed, unless such
disclosure is allowed or required by law. Examples of highly
confidential information are mental health treatment information,
substance abuse prevention, treatment or referral; developmental
disability services; HIV/AIDS testing and treatment, venereal disease
treatment, sexual assault treatment, and testing and treatment for
genetic disorders.
MERCY HOSPITAL AND MEDICAL CENTER’S RESPONSIBILITIES
• Responsible for maintaining the privacy of your health information as required by law.
• Responsible for providing you with a notice as to our legal duties
and privacy practices with respect to information we collect and
maintain about you.
• Responsible for doing what is required by this Notice or a Notice
that is in effect at the time Mercy Hospital and Medical Center uses or
discloses your health information.
• Responsible for notifying you if we are unable to agree to your
requested restriction on disclosure of your health information.
• Responsible for agreeing to reasonable requests to communicate your
health information by an alternative method or at an alternative
location.
We
reserve the right to change our privacy practices and to use a new
Notice of Privacy Practices for all health information we maintain
about you and other patients. If Mercy Hospital and Medical Center
changes its practices, a new Notice of Privacy Practices will be made
available to you upon your request, by mail or in person at this site.
USE AND DISCLOSURE OF YOUR HEALTH INFORMATION
Mercy Hospital and Medical Center will use and disclose your health
information contained within the Mercy medical record to give you
treatment, obtain payment for your treatment and operate our healthcare
businesses.
EXAMPLES OF HOW YOUR HEALTH INFORMATION WILL BE USED OR DISCLOSED FOR TREATMENT, PAYMENT AND OPERATIONS.
We will use your health information for treatment.
FOR EXAMPLE: Your physician, nurse or other members of your healthcare
team will collect and document information about you in your medical
record. We may disclose information to a physician or other health care
provider who will be assuming your care, for immediate continuity of
care. This health information will be used to choose the treatment they
believe is best for you. Nurses and other members of the team will
document in your medical record the actions they took and their
observations made of you. Your physician will then know how you are
responding to the chosen treatment.
We will use your health information for payment.
FOR EXAMPLE: We will send a bill that includes some of your health
information to you, to the person responsible for the bill and to your
third party payer (such as your health insurance company, Medicaid or
Medicare). In some instances, we may need to send a copy of part or all
of your medical record to your third party payer. The type of health
information we will send includes your name, other identifying
information, diagnosis, treatment, procedures performed and supplies
provided during your treatment.
We will use your health information for our routine operations.
FOR EXAMPLE: Physicians, nurses and quality improvement professionals
will use your health information to review the treatment you received
and its outcomes. They may also compare your treatment and outcomes to
those of other patients like you. We compare cases to help us
continually improve the quality and effectiveness of our healthcare
services.
OTHER USES OR DISCLOSURES OF YOUR HEALTH INFORMATION
Upon receipt of your written authorization to use and/or disclose your health information:
We will use and/or disclose your health information to those persons or
companies for which you give us your written authorization or
permission to do so. If you authorize us to use or disclose your
information, you must complete our Release of Health Information form.
You may revoke your authorization in writing at any time except to the
extent that we have already used or disclosed your health information
as you previously authorized. If your health information includes
highly confidential information, we may only use and disclose such
information for treatment, payment and operations as described above.
Otherwise, unless a disclosure is allowed or required by federal or
Illinois law, you must give us your written authorization to disclose
your highly confidential information. A person who can verify your
identity must witness and co-sign an Authorization to Release Health
Information form about treatment for a mental illness or developmental
disability Mercy may, without your written authorization, release your health information for the purposes described below:
Business Associates: We provide some services through other persons or
companies that need access to your health information to carry out
these services. The law refers to these persons or companies as our
Business Associates. Examples of these Business Associates include
billing and record copying companies that assist us with billing for
our services or copying medical records. Other types of business
associates are organizations that collect information about patients
who have been treated with similar problems such as cancer or trauma.
These organizations list the information in registry directories that
help physicians throughout Illinois to improve the quality of care for
other patients with these same problems. We may disclose your health
information to our Business Associates so that they can do the job we
have contracted with them to do. We require that they use appropriate
safeguards to ensure the privacy of your health information.
Health Oversight Activities and Specialized Government Functions:
We may disclose your health information to an agency that oversees
healthcare systems and ensures compliance with the rules of government
health programs such as Medicare or Medicaid, and under certain
circumstances to the U.S. Military or the U.S. Department of State.
Law Enforcement Officials, Medical Examiners and Coroners and Court or Administrative Orders:
We may disclose your health information to the police, other law
enforcement officials, medical examiners and coroners, and to courts or
administrative proceedings as allowed or required by law, a court order
or other legal process.
