JOINT NOTICE OF PRIVACY PRACTICES
Ingalls Health System Joint Notice Of Privacy Practices. Effective: August 2013
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW
IT CAREFULLY. Ingalls Health System and certain specified entities are acting as an organized health care arrangement (“OHCA”) solely 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 Home Care, Ingalls Provider Group, Ingalls Care Network, LLC, 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;
- determine how to continually improve the quality and effectiveness of the health care web 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;
- 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. Appointments/Treatment Alternatives and Services. 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 be of interest to you.
9. Fundraising. 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 Ingalls Privacy
Hotline at 708.915.6789.
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 health information. However, Ingalls Health System is not required
to agree to a requested restriction unless the disclosure is to a health plan for purpose of carrying out payment or health care
operations (and is not for purpose of carrying out treatment) and the health information pertains solely to a health care item or
service for which the health care provider involved has been paid out-of-pocket in full;
- Request to restrict disclosure of your health information to a health plan for items or services for which you have paid
out-of-pocket in full.
- Obtain a paper copy of the Notice of Privacy Practices upon request;
- Inspect and obtain a copy of your health record that we use to make decisions about your care. If we maintain your health record
in an electronic health record, you may obtain an electronic copy of your health record. You must submit a written request to the
Medical Records Office 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 if you believe the health information we have about you is incorrect or incomplete.
To request an amendment, complete and submit a Medical Records Amendment/Correction Form to the Medical Records Office. 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;
- Revoke your authorization to use or disclose health information except to the extent that action has already been taken; Receive
an accounting of disclosures made of your health information. The accounting will not include disclosures for treatment, payment,
or health care operations. If we maintain your medical records in an electronic health record system, you may request that include
disclosures for treatment, payment or health care operations made during the previous three years. To obtain this list, you must
submit your request in writing to the Medical Records Office. 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 (paper or electronically).
We may charge you for the costs of providing the list; and
- Receive notice of a breach of your unsecured protected health information within sixty days of discovery if the breach compromises
the security or privacy of your health information.
Complaints You may express complaints about your care or if you feel your
rights have been violated to Ingalls Health System 708.915.6789, to Illinois Department of Human Services 1.800.843.6154, or to Det
Norske Veritas (DNV) at 1.866.523.6842 or email@example.com. You will not be retaliated against for filling a complaint.
Authorizations Other than the uses and disclosures described in this Notice,
Ingalls Health System will not use or disclose your health information without your written authorization. Ingalls Health System
requires your written authorization for most uses and disclosures of psychotherapy notes, for marketing (other than a face-to-face
communication between you and an Ingalls Health System workforce member or a promotional gift of some nominal value), or before
selling your health information. If you provide Ingalls Health System with written authorization, you may revoke it at any time
unless disclosure is required to obtain payment for services already provided, we have otherwise already relied on the authorization,
or the law prohibits revocation.
Obligations of Ingalls Health System
Ingalls Health System is required to:
- maintain the privacy of protected health information;
- provide you with this Notice;
- abide by the terms of this Notice;
- notify you if we are unable to agree to a requested restriction;
- 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.
If you have any questions or complaints, please contact:
INGALLS PRIVACY OFFICER
Ingalls Health System
One Ingalls Drive
Harvey, IL 60426-3558
Effective: April 2003
Revised: February 2010, August 2013