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Privacy Policy

PRIVACY NOTICE

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 (815) 875-2811.

Each time you visit a hospital, physician, or other healthcare provider, a record of your visit is made.  Typically this record contains your symptoms, examination and test results, diagnoses, treatment, a plan for future care or treatment, and billing-related information.  This notice applies to all of the records of your care generated by the hospital, whether made by hospital personnel, agents of the hospital, or your personal physician.  Your personal physician may have different policies or notices regarding the physician’s use of your medical information created in the physician’s office or clinic.

  1. HOW PERRY MEMORIAL HOSPITAL MAY USE OR DISCLOSE YOUR HEALTH INFORMATION

Federal law requires Perry Memorial Hospital to maintain the privacy of individually identifiable health information (protected health information or PHI) and to provide you with notice of its legal duties and privacy practices with respect to such information.  Perry Memorial Hospital must abide by the terms and conditions of this Privacy Notice, and Perry Memorial Hospital may revise this Privacy Notice from time to time.

A.     USES OR DISCLOSURES OF HEALTH INFORMATION FOR TREATMENT, PAYMENT & HEALTH CARE OPERATIONS.

Perry Memorial Hospital may use your PHI for treatment, payment and health care operations.  Examples of treatment, payment and health care operations include:

  • “Treatment” could include consulting with or referring your case to another health care provider.  The type of health information that Perry Memorial Hospital could use or disclose includes, but is not limited to, such health conditions as blood type, diagnosis of your condition or pregnancy status.  Perry Memorial Hospital may use or disclose your PHI for its own provision of treatment or may disclose such information for the treatment activities of another health care provider.
  • “Payment” could include Perry Memorial Hospital’s efforts to obtain reimbursement from you or a responsible third party for services that Perry Memorial Hospital has provided to you.  Perry Memorial Hospital may use or disclose your PHI for its own payment or for the payment and activities of another health care provider or health plan or health care clearinghouse.
  • “Health care operations” could include activities such as quality assessment and improvement activities and audits of the process of billing you or a third party for health care services Perry Memorial Hospital provides to you.  As part of Perry Memorial Hospital’s treatment of you and operation of a health care organization, Perry Memorial Hospital may contact you, by phone or by mail, to provide appointment reminders or to provide information about treatment alternatives or other health-related services that may be of interest to you.  Perry Memorial Hospital may also contact you for fundraising purposes.  Perry Memorial Hospital may use or disclose your PHI for its own health care operations or for limited health care operations of a health plan, health care clearinghouse, or health care provider that is subject to certain federal health information privacy laws.  The entity which receives this information must have or have had a treatment relationship with you and the information we disclose must pertain to the relationship.  Limited health care operations include various quality assessment and improvement activities, credentialing and training activities, and health care fraud and abuse detection or compliance activities.

 

B.     USES OR DISCLOSURES PERRY MEMORIAL HOSPITAL MAY MAKE WITHOUT YOUR AUTHORIZATION.

In addition to treatment, payment and health care operations, and unless this Privacy Notice recites a more stringent restriction in Section C, the law permits or requires Perry Memorial Hospital to make, use and/or disclose PHI without your written authorization:  (i) for certain public health activities and purposes, including reporting of adverse product events to the Food and Drug Administration, (ii) to report suspected abuse, neglect or domestic violence, (iii) to submit information to health oversight agencies for oversight activities, such as audits, authorized by law, (iv) in the course of judicial and administrative proceedings, (v) for law enforcement purposes, (vi) to a medical examiner, coroner or funeral director, (vii) to assist an organ procurement organization or organ bank in facilitating organ or tissue donation and transplantation, (viii) to further research, provided that Perry Memorial Hospital complies with federal requirements, (ix) to avert a serious and imminent threat to public health safety, (x) for specialized government functions, including activities related to the military, veterans, or national security, (xi) to comply with workers’ compensation or similar laws.  Perry Memorial Hospital will make the above uses and/or disclosures of information in accordance with applicable law.

