NOTICE OF PRIVACY PRACTICES
Your rights under the Health Insurance Portability & Accountability Act of 1996 (HIPAA) and Omnibus Rule of 2013
How Your Medical Information May Be Used and Disclosed & How You Can Get Access to This Information
PLEASE REVIEW CAREFULLY
When we refer to Progressive Health Systems, the Hospital or we or us, we mean Progressive Health Systems and other entities of the organized healthcare arrangement. This includes Pekin Hospital, ProHealth, physicians’ office practices, ProCare Home Health Services, Park Court Pharmacy, and Pekin Hospital’s Home Health Care Agency.
Who Will Follow This Notice:
This notice describes the hospital's practices and that of:
Our Pledge Regarding Medical Information:
We understand that your protected health information, PHI, is personal. We are committed to protecting this medical information. A record is created of the care and services you receive at this hospital. This record is needed to provide the necessary care and to comply with legal requirements. This notice applies to all of the records of your care generated by the hospital. Your personal physician may have different policies or notices regarding the physician's use and disclosure of your medical information in the physician's office or clinic.
This notice will tell about the ways in which the hospital may use and disclose medical information about you. Also described are your rights and certain obligations we have regarding the use and disclosure of medical information.
The law requires the hospital to:
HOW THE HOSPITAL MAY USE and DISCLOSE YOUR MEDICAL INFORMATION:
The following categories describe different ways the hospital uses and discloses medical information. Each category will be explained. Not every possible use or disclosure will be listed. However, all the different ways the hospital is permitted to use and disclose information will fall within one of these categories.
Your medical information may be used to provide you with medical treatment or services. This medical information may be disclosed to physicians, nurses, technicians, or other agents of the hospital who are involved in your care at the hospital. Your medical information may also be disclosed to healthcare students and interns. For example: A doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. The doctor may need to tell the dietitian about the diabetes so appropriate meals can be arranged. Different departments of the hospital may also share medical information about you in order to coordinate your different needs, such as prescriptions, lab work and x-rays. The hospital also may disclose medical information about you to people outside the hospital who may be involved in your medical care after you leave the hospital, such as family members, home health agencies, or others used to provide services that are part of your care.
Your medical information may be used and disclosed so that the treatment and services received at the hospital may be billed and payment may be collected from you, the insurance company and/or a third party. You may request that your insurance not be billed or notified after you have paid your charges in full.
For Example: The health plan or insurance company may need information about the care you received from the hospital so they can provide payment for the surgery. Information may also be given to someone who helps pay for your care. Your health plan or insurance company may also need information about a treatment you are going to receive to obtain prior approval or to determine whether they will cover the treatment.
Health Care Operations:
Your medical information may be used and disclosed for purposes of furthering day-to-day hospital operations. These uses and disclosures are necessary to run the hospital and to monitor the quality of care our patients receive.
For Example: Your medical information may be:
- Reviewed to evaluate the treatment and services performed by our staff in caring for you.
- Combined with that of other hospital patients to decide what additional services the hospital should offer, what services are not needed, and whether certain new treatments are effective.
- Disclosed to doctors, nurses, technicians, and other agents of the hospital for review and learning purposes.
- Disclosed to healthcare students, interns and residents.
- Combined with information from other facilities to compare how we are doing and see where we can improve the care and services offered. Information that identifies you in this set of medical information may be removed so others may use it to study health care and health care delivery without knowing who the specific patients are.
Limited information about you may be used in the census report while you are a patient of the hospital. This information may include your name, location of the hospital, admission date and address.
While you are a patient in the hospital information about you may be disclosed to your specific clergy. This information may include your name, address, and admission date.
Your medical information may be used to contact you as a reminder of an appointment you have for treatment or medical care from the hospital.
Your medical information may be used to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
Health-Related Benefits and Services:
Your medical information may be used to tell you about health-related benefits or services that may be of interest to you.
Individuals Involved in Your Care:
With your permission, your medical information may be released to a family member, guardian or other individuals involved in your care. They may also be told about your condition unless you have requested additional restrictions. In addition, your medical information may be disclosed to an entity assisting in a disaster relief effort so your family can be notified about your condition, status, and location.
Under certain circumstances, your medical information may be used and disclosed for research purposes. For example: A research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the same conditions. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of medical information, balancing the research needs with the patients' need for privacy of their medical information. Your medical information may be disclosed to people preparing to conduct a research project; for example, helping them look for patients with specific medical needs, so long as the medical information they review does not leave the hospital. We will almost always ask for your specific permission if the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care.
As Required by Law:
Your medical information will be disclosed when required to do so by federal, state, or local authorities, laws, rules and/or regulations.
- Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, your medical information will be disclosed in response to a court or administration order, subpoena, discovery request, or other lawful process by someone else involved in the dispute when we are legally required to respond.
Law Enforcement: Your medical information will be released if requested by a law enforcement official:
- In response to a court order. subpoena, warrant, summons or similar process;
- To identify or locate a suspect, fugitive, material witness, or missing person;
- About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement;
- About a death we believe may be the result of criminal conduct; and
- In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
- National Security and Intelligence Activities: Your medical information will be released to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
- To Alert a Serious Threat to Health or Safety: Your medical information may be used and disclosed when necessary to prevent a serious threat to your health and safety and that of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
- Health Oversight Activities: Your medical information may be disclosed to a health oversight hospital for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Private Accreditation Organizations:
Your medical information may be used to fulfill this hospital's requirements to meet the guidelines of private hospital accreditation organizations such as Joint Commission, Illinois Department of Public Health, etc.
