Notice of Privacy Practices
(Pursuant to 45CFR 164.520 of the OCR/HIPAA Privacy Regulations Text)
Effective Date of this Notice: April 14, 2003
IMPORTANT: THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE
USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT
CAREFULLY.
As an essential part of the Village of Oak Brook's commitment to you, it maintains
the privacy of certain confidential health care information about you known
as Protected Health Information or PHI. The Village of Oak Brook is required
by law to protect your health care information and to provide you with the
following Notice of Privacy Practices.
This Notice outlines the Village's legal duties and privacy practices in respect
to your PHI. This Notice not only describes the Village's privacy practices
and your legal rights, but also lets you know the following things: how the
Village of Oak Brook is permitted to use and disclose PHI about you; how you
can access and copy that information; how you may request amendment of that
information; and how you may request restrictions on the Village's use and
disclosure of your PHI.
The Village of Oak Brook is also required to abide by the terms of the version
of this Notice currently in effect. In most situations, the Village may use
this information as described in this Notice without your permission. However,
there are some situations where the Village may use your PHI only after it
obtains your written authorization if the Village is required to do so by law.
The Village of Oak Brook respects your privacy, and it treats all health care
information about its patients with care under strict policies of confidentiality
that all of its staff are committed to following at all times.
PLEASE READ THE FOLLOWING DETAILED NOTICE. IF YOU HAVE ANY QUESTIONS ABOUT
IT, PLEASE CONTACT THE VILLAGE OF OAK BROOK'S PRIVACY OFFICER AT 630-368-5203.
Purpose of this Notice : The Village of Oak Brook is required by law to maintain
the privacy of certain confidential health care information known as Protected
Health Information or PHI. The Village is also to provide you with a notice
of its legal duties and privacy practices with respect to your PHI. This Notice
describes your legal rights; advises you of the Village of Oak Brook's privacy
practices; and lets you know how the Village is permitted to use and disclose
PHI about you.
Uses and Disclosures of PHI : The Village of Oak Brook may use your PHI for
the purposes of treatment, payment, and health care operations in most cases
without your written permission.
Examples of the Village of Oak Brook's use of your PHI:
For treatment : This includes such things as verbal and written information
that the Village obtains about you and uses pertaining to your medical condition
and treatment provided to you by the Village or other medical personnel (including
doctors and nurses who give orders to allow the Village to provide treatment
to you). It also includes information that the Village gives to other health
care personnel to whom it transfers your care and treatment. This use of information
includes transfer of PHI via radio or telephone to the hospital or dispatch
center as well as providing the hospital with a copy of the written/computer
generated record that the Village creates in the course of providing you with
treatment and transport.
For payment : This use of information includes any activities that the Village
must undertake in order to get reimbursed for the services that it provides
to you. It includes such things as: organizing your PHI and submitting bills
to insurance companies (either directly or through a third party billing company),
managing of billed claims for services rendered and collecting of outstanding
accounts.
For health care operations : This use of information includes quality assurance
activities, licensing, and training programs to ensure that the Village's personnel
meet its standards of care. It also insures that the staff of the Village follows
established policies and procedures by: obtaining legal and financial services;
conducting business planning; processing grievances and complaints; creating
reports that do not individually identify you for data collection purposes;
fundraising; and certain marketing activities.
Use and Disclosure of PHI Without Your Authorization : The Village of Oak
Brook is also permitted to use PHI without your written authorization or opportunity
to object in certain situations including:
- For the Village of Oak Brook's use in treating you or in obtaining
payment for services provided to you or in other health care
operations;
- For the treatment activities of another health care provider;
- To another health care provider or entity for the payment
activities of the provider or entity that receives the
information (such as your hospital, insurance company,
mutual aid ambulance services, or other governmental agencies);
- To another health care provider (such as the hospital
to which you are transported) for the health care operations
activities of the entity that receives the information
as long as the entity receiving the information has or
has had a relationship with you and the PHI pertains to
that relationship;
- For health care fraud and abuse detection or for activities
related to compliance with the law;
- To a family member, other relative or close personal
friend or other individual involved in your care if the
Village obtains your verbal agreement to do so or if the
Village gives you an opportunity to object to such a disclosure
and you do not raise an objection. The Village may also
disclose health information to your family, relatives,
or friends if it infers from the circumstances that you
would not object. For example, the Village may assume you
agree to its disclosure of your personal health information
to your spouse when your spouse has called the ambulance
for you. In situations where you are not capable of objecting
(because you are not present or due to your incapacity
or medical emergency), the Village may, in its professional
judgment, determine that a disclosure to your family member,
relative, or friend is in your best interest. In that situation,
the Village will disclose only health information relevant
to that person involved in your care. For example, the
Village may inform the person who accompanied you in the
ambulance that you have certain symptoms, and the Village
may give that person an update on your vital signs and
treatment that is being administered by the Village's ambulance
crew;
- To a public health authority in certain situations (such
as reporting a birth, death or disease as required by law)
as part of a public health investigation; to report child
or adult abuse or neglect or domestic violence; to report
adverse events such as product defects or to notify a person
about exposure to a possible communicable disease as required
by law;
- For health oversight activities including audits or government
investigations, inspections, disciplinary proceedings,
and other administrative or judicial actions undertaken
by the government (or their contractors) by law to oversee
the health care system;
- For judicial and administrative proceedings as required
by a court or administrative order; or in some cases in
response to a subpoena or other legal process;
- For law enforcement activities in limited situations,
such as when there is a warrant for the request or when
the information is needed to locate a suspect or stop a
crime;
- For military, national defense and security and other
special government functions;
- To avert a serious threat to the health and safety of
a person or the public at large;
- For workers' compensation purposes, and in compliance
with workers' compensation laws;
- To coroners, medical examiners, and funeral directors
for identifying a deceased person, determining cause of
death, or carrying on their duties as authorized by law;
- If you are an organ donor, the Village may release health
information to organizations that handle organ procurement
or organ, eye or tissue transplantation or to an organ
donation bank, as necessary to facilitate organ donation
and transplantation;
- For research projects, but this will be subject to strict
oversight and approvals. Health information will be released
only when there is a minimal risk to your privacy and adequate
safeguards are in place in accordance with the law;
- The Village may use or disclose health information about
you in a way that does not personally identify you or reveal
who you are.
