Patient’s Privacy Rights Statement
Notice Of Privacy Practices as required by the privacy regulations created as a result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
This notice describes how health information about you or your child as a patient of North Shore Pediatric Therapy may be used and disclosed and how you can get access to your individually identifiable health information.
Please review this notice carefully.
Effective Date: January 1st, 2018
North Shore Pediatric Therapy (“NSPT” or “We” or “Us” or “Our”)) is dedicated to maintaining the privacy of you and your child’s protected health information. We are required by law to maintain the privacy and security of you and your child’s protected health information. We will let you and your child know promptly if a breach occurs that may have compromised the privacy or security of you or your child’s information. We must follow the duties and privacy practices described in this notice and give you and/or your child a copy of it. We will not use or share you or child’s information other than as described herein unless you and/or your child tell us we can in writing. If you and/or your child tell us we can, you and/or your child may change your/his/her mind at any time. Let us know in writing that you/he/she change(s) your/his/her mind. You and your child’s right to confidentiality will be governed by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Illinois Mental Health and Developmental Disabilities Confidentiality Act (740 ILCS 110). If you have any questions about this policy or about you or your child’s rights, please contact our Privacy officer Megan Summer at 877-486-4140. We reserve the right to amend or change this policy based on our needs and changes in state and/or federal law.
For more information see:www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/notice.html, and www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=2043&ChapterID=57.
USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION
- Treatment. With your and/or your child’s consent, NSPT may use or disclose your or your child’s protected health information to provide, coordinate, or manage your or your child’s care or any related treatment or service including sharing information with others outside NSPT that we are consulting with or referring to you.
- Payment. With your or your child’s written consent, information may be used to obtain payment for treatment and services provided. This may include contacting your and/or your child’s health insurance company for prior approval of planned treatment services or for billing purposes.
- Healthcare Operations. NSPT may use information about you and/or your child to coordinate our business activities and operate our business. This may include setting up your or your child’s appointments, reviewing your or your child’s care, or training staff.
- Treatment Options. NSPT may use or disclose your or your child’s protected health information to inform you of potential treatment options or alternatives.
Information Disclosed Without Your or Your Child’s Consent
Under Illinois and federal law, information about you and/or your child may be disclosed without your and/or your child’s consent in the following circumstances:
- Emergencies. NSPT may share health information about you and/or your child for certain situations such as:
- a) preventing disease;
- b) helping with product recalls;
- c) reporting adverse reactions to medications;
- d) reporting suspected abuse, neglect, or domestic violence; and
- e) preventing or reducing a serious threat to anyone’s health or safety.
- Research. NSPT may use and disclose your or your child’s protected health information for research purposes in certain limited circumstances. We will obtain your and/or your child’s written authorization to use your and/or your child’s protected health informationfor research purposes except when an Internal Review Board or Privacy Board has determined that the waiver of your authorization satisfies all of the following conditions:
- a) the use or disclosure involves no more than a minimal risk to your and/or your child’s privacy based on the following:
(i) an adequate plan to protect the identifiers from improper use and disclosure; (ii) an adequate plan to destroy the identifiers at the earliest opportunity consistent with the research (unless there is a health or research justification for retaining the identifiers or such retention is otherwise required by law); and
(iii) adequate written assurances that the protected health information will not be re-used or disclosed to any other person or entity (except as required by law) for authorized oversight of the research study, or for other research for which the use or disclosure would otherwise be permitted.
- b) the research could not practicably be conducted without the waiver; and
- c) the research could not practicably be conducted without access to and use of the protected health information.
- As Required by Law. NSPT will share information about you and/or your child if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law.
- Lawsuits and Legal Actions. NSPT may share information about you and/or your child in response to a court or administrative order, or in response to a subpoena.
- Criminal Activity/ Danger to Others. NSPT may share information about you and/or your child if asked to do so by a law enforcement official under the following circumstances:
- a) regarding a crime victim in certain situations, if We are unable to obtain the person’s agreement;
- b) concerning a death We believe has resulted from criminal conduct;
- c) regarding criminal conduct at Our offices;
- d) to identify/locate a suspect, material witness, fugitive or missing person; and
- e) in an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator).
