THIS PRIVACY 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.
Northwest Community Healthcare (NCH), which includes Northwest Community Hospital, Northwest Community Day Surgery Center, and Northwest Community Medical Group, are required by law to maintain the privacy of your protected health information and to provide you with notice of their legal duties and privacy practices with respect to such information. NCH and certain groups of independent hospital-based physicians at NCH, use this “Privacy Notice” to comply with federal and state privacy rights and protections for patients whose rights are described below. NCH reserves the right to change the terms of this Privacy Notice as allowed or required by law. In the event that NCH does make a change to this Privacy Notice, NCH will provide you with a copy of the revised Privacy Notice upon request.
You or your legal representative may waive your right to the privacy and confidentiality of your protected health information. If, however, you choose not to waive this right, it will have no impact on your receipt of hospital, physician or other healthcare services.
NCH may use your protected health information for treatment, payment and healthcare operations. Some examples include, but are not limited to, the following:
NCH may use or disclose your protected health information in the following situations without your authorization or providing you the opportunity to agree or object. For each category of uses or disclosures, NCH will explain what it means and present some examples. Not every use or disclosure in a category will be listed. However, all of the ways NCH are permitted to use and disclose information will fall within one of the categories.
As Required by Law. NCH will disclose your protected health information to the extent that it is required by federal, state, or local law.
Public Health Activities. NCH may disclose your protected health information for public health activities. These activities generally include the following: to prevent or control disease, injury, or disability; to report births and deaths; to report child abuse or neglect; to report adverse reactions to medications or problems with products; to enable product recalls; to enable public health investigations; to notify a person who may have been exposed to a communicable disease or may otherwise be at risk for contracting or spreading a disease or condition.
Victims of Abuse, Neglect or Domestic Violence. NCH may disclose your protected health information if NCH reasonably believe that you are a victim of abuse, neglect or domestic violence to the appropriate government authority. NCH will only make this disclosure if you agree or when required or authorized by law.
Health Oversight Activities. NCH may disclose your protected health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, licensure and disciplinary actions. These activities are necessary for the government to oversee the healthcare system, government benefit programs (such as Medicare or Medicaid), and compliance with civil rights laws. Your written authorization may be required with respect to certain disciplinary proceedings under state law.
Judicial and Administrative Proceedings. NCH may disclose your protected health information in the course of a judicial or administrative proceeding. NCH may also disclose your protected health information in response to a subpoena, discovery request, or other lawful process. In certain situations, your written authorization may be required under state law.
Law Enforcement. NCH may disclose your protected health information if asked to do so by a law enforcement official including, but not limited to, the following: in response to a court order, court-ordered warrant, or a subpoena or summons issued by a judicial officer; for the purpose of identifying or locating a suspect, fugitive, material witness, or missing person; about a suspected victim of a crime if the individual agrees or under other certain limited circumstances; about the death of an individual if NCH believes the death may be the result of criminal conduct; and about criminal conduct that occurred on the premises of NCH.
Coroners, Medical Examiners, and Funeral Directors. NCH may release protected health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. NCH may also release medical information about patients to funeral directors, consistent with applicable law, as necessary to carry out their duties with respect to the decedent.
Organ and Tissue Donation. NCH may release your protected health information to an organ donation bank or an organ procurement organization or other entity that is involved in the procurement, banking or transplantation of organs, eyes, or tissue in order to facilitate organ or tissue donation and transplantation.
Research. NCH may disclose your protected health information to researchers when an institutional review board or privacy board has approved a waiver of authorization, reviewed the research proposal, established protocols to ensure the privacy of the requested information, and approved the research.
To Avert a Serious Threat to Health or Safety. NCH may use and disclose your protected health information when necessary to prevent or lessen a serious and imminent threat to your health or safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent or lessen the threat.