We do not use patient information for fundraising purposes.
DISCLOSURES OF HEALTH INFORMATION WHICH REQUIRE WRITTEN AUTHORIZATION:
If you provide us written authorization to release those records identified above, you may revoke that authorization at any time by sending written notice of revocation to the Pekin Hospital privacy officer. We will no longer disclose PHI under the authorization. Disclosures we made in reliance on your authorization before you revoked it will not be affected by the revocation.
Organ and Tissue Donation:
If you are an organ or tissue donor, your medical information may be released to organizations that handle organ procurement or organ, eye and tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
Your social security number and other required information will be released in accordance with federal laws and regulations to the manufacturer of any medical device(s) you have implanted or explanted during a hospitalization and to the Food and Drug Administration, if applicable. This information may be used to locate you should there be a need with regard to such medical device(s).
Military and Veterans:
If you are a member of the armed forces, your medical information may be released as required by military command authorities. If you are a member of the foreign military personnel, your medical information may be released to the appropriate foreign military authority.
If you seek treatment for a work-related illness or injury, we must provide full information in accordant with state-specific laws regarding workers' compensation claims. Once state-specific requirements are met and an appropriate written request is received, only the records pertaining to the work-related illness or injury may be disclosed.
Public Health Risk:
Your medical information may be used and disclosed 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 reactions to medications or problems with products;
- To notify people of recalls of products they may be using;
- To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
- To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.
Coroners, Medical Examiners, and Funeral Directors:
Your medical information may be released to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients of the hospital to funeral directors as necessary to carry out their duties.
If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary for the following reasons:
- For the institution to provide you with health care;
- To protect the health and safety of you and others; and
- For the safety and security of the correctional institution.
Other Uses of Medical Information:
Other uses and disclosures of medical information not covered by this notice or the laws that apply to this hospital will be made only with your written permission. If you provide the hospital permission to use or disclose your medical information, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose your medical information for the reasons covered in your written authorization. You understand that we are unable to take back any disclosures already made with your permission, and that we are required to retain our records of the care that the hospital provided to you.
ADDITIONAL INFORMATION CONCERNING THIS NOTICE:
Changes To This Notice:
We reserve the right to change this notice and make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. The hospital will post a current copy of the notice with the effective date. In addition, each time you are admitted to the hospital for care/services, as an inpatient or outpatient, we will offer you a copy of the current notice in effect.
You will not be penalized for filing a complaint. If you believe your privacy rights have been violated, you may file a complaint with the hospital or with the Secretary of the Department of Health and Human Services. To file a complaint with the hospital, contact the Hospital Privacy Officer. All complaints must be submitted in writing.
YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION:
You have the following rights regarding medical information the hospital maintains about you:
NOTE: All Requests Must Be Submitted in Writing to the Hospital’s Health Information Department.
Right to Inspect and Copy:
You have the right to inspect and copy medical information that may be used to make decisions about your care.
To inspect and copy medical information or to receive an electronic copy of the medical information that may be used to make decisions about you, you must submit a written request to the Hospital’s Health Information Department at 600 South 13th Street, Pekin, Illinois 61554. A fee may be charged for paper copy requests, covering costs of copying, mailing, and other supplies associated with your request.
The hospital uses and also maintains an electronic health record with respect to your medical information, you have the right to obtain an electronic copy of the information if you so choose.
- You may direct the hospital to transmit the copy to another entity or person that you designate provided the choice is clear, conspicuous, and specific.
- The hospital may charge a fee equal to its labor cost in providing the electronic copy.
We may deny your request to inspect and copy in some limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional, other than the person who denied your request will be chosen by the hospital to review your request and the denial. The hospital will comply with the outcome of the review unless:
- A licensed health care professional has determined, in the exercise of professional judgment, that the access requested is reasonably likely to endanger the life or physical safety of the individual or another person.
- The protected health information makes reference to another person (unless such other person is a health care provider) and a licensed health care professional has determined, in the exercise of professional judgment, that the access requested is reasonably likely to cause substantial harm to such other person.
- The request for access is made by the individual's personal representative, and a licensed health care professional has determined, in the exercise of professional judgment, that the provision of access to such personal representative is reasonably likely to cause substantial harm to the individual or another person.
Right to Amend:
If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment to information kept by or for the hospital.
To request an amendment, you must submit a written request. You must also provide a reason that supports your request. Your request for an amendment may be denied if:
- Your request is not in writing or does not include a reason to support the request;
- The medical information was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
- The medical information is not part of the medical information kept by or for the hospital;
- The medical information is not part of the information you would be permitted to inspect and copy; or
- The medical information is accurate and complete.
Right to Request Restrictions:
You have a right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member.
To request restrictions, you must make your request in writing. In your request, you must tell us:
- What information you want to limit;
- Whether you want to limit our use, disclosure or both;
- To whom you want the limits to apply. For Example: Disclosures to your spouse.
You also have a right to request that a health care item or service not be disclosed to your health plan for payment purposes or health care operations. We are required to honor your request if the health care item or service is paid out of pocket and in full. This restriction does not apply to use or disclosure of your health information related to your medical treatment.
Once we agree to your request, we must follow your restrictions (except if the information is necessary for emergency treatment). You may cancel the restrictions at any time. In addition, we may cancel a restriction at any time as long as we notify your of the cancellation and continue to apply the restriction to information collected before the cancellation.
Right to Request Confidential Communication.
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example: You can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice.
You have the right to a copy of this notice. You may ask us to give you a copy at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.