In addition, Perry Memorial Hospital may use and/or disclose your PHI as follows:

  • Organized Health Care Arrangement: Perry Memorial Hospital and its medical staff members have organized and are presenting you this document as a joint notice.  Information will be shared as necessary to carry out treatment, payment and health care operations.  Physicians and caregivers may have access to PHI in their offices to assist in reviewing past treatment as it may affect treatment at the time.
  • Business associates:  There are some services provided at Perry Memorial Hospital through contracts with business associates which are vendors, professionals and others who perform some treatment, payment or health care operations function on behalf of Perry Memorial Hospital or who otherwise provide services and have access to or use your PHI.  Examples include physician services in the emergency department and radiology, certain laboratory tests, and a copy service we use when making copies of your health record.  When these services are contracted, we may disclose your PHI to our business associate so that they can perform the job we have asked them to do and bill you or your third-party payer for services rendered.  To protect your health information, however, we require the business associate to appropriately safeguard your information by requiring that they enter into an appropriate agreement with Perry Memorial Hospital.
  • Directory:  Unless you object, we will use your name, location in the facility, general condition, and religious affiliation for directory purposes.  This information may be provided to members of the clergy and, except for religious affiliation, to other people who ask for you by name.  If you are unable to object, we may use and disclose this information consistent with your prior expressed preference, if known, and the health professional’s judgment.
  • Notification:  Unless you object, health professionals, using their best judgment, may use or disclose information to notify or assist in notifying a family member, personal representative, or any person responsible for your care, your location, and general condition.  If you are unable to object, we may exercise our professional judgment to determine if a disclosure is in your best interest and disclose only information that is directly relevant to the person’s involvement with your health care.
  • Communication with family:  Unless you object, health professionals, using their best judgment, may use or disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care.  If you are unable to object, we may exercise our professional judgment to determine if a disclosure is in your best interest and disclose only information that is directly relevant to the person’s involvement with your health care.
  • Disaster Relief:  We may use or disclose information for disaster relief purposes.
  • Incidental Uses and Disclosures:  We are permitted to use and disclose information incident to another use or disclosure of your PHI permitted or required under law.
  • Limited Data Sets:  We may use or disclose a limited data set (i.e., in which certain identifying information has been removed) of your PHI for purposes of research, public health, or health care operations.  Any recipient of that limited data set must agree to appropriately safeguard your information.

C.     MORE STRINGENT PROTECTION FOR YOUR HEALTH INFORMATION.

In certain cases, Illinois law provides more stringent privacy protections of your health information than this Privacy Notice recites above.  For example, in some cases, Illinois requires that you provide permission for the use or disclosure of your PHI.  In those cases, Perry Memorial Hospital must follow the state law even though certain federal health information privacy laws may not require permission.  State law provides more stringent protection in the following areas

