Notice of Privacy Practices
This notice of PRIVACY PRACTICES describes how health information may be used and disclosed, and how you can obtain access to this information. Please review it carefully. The privacy of your health is important to us.
I. DES PLAINES ENDOSCOPY CENTER’S COMMITMENT TO PRIVACY
At Des Plaines Endoscopy Center, we care about your privacy and are committed to protecting and preserving it. We understand that health information about you is personal and that you may be concerned over how it is used. This Notice of Privacy Practices describes the limited ways in which we may use and disclose health information about you. It also describes your rights and our obligation with respect to personal health information. We are committed to treat personal health information about you with the utmost care.
This notice applies to all use and disclosure of health information about you that is made by health care professionals, staff, employees, students, trainees and volunteers. It also applies to any sharing of information amongst our different practice locations.
II. HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU.
We use and disclose health information about you for treatment, payment, health care operations, to avert a serious threat to health or safety and/or for disaster relief efforts.
For Treatment
We may use or disclose your health information to a physician, other healthcare providers or medical facilities providing treatment or services to you.
For Payment
We may use and disclose your health information to obtain payment for services we provided to you.
For Health Care Operations
We may use or disclose your personal health information in order to run and improve our quality of care.
For Appointment Reminders
We may use and disclose your personal health information in order to remind you that you have an upcoming appointment for medical services with us.
To Avert a Serious Threat to Health or Safety
We may use or disclose your medical information if necessary to prevent a serious threat to your health or safety or the health and safety of another personal or general public. Any disclosure, however, would only be to someone able to prevent the treat.
Disaster Relief Efforts
We may disclose medical information about you to an entity assisting in disaster recovery relief effort so that your family can be notified about your condition, status, and location.
III. SPECIAL SITUATIONS
Military and Veterans
If you are or were a member of the armed forces we may release medical information about you to military command authorities, as required by law. We also may release medical information to foreign military personnel or to an appropriate foreign military authority as required by law.
Organ and Tissue Donation
If you are an organ donor, we may release appropriate medical information about you to organizations that handle organ and tissue procurement in order to facilitate organ or tissue donation.
Workers’ Compensation
We may use or disclose medical information about you for workers’ compensation or similar programs as permitted or required by law.
Public Health Risk
We may disclose medical information about you for public health purposes. Including but not limited to:
- Preventing or controlling disease, injury or disability
- Reporting vital events
- Reporting child abuse or neglect
- Notifying a person who may have been exposed to a disease or who may be at risk of contracting or spreading a disease or condition
- Notifying the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence as required or permitted by law.
Health Oversight Activities
We may disclose your medical information to agencies that oversee the health care system. This sight might be done by the government, licensing, accreditation organizations and other agencies authorized by law.
Lawsuits and Other Legal Action
If you are involved in a lawsuit or other similar proceeding, we may disclose your medical information under subpoena or court or administrative order. A subpoena or court order may also require us to disclose your medical information to another party to a law suite. We will only disclose information in this situation after we have tried to inform you of the request or tried to obtain a court order to protect the information request.
Law Enforcement
We may release your medical information if law enforcement official require us to do so, including and not limited to; coroners, medical examiners, funeral directors, national security and intelligence activities, inmates and state laws.
IV. YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION
Your medical information is the property of Des Plaines Endoscopy Center. However, you have the following rights regarding your medical records.
Right to Inspect and Copy
With certain exceptions, you have the right to inspect and/or receive a copy of your medical information that is contained in our records. A request in writing would need to be sent to the appropriate practice location before records are released.
Right to Request and Amendment or Addendum
You may ask us to amend your record if you believe that the medical information we have about you is incomplete or incorrect. To request an amendment or addendum, you must present a written notice to your practice location stating what you wish to have corrected and why you want to make the changes. We may deny your request under certain circumstances.
Right to an Accounting of Disclosures
You have the right to request an “accounting of disclosures.” We are not required to make an accounting for those disclosures we make under an authorization signed by you or your legal representative. Your request cannot go back farther than the past 6 years and cannot include any dates before April 14, 2003. To obtain a list of disclosures your must submit a written request to your practice location.
Right to Request Confidential Communication
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or only contact you by mail or email. You must tell us in a written request how and/or where you want us to contact you. We will accommodate all reasonable requests.
V. OUR LEGAL DUTY
We are required by applicable federal and state law to maintain the privacy of your health information. We are also required to give you this notice about our privacy practices, our legal duties and your rights concerning your health information. We must follow the privacy practices that are described in this notice while it is in effect. This notice took effect October 1, 2013 and will remain in effect until replaced.
We reserve the right to change our privacy practice and terms of this notice at any time, provided such changes are permitted by applicable law. Before we make a significant change in our privacy practices, we will change this notice and make the notice available upon request.
VI: QUESTIONS OR COMPLAINTS
If you would like more information about our privacy policies or have questions or concerns about this notice, please contact us. If you are concerned that we may have violated your privacy rights or you disagree with a decision we made about access to your health information in response to a request you made to amend or restrict the use or disclosure of your health information, you may file a complaint with us by notifying one of our practice locations. You may also submit a written complaint to the U.S. Department of Health and Human services.
If you have any questions or concerns, please contact us at the phone number listed below. All written requests can be mailed or faxed to the following destination:
Des Plaines Endoscopy Center
150 N River Rd, Suite 215
Des Plaines, IL 60016
Fax number: (847) 813-5187