Any other use or disclosure of PHI, other than those listed above,
will only be made with your written authorization. (The authorization
must specifically identify the information that the Village seeks
to use or disclose; as well as, when and how it seeks to use or disclose
the information). You may revoke such authorization at any time in
writing, except for the medical information that the Village had
already used or disclosed in reliance on your initial authorization.
Patient Rights : As a patient, you have a number of rights with
respect to the protection of your PHI including the following:
The right to access, copy or inspect your PHI. This right means
that you may come to the Village's office and inspect and copy
most of the medical information about you that the Village maintains.
The Village will normally provide you with access to this information
within 30 days of your request. The Village may also charge you
a reasonable fee for you to copy any medical information that you
have the right to access. In limited circumstances, the Village
may deny you access to your medical information, and you may appeal
certain types of denials.
The Village has forms available for you to request access to your
PHI, and it will provide a written response if it denies you access
and will let you know your appeal rights. If you wish to inspect
and copy your medical information, you should contact the records
management clerk listed at the end of this Notice.
The right to amend your PHI. You have the right to ask the Village
to amend written medical information that it may have about you.
The Village will generally amend your information within 60 days
of your request and will notify you when it has amended the information.
The Village is permitted by law to deny your request to amend your
medical information only in certain circumstances. For example,
if the Village believes that the information to be amended is correct.
If you wish to request that the Village amend the medical information
that it has about you, you should contact the privacy officer listed
at the end of this Notice.
The right to request an accounting of the Village's use and disclosure
of your PHI. You may request an accounting from the Village of
certain disclosures of your medical information that the Village
has made in the last six years prior to the date of your request.
The Village is not required to give you an accounting of information
that it has used or disclosed for purposes of treatment, payment
or health care operations, or when it shares your health information
with its business associates, such as its billing company or a
medical facility from/to which the Village has transported you.
The Village is also not required to give you an accounting of
its uses of protected health information for which you have already
given it written authorization. If you wish to request an accounting
of the medical information about you that the Village has used
or disclosed that is not exempted from the accounting requirement,
you should contact the privacy officer listed at the end of this
Notice.
The right to request that the Village restrict the uses and disclosures
of your PHI. You have the right to request that the Village restricts
how it uses and discloses your medical information that the Village
has about you for treatment, payment or health care operations,
or to restrict the information that is provided to family, friends
and other individuals involved in your health care. However, if
you request a restriction and the information you asked the Village
to restrict is needed to provide you with emergency treatment,
then the Village may use the PHI or disclose the PHI to a health
care provider to provide you with emergency treatment. The Village
of Oak Brook is not required to agree to any restrictions you request;
but any restrictions agreed to by the Village are binding on the
Village.
Internet, Electronic Mail, and the Right to Obtain Copy of Paper
Notice on Request: If the Village maintains a web site, it will
prominently post a copy of this Notice on its web site and make
the Notice available electronically through the web site. If you
give permission to the Village of Oak Brook, it will forward you
this Notice by electronic mail instead of on paper, and you may
always request a paper copy of this Notice.
Revisions to the Notice: The Village of Oak Brook reserves the
right to change the terms of this Notice at any time, and the changes
will be effective immediately and will apply to all protected health
information that the Village maintains. Any material changes to
this Notice will be promptly posted to our web site if the Village
maintains one. You can get a copy of the latest version of this
Notice by contacting the privacy officer listed at the end of this
Notice.
Your Legal Rights and Complaints: You also have the right to complain
to the Village, or to the Secretary of the United States Department
of Health and Human Services if you believe your privacy rights
have been violated. You will not be retaliated against in any way
for filing a complaint with the Village or to the government. If
you have any questions, comments or complaints, you may direct
all inquiries to the privacy officer listed at the end of this
Notice. Individuals will not be retaliated against for filing a
complaint.
If you have any questions or if you wish to file a complaint or
exercise any rights listed in this Notice, please contact:
Privacy Officer
Village of Oak Brook
1200 Oak Brook Road
Oak Brook, IL 60523
(630) 368-5190
www.oak-brook.org
If you wish to request a copy of your medical record, please contact:
Records Management Clerk
Village of Oak Brook
1200 Oak Brook Road
Oak Brook, IL 60523
(630) 368.5056
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