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Privacy Policy

NCH Medical Group Privacy Policy

Notice of Privacy Practices for Protected Health Information

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!

With your consent, the practice is permitted by federal privacy laws to make uses and disclosures of your health information for purposes of treatment, payment, and healthcare operations. Protected health information is the information we create and obtain in providing our services to you. Such information may include documenting your symptoms, examination and test results, diagnoses, treatment, and applying for future care or treatment. It also includes billing documents for those services. This notice takes effect 1/15/03 and will remain in effect until we replace it. Find some examples below:

Treatment: We may use and disclose your protected health information in order to provide, coordinate or manage your care or related services. We may also disclose your protected health information to other dentists, physicians, and healthcare service providers who are now or become involved in taking care of you.

Payment: We may use or disclose your protected health information in order to obtain payment for services we provide to you.

Healthcare Operations: We may use or disclose your health information as needed in connection with our healthcare operations, such as contacting you regarding an appointment, our practice’s quality assessment and improvement, development of protocol and clinical guidelines, conducting training programs, credentialing, medical review, legal and insurance services.

Your Health Information Rights

The health record we maintain and billing records are the physical property of the practice. The information in it, however, belongs to you. You have a right to:

  • Request a restriction on certain uses and disclosures of your health information by delivering the request in writing to our office. We are not required to grant the request but we will comply with any request granted
  • Obtain a paper copy of this Notice of Privacy Practices for Protected Health Information (“Notice”) by making a request at our office
  • Request that you be allowed to inspect and copy your health record and billing record—you may exercise this right by delivering the request in writing to our office
  • Appeal a denial of access to your protected health information except in certain circumstances
  • Request that your healthcare record be amended to correct incomplete or incorrect information by delivering a written request to our office
  • File a statement of disagreement if your amendment is denied, and require that the request for amendment and any denial be attached in all future disclosures of your protected health information
  • Obtain an accounting of disclosures of your health information as required to be maintained by law by delivering a written request to our office. An accounting will not include internal uses of information for treatment, payment, or operations, disclosures made to you or made at your request, or disclosures made to family members or friends in the course of providing care
  • Request that communication of your health information be made by alternative means or at an alternative location by delivering the request in writing to our office
  • Revoke authorizations that you made previously to use or disclose information except to the extent information or action has already been taken by delivering a written revocation to our office
Our Responsibilities

The practice is required to:

  • Maintain the privacy of your health information as required by law
  • Provide you with a notice of our duties and practices as to the information we collect and maintain about you
  • Abide by the terms of this Notice
  • Notify you if we cannot accommodate a requested restriction or request
  • Accommodate your reasonable requests regarding methods to communicate health information with you

We reserve the right to amend, change, or eliminate provisions in our privacy practices and access practices and to enact new provisions regarding the protected health information we maintain. If our information practices change, we will amend our Notice. You are entitled to receive a revised copy of the Notice by calling and requesting a copy of our Notice or by visiting our office and picking up a copy.

To Request Information or File a Complaint

If you have questions, would like additional information, or want to report a problem regarding the handling of your information, you may contact Randi Widen.

Additionally, if you believe your privacy rights have been violated, you may file a written complaint at our office by delivering the written complaint to 1450 Busch Parkway, Buffalo Grove, IL 60089.

You may also file a complaint by mailing it or phoning the Secretary of Health and Human Services whose street address and phone number is 105 W. Adams Street, Chicago, Il 60603, 312-353-5160.

We cannot, and will not, require you to waive the right to file a complaint with the Secretary of Health and Human Services (HHS) as a condition of receiving treatment from the practice.

We cannot, and will not, retaliate against you for filing a complaint with the Secretary.

Other Disclosures and Uses
Notification

Unless you object, we may use or disclose your protected health information to notify, or assist in notifying, a family member, personal representative, or other person responsible for your care, about your location, and about your general condition, or your death.

Communication with Family

Unless you object, we may disclose to a member of your family, a relative, close friend or other person you identify, your protected health information that directly relates to that person’s involvement in your healthcare. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location or general condition.

Food and Drug Administration (FDA)

We may disclose to the FDA your protected health information relating to adverse events with respect to products and product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacements.

Workers’ Compensation

If you are seeking compensation through Workers’ Compensation, we may disclose your protected health information to the extent necessary to comply with laws relating to Workers’ Compensation.

Public Health

As required by law, we may disclose your protected health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

Abuse and Neglect

We may disclose your protected health information to public authorities as allowed by law to report abuse or neglect.

Correctional Institutions

If you are an inmate of a correctional institution, we may disclose to the institution, or its agents, your protected health information necessary for your health and the health and safety of other individuals.

Law Enforcement

We may disclose your protected health information for law enforcement purposes as required by law, such as when required by a court order, or in cases involving felony prosecutions, or to the extent an individual is in the custody of law enforcement.

Health Oversight

Federal law allows us to release your protected health information to appropriate health oversight agencies or for health oversight activities.

Judicial/Administrative Proceedings

We may disclose your protected health information in the course of any judicial or administrative proceeding as allowed or required by law, with your consent, or as directed by a proper court order.

Other Uses

Other uses and disclosures besides those identified in this Notice will be made only as otherwise authorized by law or with your written authorization and you may revoke the authorization as previously provided.

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