Notification and Other Communications with Your Relatives, Close Friends or Caregivers:
You or your legal representative must tell your physician, nurse or
other healthcare team members which of your relatives or other persons
may receive information about you. After learning who these persons
are, we may, in our best judgment, use and disclose your health
information, except for your Highly Confidential Information, to notify
these person(s) of what they need to know to care for you. In an
emergency or other situation where you are not able to identify your
chosen person(s) to receive communications about you, we may exercise
our professional judgment to determine whether such a disclosure is in
your best interest, the appropriate person(s) to whom the information
will be disclosed and what health information is relevant to their
involvement with your healthcare.
Funeral Directors and Organ, Eye and Tissue Organizations:
We may disclose your health information to funeral directors as
necessary to carry out their duties and as allowed by law; or to organ,
eye and tissue organizations that facilitate organ, eye or tissue
procurement, banking or transplantation.
Public Health Activities:
We may report your identity and other health information as follows: to
public health authorities for the purpose of controlling disease,
injury or disability; to the U.S. Food and Drug Administration for
regulating certain products or activities; to governmental authorities
about suspected or known child abuse and neglect, elder adult abuse and
neglect, or domestic violence; to a person exposed to a contagious
disease or who has the risk of contracting or spreading a disease; to
your employer and governmental agencies as required by federal and
state laws regarding work-related illness or injury; to prevent or
lessen a serious or imminent threat to a person’s or the public’s
health or safety; or, to a public or private entity that is authorized
to assist in disaster relief efforts.
Research:
We may use or disclose your health information to identify you as a
potential candidate for a research study that has been approved by an
Institutional Review Board or for governmental research studies in
which your identifiable information will not be released.
Workers Compensation:
We may disclose your health information as allowed or required by
Illinois law relating to workers’ compensation or to other similar
programs.
Other Communications with You:
We may contact you to remind you of appointments with your physicians
or other healthcare team members and to follow up on the services you
received. We may leave messages about appointments or other reminders
on your telephone or with a person who answers the phone. Unless you
notify your nurse or registration coordinator that you object, we may
also contact you about other health care services we offer that may
benefit you.
USES AND DISCLOSURES THAT YOU MAY OBJECT TO OR REQUEST
Directory (Hospital Only):
We may list the name, location in our hospital, and religious
affiliation of hospitalized patients in our inpatient directory. If you
do not object, we may disclose your name, location in our hospital and
religious affiliation to a member of the clergy who presents the
appropriate identification and asks for you by your name or by your
listed religious affiliation. We may disclose your name and general
condition to a member of the media who asks for you by name. We may
disclose your name and location in the hospital to a member of the
general public who asks for you by name. If you do not want to be
listed in our hospital directory or do not want us to give such
information to members of either the clergy, media, or general public,
you must inform your nurse or your registration coordinator. Please
note that if you are not listed in our hospital directory, we will tell
all individuals who ask for you at the visitors’ desks or who call the
operator that you are not currently a patient.
If
you are receiving mental health or alcohol/substance abuse services on
an inpatient behavioral health unit during this hospitalization, we
will not disclose any information without your prior written
authorization.
ADDITIONAL EXAMPLES OF HOW YOUR HEALTH INFORMATION WILL BE USED OR DISCLOSED
Fundraising:
Unless you notify the person listed below or the person who registers
you that you object, we may disclose your name, address, phone number
and dates of treatment to the Mercy Foundation, Inc. The Foundation may
use this information to contact you in their fundraising efforts for
Mercy.
Marketing:
Upon receiving your written authorization, we may use your health
information to provide you with marketing information about Mercy
Hospital and Medical Center’s programs and services.
If
you object to using your health information for the hospital directory,
please contact the Admitting Department at 312-567-2177.
If you object to using your health information for fundraising, please contact the Mercy Foundation, Inc. at 312-567-2114.
RIGHT TO FILE A COMPLAINT
If you would like to report a Privacy Problem or want further information, please contact Mercy Cares at 312-567-2003. If
you believe your privacy rights have been violated, you may file a
complaint with Mercy Hospital and Medical Center, the Director of the
office of Civil Rights (OCR) or the U.S. Secretary of Health and Human
Services (HHS). We will not retaliate against you if you file a
complaint with us or with the Directors of OCR or HHS.
DISCLAIMER:
THIS NOTICE OF PRIVACY PRACTICES HAS BEEN ADOPTED AS THE ONLY APPROVED
NOTICE FORM FOR USE THROUGHOUT MERCY HOSPITAL AND MEDICAL CENTER. ANY
CHANGES ARE UNAUTHORIZED AND INVALID.
This Notice applies to all Mercy Hospital and Medical Center sites, including:
Hospital and Medical Staff
Mercy Hospital and Medical Center
Others
Mercy Family Health Center
Mercy Medical Satellite locations
MercyWorks Occupational Medicine locations
Any other Health Care Facility or Physician Practice currently operated by Mercy.
THIS NOTICE BECAME EFFECTIVE ON APRIL 14, 2003.
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