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.
At Thorek Memorial Hospital (TMH), we understand that medical information about you and your health is personal. TMH will maintain your personal protected health information (PHI) in a secure and confidential manner, as required by law. All employees and staff of TMH must follow the privacy practices described in this Notice.
We create a record of the care and services you receive at TMH that contains your PHI. This may include written, electronic and photographic information used for your treatment. TMH employees and staff must use and disclose your PHI to provide you with quality healthcare services. To do this, TMH must share your PHI as necessary for treatment, payment and health care operations. We are committed to do everything possible to protect the privacy of your health information and care. We will restrict authorized access to patient information, enforce our policies on the matter, and remind our staff of the importance of confidentiality.
We are providing you with a copy of this notice, which describes the health information privacy practices of Thorek Memorial Hospital and any affiliated entities that jointly perform health care, payment, and business activities with us. A copy of our current notice will always be posted in the first floor registration areas (admitting, outpatient, and emergency room). You will also be able to obtain copies on our website at www.thorek.org, by calling our office at 773-975-6867 or by asking for one at your next visit.
Your personal doctor may also have different policies or notices regarding the doctor’s use and disclosure of your medical information, which may be in the doctor’s possession and control.
If you have any questions about this notice or would like further information, contact the Admitting Manager at 773-525-6780, ext. 5565.
Important Summary Information
Requirement for Acknowledgment of Notice of Privacy Practices.We will ask you to sign a form acknowledging that you have received this Notice of Privacy Practices.
Requirement For Written Authorization. We will obtain your written authorization before sharing your PHI with others unless its use is for purposes as described in the following “exceptions” section. Your authorization will also be required if you wish to transfer your records to another person. If you provide us with written authorization, you may revoke that authorization at any time, except to the extent that we have already relied upon it. To revoke an authorization, please write to TMH’s Director of Health Information Management, 850 W. Irving Park Rd., Chicago, IL 60613.
Exceptions To Requirement. There are some situations when we do not need your written authorization before using your PHI or sharing it with others.
1) Treatment, Payment, And Business Operations. We are allowed to use and disclose your PHI without your consent to treat your condition, collect payment for that treatment, or run our normal business operations.
2) Disclosure To Friends And Family Involved In Your Care. We will ask you whether you have any objection to including information about you in our patient directory or sharing information about your health with your friends and family involved in your care. More information about this exception is provided below.
3) Emergencies Or Public Need. We may use or disclose your PHI in an emergency or for important public needs. For example, we may share your information with public health officials who are authorized to investigate and control the spread of diseases. Additional examples of potential exceptions are detailed below.
4) Information Does Not Identify You. We may use or disclose your PHI if we have removed any information that might reveal your identity.
How To Access Your Health Information. You generally have the right to inspect and obtain a copy your PHI. Details about this right are provided below.
How To Correct Your Health Information. You have the right to request that we amend your PHI if you believe it is inaccurate or incomplete. This right is described further below.
How To Determine If Your Health Information Has Been Shared With Others. You have the right to receive a list from us, called an "accounting list", which provides information about when and how we have disclosed your PHI to outside persons or organizations. The list will identify non-routine disclosures of your information, but routine disclosures will not be included. The list will not include disclosures you have authorized. For more information about your right to see this list, see below.
How To Request Additional Privacy Protections. You have the right to request further restrictions on how we use your PHI or share it with others. We are not required to agree to the restriction you request, but if we do, we will be bound by our agreement.
How To Request More Confidential Communications. You have the right to request that we contact you in a way that is more confidential for you, such as at home instead of at work. We will try to accommodate all reasonable requests.
How Someone May Act On Your Behalf. You have the right to name a personal representative who may act on your behalf to control the privacy of your PHI. Parents and guardians will generally have the right to control the privacy of PHI about minors unless the minors are permitted by law to act on their own behalf.
How To Obtain A Copy Of This Notice. You should keep this notice as your copy. You may request copies at any time. To do so, please call TMH’s Admitting Manager at 773-525-6780 ext. 5565. You may also obtain a copy by requesting one at your next visit.