  • If you are a patient of an advanced practice nurse, neither Perry Memorial Hospital nor the nurse may reveal your medical records to the Advanced Practice Nursing Board or the Department of Professional Regulation without your written permission in instances in which (i) the Advanced Practice Nursing Board has taken a final adverse action against the nurse, (ii) the nurse has surrendered his or her license while under disciplinary investigation by the Advanced Practice Nursing board, or (iii) Perry Memorial Hospital has terminated or restricted the nurse’s organized professional staff clinical privileges for disciplinary violations related to your treatment.  However, please note that the nurse or Perry Memorial Hospital may reveal your name or other means of identifying you as a patient without your written permission and may release such information as otherwise described in this Privacy Notice.
  • If you are a patient of a podiatrist, Perry Memorial Hospital may not reveal your medical records to the Podiatric Medical Licensing Board without your written permission in instances in which your treatment is a subject of a report concerning a podiatrist who is impaired by reason of age, drug or alcohol abuse or physical or mental impairment and who is under supervision or is in a program of rehabilitation.  However, please note that Perry Memorial Hospital may include your name, address and telephone number in its periodic reports to the Podiatric Medical Licensing Board concerning the impaired podiatrist if the Podiatric Medical Licensing Board requires Perry Memorial Hospital to do so and may release such information as this Privacy Notice may otherwise describe.
  • If you are a patient of a physician, Perry Memorial Hospital may not reveal your medical records to the Medical Disciplinary Board without your written permission in instances in which your treatment is a subject of a report relating to a physician’s professional conduct or capacity, including reports regarding a physician who is impaired by reason of age, drug or alcohol abuse or physical or mental impairment.  However, please note that Perry Memorial Hospital may include your name or other means of identifying you in its reports to the Medical Disciplinary Board without your permission and may release such information as this Privacy Notice may otherwise describe.  Perry Memorial Hospital may also provide copies of your hospital or medical records in cases involving your death or permanent bodily injury, provided that the law requires Perry Memorial Hospital to report such events to the Department of Professional Regulation, and the Department of Professional Regulation or the Medical Disciplinary Board has subpoenaed such records.
  • If you are a patient of a physician, the physician may not disclose any information that he or she may have acquired while attending to you in a professional capacity that was necessary to enable him or her to professionally serve you, without your permission, or in the case of your death or disability, without the permission of your personal representative, except that the physician may disclose such information where otherwise required by law.
  • If you are a patient of a physician or other health care provider, either you or your guardian may waive your right to the privacy and confidentiality of your PHI.  However, if you refuse to do so, the physician or other health care provider may not deny services to you.
  • If you are or have been a recipient of an HIV test, Perry Memorial Hospital may only disclose your test results in a manner which identifies you to those persons you (or your legally authorized representative) have designated in writing, except that Perry Memorial Hospital may disclose your test results to you or your legally authorized representative or to certain person(s) for certain reasons listed under Section I.B of this Notice.  Please note that a recipient of your test results may not redisclose this information except as this Privacy Notice may describe.
  • If you are or have been a recipient of genetic testing, Perry Memorial Hospital may only disclose the genetic testing and information derived from genetic testing to you and to those persons you (or your legally authorized representative) have designated in writing to receive that information, except that Perry Memorial Hospital may disclose the results of your genetic test to (i) you or your legally authorized representative; (ii) persons for certain reasons listed under Section I.B of this Notice; and (iii) your parent or legal guardian if you are a minor under 18 years of age if, in the professional judgment of your health care provider, notification would be in your best interest and your health care provider has first sought unsuccessfully to persuade you to notify your parent or legal guardian, or if your health care provider believes that you have not provided notification to your parent or legal guardian as you had previously agreed.  Further, a recipient of your test results may not redisclose this information except as the Genetic Information Privacy Act may otherwise allow.  The law defines “genetic testing” as “a test of a person’s genes, gene product, or chromosomes for abnormalities or deficiencies, including carrier status, that (i) are linked to physical or mental disorders or impairments, (ii) indicate a susceptibility to illness, disease, impairment, or other disorders, whether physical or mental, or (iii) demonstrate genetic or chromosomal damage due to environmental factors.  “Genetic testing” does not include routine physical measurements; chemical, blood and urine analyses that the medical community widely accepts as standard use in clinical practice; tests for use of drugs; and tests for the presence of the human immunodeficiency virus.  This paragraph does not apply to results of genetic testing that indicate that you are, at the time of the test, afflicted with a disease, whether or not currently symptomatic.
  • If you are a minor under 18 years of age who is the recipient of genetic testing, the health care provider who ordered the test may not notify your parent or legal guardian of your test results without your written permission.  However, please note that the health care provider may disclose such information to your parent or legal guardian if, in the professional judgment of the health care provider, notification would be in your best interest and the health care provider has first sought unsuccessfully to persuade you to notify your parent or legal guardian, or the health care provider has reason to believe that you have not made the notification as you had previously agreed.
  • If you are a client of a rape crisis counselor, the rape crisis counselor may not disclose any confidential communications or testify as a witness as to any confidential communications without the written permission of either you or your authorized representative.  However, please note that a rape crisis counselor may disclose confidential communications without your written permission if his or her failure to do so would likely result in a clear, imminent risk of serious physical injury or the death of you or another person.
  • If you are a client of a victim aid organization, no counselor, employee, volunteer or personnel may disclose any statement or the contents of any statement that you make relating to the crime or its circumstances during the course of therapy or consultation without your written permission, unless a court order requires disclosure of that information for a judicial proceeding.
