HIPAA Privacy Statement

Ingalls Health System Joint Notice of Privacy Practices Effective: April 14, 2003

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. Ingalls Health System and certain specified entities are acting as an organized health care arrangement ("OHCA")soley for purposes of compliance with the Health Insurance Portability and Accountability Act ("HIPAA"). This designation is not intended and shall not be construed to have any other legal effect or create between the parties a partnership, joint venture, employment relationship, or any other relationship. The following entities are included in this OHCA: Ingalls Memorial Hospital, Ingalls Development Foundation, Ingalls Home Care, Ingalls Provider Group, Ingalls Same Day Surgery Center, Ltd., and, MedCentrix, Inc., as well as any health care professional providing services to you in the Ingalls' clinically integrated setting, regardless of whether such services are provided by Ingalls' employees or by independent members of the medical staff. Ingalls Health System will use health information about you for treatment, to obtain payment for treatment, for administrative purposes, and to evaluate the quality of care that you receive. Your health information is contained in a medical record that is the physical property of Ingalls Health System.

How Ingalls Health System May Use or Disclose Your Health Information

We use and disclose health information for many different reasons. For some of these uses or disclosures, we need your prior consent or specific authorization. Below, we describe the different categories of our uses and disclosures and give you some examples of each category.

A. Uses and Disclosures Relating to Treatment, Payment or Health Care Operations

  • 1. For treatment. Ingalls Health System may use your health information to provide you with medical treatment or services. For example, a physician, nurse, or other person providing health services to you will record information in your record that is related to your treatment. This information is necessary for health care providers to determine what treatment you should receive. Health care providers will also record actions taken by them in the course of your treatment and note how you respond to the actions.
  • 2. For payment. Ingalls Health System may use and disclose your health information to others for purposes of receiving payment for treatment and services that you receive. For example, a bill may be sent to you or a third-party payor, such as an insurance company or health plan. The information on the bill may contain information that identifies you, your diagnosis, and treatment or supplies used in the course of treatment.
  • 3. For health care operations. Ingalls Health System may use and disclose health information about you for operational purposes. For example, your health information may be disclosed to members of the medical staff, risk or quality improvement personnel, and others to:
    • evaluate the performance of our staff;
    • assess the quality of care and outcomes in your case and similar cases;
    • learn how to improve our facilities and services; and
    • determine how to continually improve the quality and effectiveness of the health care we provide.

B.Other Permitted Uses and Disclosures That May Be Made Without Your Consent.

  • 1. Required by Law. Ingalls Health System may use and disclose information about you as required by law. For example, Ingalls Health System may disclose information for the following purposes:
    • for judicial and administrative proceedings pursuant to legal authority;
    • to report information related to victims of abuse, neglect or domestic violence; and
    • to assist law enforcement officials in their law enforcement duties;
  • 2. Public Health. Your health information may be used or disclosed for public health activities such as assisting public health authorities or other legal authorities to prevent or control disease, injury, or disability, or for other health oversight activities.
  • 3. Decedents. Health information may be disclosed to funeral directors or coroners to enable them to carry out their lawful duties.
  • 4. Organ/Tissue Donation. Your health information may be used or disclosed for cadaveric organ, eye or tissue donation purposes.
  • 5. Research. Ingalls Health System may use your health information for certain approved research purposes once its institutional review board has reviewed the research proposal and established protocols to ensure the privacy of your health information.
  • 6. Health and Safety. Your health information may be disclosed to avert a serious threat to the health or safety of you or any other person pursuant to applicable law.
  • 7. Government Functions. Specialized government functions such as protection of public officials or reporting to various branches of the armed services that may require use or disclosure of your health information.
  • 8. Appointment/Treatment Alternatives and Service . Ingalls Health System may use your information to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may you.
  • 9. Fund Raising. Ingalls Health System may use your information to contact you to raise funds for our organization. The money raised through these activities is used to expand and support the health care services and educational programs we provide to the community. If you do not wish to be contacted as part of our fundraising efforts, please contact the person listed below.
  • 10. Workers Compensation. Your health information may be used or disclosed in order to comply with laws and regulations related to Worker's Compensation.

Your Health Information Rights.

You have the right to:

  • Request a restriction on certain uses and disclosures or your information as provided by 45 CFR §164.522. For example, you could request that we not use or disclose information about a surgery you had to someone who is involved in your care or the payment for it, like a family member or friend. However, Ingalls Health System is not required to agree to a requested restriction;
  • Obtain a paper copy of the notice of information practices upon request;
  • Inspect and obtain a copy of your health record (such as medical and billing records) as provided for in 45 CFR §164.524, that we use to make decisions about your care. You must submit a written request to the Privacy Officer (see below) in order to inspect and/or copy your health information. If you request a copy of the information, we may charge a fee for the costs of copying and mailing. We may deny your request to inspect and/or copy your information in certain limited circumstances. If you are denied access to your health information, you may ask that the denial be reviewed.;
  • Amend your health record as provided in 45 CFR §164.526 if you believe the health information we have about you is incorrect or incomplete. To request an amendment, complete and submit a Medical Record Amendment/Correction Form to the Privacy Officer. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that: (a) we did not create, unless the person or entity that created the information is no longer available to make the amendment, (b) is not part of the health information that we keep, (c) you would not be permitted to inspect and copy, or (d) is accurate and complete.;
  • Request confidential communications of your health information by alternative means or at alternative locations. For example, you can ask that we only contact you at work or by mail. We will accommodate all reasonable requests;
  • Revoke your authorization to use or disclose health information except to the extent that action has already been taken; and
  • Receive an accounting of disclosures made of your health information as provided by 45 CFR §164.528. This is a list of the disclosure we made of medical information about you for the purposes other than treatment, payment and health care operations. To obtain this list, you must submit your request in writing to the Privacy Officer. It must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper or electronically). We may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.


You may complain to Ingalls Health System or to the Department of Health and Human Services if you believe your privacy rights have been violated. You will not be retaliated against for filing a complaint.

Obligations of Ingalls Health System.

Ingalls Health System is required to:

  • maintain the privacy of protected health information;
  • provide you with this notice of its legal duties and privacy practices with respect to your health information;
  • abide by the terms of this notice;
  • notify you if we are unable to agree to a requested restriction on how your information is used or disclosed;
  • accommodate reasonable requests you may make to communicate health information by alternative means or at alternative locations; and
  • obtain your written authorization to use or disclose your health information for reasons other than those listed above and permitted under law.

Changes to this Notice.

Ingalls Health System reserves the right to change its information practices and to make the new provisions effective for all protected health information it maintains. Revised notices will be made available to you as they become available.

Contact Information.

If you have any questions or complaints, please contact:

Ingalls Health System
One Ingalls Drive
Harvey, IL 60426-3558