How To Obtain A Copy Of Revised Notices. We may change our privacy practices from time to time. If we do, we will post any revised notice in the three first floor registration areas (admitting, outpatient and emergency room) and on our web site noted above. The revised notice will apply to all of your health information, and we will be required by law to abide by its terms. To obtain a copy of the revised notice use the channels identified above. The effective date will be noted at the top of the first page.
How To File A Complaint. If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. To file a complaint with us, please contact TMH’s privacy officer at 773-975-6867. There will be no retaliation for filing a complaint.
What Health Information is Protected
Some examples of protected health information are:
- Information about your health condition (such as a disease you may have)
- Information about health care services you have received or may receive in the future (such as an operation or specific therapy)
- Information about your health care benefits under an insurance plan (such as whether a prescription or medical test is covered)
- Geographic information (such as where you live or work)
- Demographic information (such as your race, gender, ethnicity, or marital status)
- Unique numbers that may identify you (such as your social security number, phone number, or driver's license number) and
- Other types of information that may identify who you are.
How We May Use and Disclose Your Health Information Without Written Authorization
1. Treatment, Payment And Normal Business Operations
Physicians and other staff members at TMH may use your PHI or share it with others in order to treat you, obtain payment, and/or run TMH's normal business operations. Below are examples of how your PHI may be used:
Treatment. We may share your PHI with those who are involved in taking care of you, and they may in turn use that information to diagnose or treat you. For example, different departments may share PHI about you to coordinate the different things you need, such as prescriptions, lab work and x-rays. We also may disclose PHI to people outside the hospital who may be involved in your medical care after you leave the hospital, such as family members, clergy or others to provide services that are part of your care.
Payment. We may use your PHI or share it with others to obtain payment for your health care services. For example, we may share information about you with your health insurance company to verify benefits, obtain approval or claim payment for your treatment.
Business Operations. We may use your PHI or share it with others in order to conduct our normal business operations. For example, we may use your PHI to evaluate the performance of our physicians or staff, or to educate our physicians or staff on how to improve the care they provide. We may also share your PHI with another company that performs business services for us, such as billing. If so, we will have a written contract to ensure that this company also protects the privacy of your PHI.
Appointment Reminders, Treatment Alternatives, Benefits And Services. We may use your PHI when we contact you with a reminder that you have an appointment for treatment or services. We may also use your PHI to recommend possible treatment alternatives or health-related benefits and services that may be of interest to you.
2. Friends And Family
We may use your PHI in our patient directory, or share it with friends and family involved in your care, without your written authorization. We will always give you an opportunity to object unless there is insufficient time because of a medical emergency (in which case we will discuss your preferences with you as soon as the emergency is over). We will follow your wishes unless we are required by law to do otherwise.
Friends And Family Involved In Your Care. If you do not object, we may share your PHI with a family member, relative, or close personal friend who is involved in your care or payment for that care. We may also notify a family member, personal representative or another person responsible for your care about your general condition.
3. Special Situations.
We may use your PHI and share it with others in certain special situations such as those listed below. We will not be required to obtain your written authorization, consent or any other type of permission before using or disclosing your information for these reasons.
Emergencies. We may use or disclose your PHI if you need emergency treatment or if we are required by law to treat you but are unable to obtain your consent. If this happens, we will try to obtain your consent as soon as we reasonably can after we treat you.
As Required By Law. We may use or disclose your PHI if we are required by law to do so. We also will notify you of these uses and disclosures if notice is required by law.
Public Health Activities. We may disclose your PHI to authorized public health officials responsible for controlling disease, injury or disability. We may also disclose your PHI to a person who may have been exposed to a communicable disease or be at risk for contracting or spreading the disease if a law permits us to do so.
Workers' Compensation. We may disclose your PHI for workers' compensation or similar programs that provide benefits for work-related injuries.
Organ and Tissue Donation. If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
Medical Examiners and Funeral Directors. We may release medical information to a medical examiner, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients of the hospital to funeral directors as necessary to carry out their duties.
YOUR RIGHTS TO ACCESS AND CONTROL YOUR HEALTH INFORMATION
We want you to know that you have the following rights to access and control your PHI. These rights are important because they will help you make sure that the health information we have about you is accurate.