- Coroners. NSPT may share information to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. If necessary, We also may release information in order for funeral directors to perform their jobs.
- Organ and Tissue Donation. NSPT may share information to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation banks, as necessary to facilitate organ or tissue donation and transplantation if that person is an organ donor.
- Workers’ Compensation and Other Governmental Requests. NSPT may share your or your child’s information to a health oversight agency for activities authorized by law. Oversight activities can include investigations, inspections, audits, surveys, licensure and disciplinary actions, civil, administrative and criminal procedures, or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general. NSPT may also share your or your child’s information for workers’ compensation and similar programs.
- Confidential Communications. You and/or your child have the right to request that Our practice communicate with you and/or your child about your health and related issues in a particular manner or at a certain location. We will accommodate all reasonable requests.
- Inspection and Copies. You and/or your child have the right to get a copy of your and/or your child’s paper or electronic medical record. You and/or your child must submit your request in writing. We may charge a reasonable fee for copying.
- Amendments. You and/or your child have the right to correct your paper or electronic medical record if you believe it is incorrect or incomplete. To request an amendment, your and/or your child’s request must be made in writing. You and/or your child must provide us with a reason to support your and/or your child’s request. We may deny your and/or your child’s request but we will tell you and/or your child why in writing within 60 days.
- Restrictions. You and/or your child may request a restriction in our use or disclosure of certain health information for treatment, payment or health care operations. We are not required to agree to your request and may say no if it would affect your and/or your child’s care. If you and/or your child pay for a service out of pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will agree unless the law requires Us to share that information. In order to request a restriction in Our use or disclosure of your and/or your child’s health information, you must make your request in writing.
- Accounting of Disclosures. You and/or your child have the right to request an accounting of disclosures. This means you can ask Us for a list (accounting) of the times we have shared your and/or your child’s health information for six years prior to the date you and/or your child ask, who We shared it with, and why. We will include all the disclosures expect for those about treatment, payment, and healthcare operations, and certain other disclosures (such as any you and/or your child asked us to make). The first list you and/or your child request(s) within a 12-month period is free of charge. NSPT may charge you and/or your child for additional lists within the same 12-month period. We will notify you and/or your child of the costs involved with additional requests, and you and/or your child may withdraw your and/or your child’s request before you and/or your child incur any costs.
- Get a Copy of Privacy Notice. You and/or your child are entitled to receive a paper copy of this notice. You and/or your child may ask us to give you and/or your child a copy of this notice at any time.
- Choosing Someone to Act for You or Your Child. If you and/or your child have given someone medical power of attorney or if someone is your and/or your child’s legal guardian, that person can exercise your and/or your child’s rights and make choices about your and/or your child’s health information. We will make sure this person has this authority and can act for you and/or your child before we take any action.
- File a Complaint. If you believe your and/or your child’s privacy rights have been violated, you and/or your child may file a complaint with Us or with the Secretary of the Department of Health and Human Services. To file a complaint Us, contact our Privacy Officer Megan Summer at 877-486-4140. You and/or your child will not be penalized for filing a complaint.
- Consent to Release of Records. You and/or your child have the right to consent to the release of your and/or your child’s records to others, for any purpose you and/or your child choose. You may revoke this consent at any time but only to the extent that no action has been taken in reliance on your prior authorization.
- Rights, Benefits, and Privileges Guaranteed by Law. You and/or your child have all rights, benefits, or privileges guaranteed by law, the Constitution of the United States, or the Constitution of the State of Illinois solely on account of the receipt of such services.
- Adequate and Humane Care in the Least Restrictive Environment. You and/or your child have the right to be provided with adequate and humane care and services in the least restrictive environment pursuant to an individual services plan.
- Mental Illness/Developmental Services. You and your child have the right not to be deprived of any mental illness or developmental services because of age, sex, race, religious belief, ethnic origin, marital status, physical or mental disability or criminal record unrelated to present dangerousness.
- Legal Disability. No patient of NSPT shall be deemed legally disabled unless as determined by a court.
If you and/or your child have any questions regarding this notice, please contact our privacy officer Megan Summer, at 877-486-4140.