  • If you are the victim of sexual assault, Perry Memorial Hospital may not release your evidence collection kit to the Illinois State Police without your written permission, or if you are a minor under the age of 13, without the written permission of your parent, guardian, appropriate representative of the Department of Children and Family Services, or an investigating law officer.
  • If you are a victim of a sexual assault and Perry Memorial Hospital takes photographs of your injuries, Perry Memorial Hospital may not release the photographs without your written permission, or if you are a minor, without the written permission of your parent or guardian.  If you are a minor and your parent or guardian refuses to grant permission, Perry Memorial Hospital must give all existing photographs and negatives to your parent or guardian.
  • If you are a resident of a community living facility, a nursing home facility, a skilled nursing or intermediate care facility, an intermediate care facility for the developmentally disabled, a sheltered care facility, or a veterans’ home, Perry Memorial Hospital may not allow any person who is not directly involved in your care to be present during a discussion of your case or health status, a consultation on your condition, or your examination or treatment, without your permission, which may be oral or written.  Please note that we interpret “any person who is not directly involved in your care” to mean those individuals other than facility personnel (or contractors) directly responsible for rendering care to you at the facility.  Thus, these individuals would include your family members and significant others who are “not directly involved in your care.”  These individuals would also include facility personnel not directly involved in the rendering of care, such as the housekeeping staff in most circumstances.
  • If you are a minor under 18 years of age who is the recipient of an HIV test, and a Western Blot Assay or a more reliable test has confirmed that your results are positive, the health care provider who ordered the test may not notify your parent or legal guardian of your test results without your written permission.  However, please note that the health care provider may disclose such information to your parent or legal guardian if, in the professional judgment of the health care provider, notification would be in your best interest and the health care provider has first sought unsuccessfully to persuade you to notify your parent or legal guardian, or if the health care provider believes that you have not provided notification to your parent or legal guardian as you had previously agreed.
  • If you are a minor who has sought counseling regarding your own drug or alcohol abuse, or that of a family member, from a physician who provides diagnosis or treatment or any licensed clinical psychologist or professional social worker with a master’s degree or any qualified employee of (i) an organization that is a licensee or a recipient of funding by the Department of Human Services, or (ii) agencies or organizations operating drug abuse programs that are licensees or recipients of funding by the Federal Government or the State of Illinois or any qualified person who is an employee or works in association with any public or private alcoholism or drug abuse program licensed by the State of Illinois, and you have come into contact with a sexually-transmitted disease, these professionals may not inform your parent, parents, guardian, or other responsible adult of your condition or treatment without your written permission.  However, please note that these professionals may disclose such information to your parent, parents, guardian, or other responsible adult without your written permission if such action is, in the person’s judgment, necessary to protect your safety or that of a family member or other individual.
  • If you are a resident of a long-term care facility for persons under the age of 22, Perry Memorial Hospital may not allow any person who is not involved in your care to be present during a discussion of your health status, a consultation on your condition, or your examination or treatment, without your permission, which may be oral or written.
  • If you are a client of a clinical psychologist, the psychologist may not disclose any information he or she may have acquired while attending to you in a professional capacity if the psychologist did not ensure that you understood the possible uses or distributions of the information and without your permission, or in the case of your death or disability, without the permission of your personal representative, except that the clinical psychologist may disclose such information for certain proceedings.
  • If you are a recipient of mental health or developmental disability services, Perry Memorial Hospital may not disclose your mental health or developmental disability information (including personal/psychotherapy notes) without your written permission except to (i) persons for certain reasons listed under Section I.B of this Notice or (ii) persons as permitted under the Illinois Mental Health and Developmental Disabilities Confidentiality Act.  With respect to certain exceptions listed in Section I.B., Illinois law only permits limited mental health or developmental disability information to be disclosed.  Illinois law restricts redisclosure of mental health or developmental disability information.
  • If you are a minor of at least 12 years of age but under 18 years of age who receives mental health or developmental disability services, your parent or guardian may inspect and copy your records if you are informed and do not object or if the therapist does not find that there are compelling reasons to deny access.  Should your parent or guardian be denied access by either you or the therapist, your parent or guardian may petition a court for access.
  • If you are a client of a clinical social worker, the social worker may not disclose any information he or she may have acquired while attending to you in a professional capacity without your written permission, except (i) in the course of reporting, conferring or consulting with administrative supervisors, colleagues or consultants who share professional responsibility, (ii) in the case of your death or disability, with the written permission of your personal representative, to a person with authority to sue on your behalf, or the beneficiary of an insurance policy on your life, health or physical condition; (iii) when a communication reveals that you intend to commit certain crimes or harmful acts; (iv) when you waive the privileged nature of communication by bringing public charges against the social worker; or (v) when the social worker acquires the information during an elder abuse investigation.
  • If you are a client of a clinical licensed professional counselor, licensed clinical professional counselor, marriage and family therapist or associate marriage and family therapist, the counselor or therapist may not disclose any information he or she may have acquired while attending to you in a professional capacity without your written permission, except (i) in the course of reporting, conferring or consulting with administrative supervisors, colleagues or consultants who share professional responsibility; (ii) in the case of your death or disability, with the written permission of your personal representative, to a person with authority to sue on your behalf, or the beneficiary of an insurance policy on your life, health or physical condition; (iii) when a communication reveals that you intend to commit certain crimes or harmful acts; or (iv) when you waive the privileged nature of communication by bringing public charges against the counselor or therapist.