Specialized Government Functions. If you are a member of the armed forces, NCH may release your protected health information as required by military command authorities. NCH may also release protected health information about foreign military personnel to the appropriate foreign military authority. NCH may also release your protected health information to authorized federal officials for the conduct of lawful intelligence, counter-intelligence, and other national security activities authorized by law.
Inmates. If you are an inmate of a correctional institution or are in the custody of a law enforcement official, NCH may disclose your protected health information to the correctional institution or law enforcement official if necessary (1) for the provision of healthcare to you; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
Workers’ Compensation. NCH may release your protected health information for workers’ compensation or similar programs.
In addition, NCH may use and/or disclose your health information as follows:
Other uses and disclosures of your protected health information, other than those described above, will only be made pursuant to your written authorization unless otherwise permitted or required by law. You may revoke your written authorization at any time, so long as the revocation is in writing. The written revocation should be given to a representative in Health Information Management. Once we receive your written revocation, it will only be effective for future uses and disclosures. This means that your revocation does not impact the release of information prior to receipt of this revocation. Disclosure of certain types of protected health information requires your specific permission or a law that allows its disclosure. Examples include:
You may request other restrictions on certain uses and disclosures of protected health information for purposes of treatment, payment, and healthcare operation; however, the law does not require NCH to agree to the requested restrictions. To make the request, complete the form and return it to Northwest Community Healthcare.
NCH and our business associates will need your written authorization to use and disclose your protected health information for marketing purposes, unless the marketing is a face-to-face communication or if it involves a promotional gift of nominal value. NCH requires your authorization for the sale of or any additional uses not described above.
Patients affected by a breach of unsecured protected health information have the right to be notified by NCH.
Your Right to Receive Confidential Communications and to Request Restrictions. You may request that you receive communications from NCH regarding your protected health information by alternative means or at alternative locations. You must make your request for confidential communications in writing and must submit this request to the Health Information Management Office. NCH reserves the right to condition your request on the receipt of information regarding how you desire NCH to handle payment and/or on the availability of an alternative address or method of contact. You may request other restrictions on certain uses and disclosures of protected health information for purposes of treatment, payment, and healthcare operations; however, the law does not require NCH to agree to the requested restrictions. However, you have the right to restrict certain disclosures of protected health information to a health plan for the purposes of payment or our operations where you pay out of pocket in full for the service(s) provided.
Your Right to Inspect and Copy. You have the right to inspect and obtain a copy of any protected health information in your medical records, with the exception of psychotherapy notes and certain other protected health information which the law restricts NCH from disseminating. If your request is denied, you may request in writing that the denial be reviewed. You may be charged reasonable fees to cover the cost of duplicating your medical record.
Your Right to Amend. You also have the right to request an amendment of your protected health information. NCH may deny your request in certain circumstances, for example, if NCH did not create such information or if NCH determines that your medical record is accurate and complete in its existing form. If NCH denies your request, you have the right to submit a written statement of disagreement, which will be included in your medical record and any future disclosures of your protected health information to which the disagreement relates.
Your Right to an Accounting. You have the right to request and receive an accounting of disclosures of your protected health information that NCH has made for up to six years before the request date. Such an accounting may not include disclosures made to carry out treatment, payment or healthcare operations, to create patient directories or notify persons involved in your care, to ensure national security, to comply with the authorized requests of law enforcement or to inform you of the content of your medical records.
The Right to Get This Notice by Email. You have the right to get a copy of this notice by email. Even if you have agreed to receive a copy of this notice by email, you still have the right to request a paper copy.
If you believe that NCH has violated your privacy rights with respect to protected health information, you may file a complaint with NCH or the Department of Health and Human Services. To file a complaint with NCH, please contact the Patient Advocate at 847-618-4390. Filing a complaint will not affect the treatment or services you receive at NCH. You may also contact the above office for a copy of this Privacy Notice or further information regarding your rights.
Please see important information regarding the State of Illinois and Federal False Claims Acts and the Deficit Reduction Act.