McKinley Health Center - University of Illinois at Urbana-Champaign
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.
If you have any questions about this Notice please contact our Privacy Officer at (217) 333-2711 or firstname.lastname@example.org.
"Protected health information" is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health condition and related health care services. This notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. We may change the terms of our notice at any time. The new notice will be effective for all protected health information that we maintain at the time. You may request any revised Notice of Privacy Practices by accessing our website at http://www.mckinley.illinois.edu, calling our office and requesting that a revised copy be sent to you in the mail or asking for one at the time of your next appointment.
YOUR MEDICAL RECORD
Everyone who is eligible for health services at the McKinley Health Center has a medical record; this is consistent with the national standard of medical practice. Any medical or mental health information that is created or received by McKinley Health Center becomes a part of your medical record. Safe and effective treatment at McKinley Health Center requires some sharing of treatment information among clinicians at the Health Center. Mental health records are kept in a separate section of the medical record subject to additional regulations beyond those required of general health records. HIV information is also protected by additional confidentiality regulations.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
Your protected health information may be used and disclosed by McKinley Health Center for treatment, payment or operations purposes. Following are examples of types of uses and disclosures of your protected health care information that McKinley Health Center is permitted to make. These examples are not meant to be exhaustive but to describe the types of uses and disclosures that may be made by McKinley Health Center.
We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you. We may disclose your protected health information to another physician or health care provider (e.g., a specialist or laboratory) who, at the request of your physician, nurse practitioner, or therapist becomes involved in your care.
McKinley Health Center does not routinely bill patients or third parties for services rendered. However, should circumstance require billing, your protected health information will be used, as needed, to obtain payment for your 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. For example, obtaining approval for a hospital stay or for a referral to a specialist may require that your relevant protected health information be disclosed to the health plan.
We may use or disclose, as needed, your protected health information in order to support our business. These activities include, but are not limited to, quality assessment activities, employee review activities, licensing and accreditation activities, marketing and conducting or arranging other business activities. For example, we may use or disclose your protected health information, as necessary, to e-mail a reminder to you of your scheduled appointment. We may also call you by name in the waiting room when your physician is ready to see you. We may leave a voice mail message on your phone asking you to contact the Health Center in order to ensure adequate follow-up care.
We may provide certain services through contracts with others. When services are contracted, your health information may be disclosed in order to carry out specific operational functions. Whenever an arrangement for services involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information. For example, the Health Center may have a contract with another facility to provide 24-hour nursing advice during hours when the Health Center is not in operation. Your protected health information may be shared with that facility. McKinley Health Center will have a written contract with the outside facility that will protect the privacy of your protected health information.
We may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you. For example your protected health information may be used for mailing purposes to notify you when flu vaccine is available. Your protected health information may be used to notify you of any encumbrance you may have related to a deficiency in your immunizations. We may use your protected health information to solicit your feedback on services or programs you have utilized at the Health Center, or that the Health Center may be considering implementing.
Uses and Disclosures of Protected Health Information Based Upon Your Written Authorization
Other uses and disclosure of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described below. We will disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person's involvement in your health care, only with your authorization. You may revoke an authorization at any time, in writing, except to the extent that McKinley Health Center has taken an action in reliance on the use or disclosure indicated in that authorization.
Other Permitted and Required Uses and Disclosures That May Be Made With Your Consent, Authorization or Opportunity to Object
We may use and disclose your protected health information in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your protected health information. If you are not present or able to agree or object to the use or disclosure of the protected health information, then McKinley Health Center may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the protected information that is relevant to your health care will be disclosed.
Others Involved in Your Healthcare:
We may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts. We may provide information to the Emergency Dean's office regarding dates you were seen at McKinley Health Center if you have initiated contact with the Emergency Dean's office for this purpose.
We may use or disclose your protected health information in an emergency treatment situation.
Other Permitted and Required Uses and Disclosures That May be Made Without Your Consent, Authorization or Opportunity to Object
We may use or disclose your protected health information in the following situations without your consent or authorization.
These situations include:
Required By Law:
We may use or disclose your protected health information to the extent that the use or disclosure is required by law. The use or disclosure will be limited to the relevant requirements of the law.
We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purposes of controlling disease, injury or disability.
We may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections.
Abuse or Neglect:
We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.
Food and Drug Administration:
We may disclose to the FDA health information relative to adverse events with respect to food, supplements, produce and product defects, or post marketing surveillance information to enable product recalls, repairs or replacements.
We may disclose protected health information as required by law or in response to a court order or in response to a valid subpoena, discovery request or other lawful process.
Law Enforcement and Criminal Activity:
We may disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes. Consistent with applicable federal and state laws, we may disclose your protected health information if we believe that the use or disclosure is necessary to prevent or lessen a serious imminent threat to the health or safety of a person or the public.
Coroners, Funeral Directors, and Organ Donation:
We may disclose protected health information to a coroner or medical examiner consistent with applicable law to enable them to carry out their duties. Protected health information may be used and disclosed for cadaveric organ, eye or tissue donation and transplant.
We may disclose your protected health information to researchers when their research has been approved by the University's Institutional Review Board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.
Military Activity and National Security:
When the appropriate conditions apply, we may use or disclose protected health information of individuals who are Armed Forces personnel. We may disclose protected health information to authorized federal officials for conducting national security and intelligence activities including the provision of protective services to the President or others legally authorized.
Worker's Compensation: We may disclose your protected health information as authorized to comply with workers' compensation laws and other similar legally established programs.
Following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights. You may obtain forms for submitting a request in writing for any of the following processes through our medical records unit.
You have the right to inspect and copy your protected health information.
This means you may inspect and obtain a copy of protected health information about you for as long as we maintain the information. Certain information may not be inspected or copied including the following: information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding; protected health information that is subject to law that prohibits access to protected health information; a psychotherapist's personal notes. Please contact our Medical Records department if you have questions about access to your medical record.
You have the right to request restrictions of your protected health information.
This means you may ask us not to disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed for notification purposes as described in this Notice of Privacy. McKinley Health Center is not required to agree to restrictions that you may request. You may request a restriction by submitting your request in writing to our Privacy Officer.
You have the right to request to receive confidential communications from us by alternative means or at an alternative location.
We will accommodate reasonable requests. We will ask you for specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for this request. Please make this request in writing to our Privacy Officer.
You have the right to request that McKinley Health Center amend your protected health information.
This means you may request an amendment of protected health information about you for as long as we maintain this information. Amendments to records will be made only in the instance where it is determined the information was created by McKinley Health Center and is not accurate or complete. If we deny your request for amendment, you have the right to file a statement of disagreement with us. Requests for amendment of protected health information must be submitted in writing to our Privacy Officer.
You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information.
This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures we have made to you or for notification purposes. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003. You may request a shorter time frame. The right to receive this information is subject to certain exceptions, restrictions and limitations.
You have the right to obtain a paper copy of this notice from us.
Should you have questions or if you believe your privacy rights have been violated, you can file a complaint by contacting our Privacy Officer at (217) 333-2711 or email@example.com. There will be no retaliation for filing a complaint.
This notice was published and becomes effective on June 1, 2005.
of the Vice Chancellor for Student Affairs
© 2009 The Board of Trustees of the University of Illinois at Urbana-Champaign