 

NOTE:  References in this Privacy Notice to health care professionals include only those professionals that Perry Memorial Hospital employs, or those included in the Organized Health Care Arrangement described in Section I.B.

D.     MARKETING

We will need your written authorization to use and disclose your PHI for marketing purposes, except if the marketing is a face-to-face communication or if it involves a promotional gift of nominal value.  “Marketing” includes a communication about a product or service that encourages you to purchase or use the product or service.  It also includes an arrangement whereby the Plan discloses your PHI to another entity, in exchange for compensation, and the other entity communicates about its own product or service to encourage purchase or use of the product or service.  Marketing does not include our describing a health-related product or service (or payment for such product or service) that we provide or include in our plan of benefits.  For example, we may communicate to you (without your authorization) about our provider network, replacement of, or enhancements to, our health plan, and health-related products or services available only to our plan participants that add value to, but are not part of our plan of benefits.  Marketing also does not include our communication for your treatment or for case management or care coordination purposes, or to direct or recommend to you alternative treatments, therapies, health care providers, or settings of care.

E.     NO OTHER USES OR DISCLOSURES WITHOUT YOUR WRITTEN AUTHORIZATION.

Perry Memorial Hospital may not make any other uses and disclosures of your PHI without your written authorization.  You may revoke your authorization at any time if you provide written notice to Perry Memorial Hospital.

II.         YOUR RIGHTS

Federal and state laws protect your right to keep your PHI private.