1. Right to Inspect and Obtain a Copy of Records
You have the right to inspect and obtain a copy of any of your PHI for as long as we maintain this information in our records. This includes medical and billing records. To inspect or obtain a copy of your health information, please submit your request in writing to TMH’s Department of Health Information Management, 850 W. Irving Park Rd., Chicago, IL 60613. If you request a copy of the information, there will be a fee for the costs of copying, mailing or other supplies we use to fulfill your request.
We ordinarily will respond to your request within 30 days if the information is located in our facility, and within 60 days if it is located off-site at another facility. If we need additional time to respond, we will notify you in writing within the time frame above to explain the reason for the delay and when you can expect to have a final answer to your request.
Under certain very limited circumstances, we may deny your request to inspect or obtain a copy of your information. If we deny part or all of your request, we will provide a written denial that explains our reasons for doing so, and a complete description of your rights.
2. Right To Amend Records
If you believe that the health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept in our records. To request an amendment, please write to the Director of Health Information Management, 850 W. Irving Park Rd., Chicago, IL 60613. Your request should include the reasons why you think we should make the amendment. Ordinarily we will respond to your request within 60 days. If we need additional time to respond, we will notify you in writing within 60 days to explain the reason for the delay and when you can expect to have a final answer.
If we deny part or all of your request, we will provide a written notice that explains our reasons for doing so. You will have the right to have certain information related to your request included in your records. For example, if you disagree with our decision, you will have an opportunity to submit a statement explaining your disagreement, which we will include in your records.
3. Right To An Accounting Of Disclosure
After April 14, 2010, you have a right to request an “accounting of disclosures" which is a list with information about how we have shared your information with others. An accounting list, however, will not include:
- Disclosures we made to you;
- Disclosures you authorized;
- Disclosures we made in order to provide you with treatment, obtain payment for that treatment, or conduct our normal business operations;
- Disclosures made from the patient directory;
- Disclosures made to your friends and family involved in your care;
- Disclosures made to federal officials for national security and intelligence activities;
- Disclosures about inmates or detainees to correctional institutions or law enforcement officers; or
- Disclosures made before April 14, 2010.
To request this list, please write to the Director of Health Information Management, 850 W. Irving Park Rd., Chicago, IL 60613. Your request must state a time period for the disclosures you want us to include. For example, you may request a list of the disclosures that we made between January 1, 2009, and January 1, 20010.
You have a right to one list within a 12-month period at no charge. However, we may charge you for the cost of providing any additional lists in that same 12 month period. We will notify you if any cost is involved so that you may choose to withdraw or modify your request before any costs are incurred.
Ordinarily we will respond to your request for an accounting list within 60 days. If we need additional time to prepare the accounting list you have requested, we will notify you in writing about the reason for the delay and the date when you can expect to receive the accounting list. In rare cases, we may have to delay providing you with the accounting list without notifying you because a law enforcement official or government agency has asked us to do so.
4. Right To Request Additional Privacy Protections
You have the right to request that we further restrict the way we use and disclose your PHI to treat your condition, collect payment for that treatment, or run our normal business operations. You may also request that we limit how we disclose information about you to family or friends involved in your care. For example, you could request that we not disclose information about a surgery or therapy you had. To request restrictions, please write to the Privacy Officer, c/o TMH Administration Office, 850 W. Irving Park Road, Chicago, IL 60613. Your request should include (1) what information you want to limit; (2) whether you want to limit how we use the information, how we share it with others, or both; and (3) to whom you want the limits to apply.
We are not required to agree to your request for a restriction, and in some cases the restriction you request may not be permitted under law. However, if we do agree, we will be bound by our agreement unless the information is needed to provide you with emergency treatment or comply with the law. Once we have agreed to a restriction, you have the right to revoke the restriction at any time. Under some circumstances, we will also have the right to revoke the restriction as long as we notify you before doing so; in other cases, we will need your permission before we can revoke the restriction.
5. Right To Request Confidential Communications
You have the right to request that we communicate with you about your medical matters in a more confidential way. For example, you may ask that we contact you at home instead of at work.
To request more confidential communications, please write to: TMH Privacy Officer, Administration Office, 850 W. Irving Park Road, Chicago, IL 60613.
We will not ask you the reason for your request, and we will try to accommodate all reasonable requests. Please specify in your request how or where you wish to be contacted, and how payment for your health care will be handled if we communicate with you through this alternative method or location.