Your Right to Receive Confidential Communications and to Request Restrictions.  You may request that you receive communications from Perry Memorial Hospital regarding your PHI by alternative means or at alternative locations.  You must make your request for confidential communications in writing and must submit this request to the office listed below.  Perry Memorial Hospital reserves the right to condition your request on the receipt of information regarding how you desire Perry Memorial Hospital to handle payment and/or on the availability of an alternative address or method of contact that you may request.  You may request other restrictions on certain uses and disclosures of protected health information for purposes of treatment, payment, and health care operations; for example, you may restrict disclosure of PHI to a healthcare plan if you choose to pay in full for healthcare services received on the date of services rendered.

Your Right to Inspect and Copy.  You generally have the right to inspect and obtain a copy of any PHI in your medical record, with the exception of psychotherapy notes, information compiled in anticipation of use in a civil, criminal, or administrative proceeding and certain other health information which the law restricts Perry Memorial Hospital from disseminating.  However, if you are a patient of certain types of providers or facilities, you may have a right to access your patient records or information on an unqualified basis.  Specifically, the following: 

  • If you are a patient at a facility that performs mammograms, you have the right to access your original mammograms and copies of your patient reports on an unqualified basis.
  • If you are a patient of a hospital, you have the right to access your patient records on an unqualified basis, upon written request.
  • If you are a patient of a physician, you have the right to access your medical data on an unqualified basis upon request.
  • If you are a resident of a skilled nursing facility or an intermediate care facility, you have the unqualified right to obtain from your physicians, or the physicians attached to the facility, complete and current information concerning your medical diagnosis, treatment and prognosis in terms and language that you can reasonably be expected to understand.  You, and your guardian or representative or parent if you are a minor, also have the unqualified right to inspect and copy your medical records that the facility or your physician maintains.

Your Right to Amend.  You also have the right to amend your PHI, unless Perry Memorial Hospital did not create such information or unless Perry Memorial Hospital determines that your medical record is accurate and complete in its existing form.

Your Right to an Accounting.  You have the right to request and receive an accounting of disclosures of your PHI that Perry Memorial Hospital has made in either the six (6) years prior to the request date, or during the period between the request date and the date that federal law required Perry Memorial Hospital to comply with federal privacy regulations, whichever is more recent.  Such an accounting may not include disclosures made to carry out treatment, payment or health care operations, to create an accurate patient directory or notify persons involved in your care, to ensure national security, to comply with the authorized requests of law enforcement, to inform you of the content of your medical records, or those disclosures which you have previously authorized pursuant to a validly executed authorization form.

Your Right to be Notified. You have the right to be notified after a breach of unsecured PHI is reported.

Your Right to Opt Out. You have the right to opt out of being contacted for fundraising purposes. To do so, please call 815-875-2811 and request to speak to the Marketing Department.

The Right to Get This Notice by E-Mail.  You have the right to get a copy of this notice by e-mail.  Even if you have agreed to receive notice via e-mail, you also have the right to request a paper copy of this notice.

If you would like more information on how to exercise these rights, please contact Perry Memorial Hospital’s Privacy Officer at (815) 875-2811.

III.        GRIEVANCES OR FURTHER INQUIRIES

If you believe that Perry Memorial Hospital has violated your privacy rights with respect to PHI, you may file a complaint with Perry Memorial Hospital and the Department of Health and Human Services.  To file a complaint with Perry Memorial Hospital, please contact Privacy Officer at 530 Park Avenue East, Princeton, IL 61356, or by phone at (815) 875-2811.  Perry Memorial Hospital will not retaliate against you for filing a complaint. 

IV.       AMENDMENTS

Perry Memorial Hospital reserves the right to amend the terms of this Privacy Notice at any time and to apply the revised Privacy Notice to all PHI that it maintains.  If Perry Memorial Hospital amends this Privacy Notice, you will be provided with a revised copy at your next visit to Perry Memorial Hospital, or upon your request.  The revised Privacy Notice will also be available on Perry Memorial Hospital’s web site, www.perrymemorial.org.

This Privacy Notice is effective on September 23, 2013.


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