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.
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, physician office practices, durable medical equipment locations, Tremont and Park Court Pharmacies, and Pekin Hospital Home Health Care Agency. This notice describes our hospital's practices and that of:
All these entities, sites, and locations follow the terms of this notice. In addition, these entities, sites and locations may share medical information with each other for treatment, payment, or hospital operations purposes described in this notice.
- Any health care professional authorized to enter information into our hospital chart.
- All departments and units of the hospital.
- Any member of a volunteer group we allow to help you while you are in the hospital.
- All employees, staff, and other hospital personnel.
- Durable Medical Equipment, Home Health Care, Physician Office Practices and Retail pharmacies.
Our Pledge Regarding Medical Information:
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at the hospital. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by the hospital, whether made by hospital personnel or your personal doctor. Your personal doctor may have different policies or notices regarding the doctor's use and disclosure of your medical information created in the doctor's office or clinic. This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.
We are required by law to:
How We May Use and Disclose Medical Information About You
- Make sure that medical information that identifies you is kept private;
- Give you this notice of our legal duties and privacy practices with respect to medical information about you; and
- Follow the terms of the notice that is currently in effect.
In order for treatment, payment and healthcare operations to occur, protected health information must be used within entities and shared with business associates with whom we do business. Protected health information or "PHI" is current, past or future information created or received by Progressive Health Systems through its healthcare providers, health plans and contractors. It relates to the physical or mental condition of a patient, the provision of healthcare to that person, or payment for the provision of healthcare to the person. The term "PHI" does not generally include publicly available information, or information available or reported in a summarized or grouped manner. In our efforts to keep you informed we have described the following ways in which we may use and disclose individually identifiable health information about you or a member of your family without your consent. Please keep in mind that this is not an all-inclusive list. If you have any questions or need further clarification we will be happy to address and answer any of your questions. The following categories describe different ways that Progressive Health Systems may use and disclose medical information about you and your dependents. For each category of uses or disclosures we will explain what is meant and try to give some examples of how we use this information to provide services to you and your dependents. Not every use or disclosure in a category will be listed.
We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other hospital personnel who are involved in taking care of you in the hospital. For example, information obtained by a nurse, physician, or other member of your health care team will be recorded in your record and used to determine the course of treatment that should work best for you. Your physician will document in your record his or her expectations of the members of your health care team. Members of your health care team will then record the actions they took and their observations. In that way, the physician will know how you are responding to treatment.
We may use and disclose medical information about you so that the treatment and services you receive may be billed to and payment may be collected from you, an insurance company, or a third party. For example, we may need to give your health plan information about surgery you received at the hospital so your health plan will pay us or reimburse you for the surgery. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
For Health Care Operations.
We may use and disclose medical information about you for hospital operations. These uses and disclosures are necessary to run the hospital and make sure that all of our patients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine medical information about many hospital patients to decide what additional services the hospital should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, technicians, medical students, and other hospital personnel for review and learning purposes. We may also combine the medical information we have with medical information from other hospitals to compare how we are doing and see where we can make improvements in the care and services we offer. We may remove information that identifies you from this set of medical information so others may use it so study healthcare and healthcare delivery without learning who the specific patients are.
We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
Health-Related Benefits and Services.
We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you. For example, support groups, recommendations regarding women's heart health, diabetes health management, and other population specific health programs.
We may use medical information about you to contact you in an effort to raise money for the hospital and its operations. We may disclose information to a foundation related to the Progressive Health Systems so that the foundation may contact you in raising money for the hospital. We only would release contact information such as your name, address, and phone number and the dates you received treatment or services at the hospital. If you do not want Progressive Health Systems to contact you for fundraising efforts, you must notify the Department of Regulatory Compliance/ Patient Relations in writing at 600 South 13th Street, Pekin, Illinois, 61554.
For quality of care purposes, Progressive Health Systems may use your medical information to contact you as a reminder that - to the best of our knowledge - you are due for an appointment for specific treatment or medical care with one of our provider areas.
We may include certain limited information about you in the hospital directory while you are a patient at the hospital. This information may include your name, location in the hospital, your general condition (e.g., fair, stable, etc.) and your religious affiliation. The directory information, except for your religious affiliation, may also be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy, such as a priest or rabbi, if you have given authorization, even if they don't ask for you by name. This is so your family, friends, and clergy can visit you in the hospital and generally know how you are doing.
Individuals Involved in Your Care or Payment for Your Care.
We may release medical information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. We may also tell your family or friends your condition and that you are in the hospital. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.
As Required By Law.
We will disclose medical information about you when required to do so by federal, state, or local law.
To Avert a Serious Threat to Health of Safety.
We may use and disclose medial information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
Organ and Tissue Donation.
If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye, or tissue transplantation or to an organ donation bank as necessary to facilitate organ or tissue donation and transplantation.
Military and Veterans.
If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.
We may release medical information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.
Public Health Risks.
We may disclose medical information about you for public health activities. These activities generally include the following:
Health Oversight Activities.
- 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.
We may disclose medical information to a health oversight agency 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 healthcare system, government programs, and compliance with civil rights law.
Lawsuits and Disputes.
If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if effort has been made to tell you about the request or to obtain an order protecting the information requested.
We may release medical information, if asked, to a pharmaceutical company for marketing purposes.
We may release medical information if asked to do so by a law enforcement official:
Coroners, Medical Examiners, and Funeral Directors.
- 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;
- About criminal conduct at the hospital; 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.
We may release medical information 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.
National Security and Intelligence Activities.
We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
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 (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
Your Rights Regarding Medical Information About You
You have the following rights regarding medical information we maintain about you and your dependents:
Right to Access.
You have the right to inspect and to obtain a copy of your own protected health information in a designated record set. For Progressive Health Systems, this includes medical and billing records but does not include psychotherapy notes.
To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to the Department of Health Information at 600 South 13th Pekin, Illinois, 61554. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other supplies associated with your request.
We reserve the right to deny you access to all or part of any designated record set at Progressive Health Systems. Psychotherapy notes or information compiled in reasonable anticipation of, or for use in a civil, criminal, or administrative action proceedings are examples of when you would be denied access to all or part of any designated record set. If you are denied access to all or part of your protected health information, we will do our best to provide you with access to any other protected health information requested after excluding the protected health information to which we have grounds to deny. If you are denied access to medical information, you may request the denial be reviewed. Another licensed healthcare professional chosen by the hospital will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
Right to Amend.
If you feel that medical information that we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the hospital.
To request an amendment, your request must be made in writing and submitted to the Department of Health Information. In addition, you must provide a reason that supports your request.
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:
Right to an Accounting of Disclosure.
- Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
- Is not part of the medical information kept by or for Progressive Health Systems;
- Is not part of the information which you would be permitted to inspect and copy; or
- Is accurate and complete.
You have the right to request an "accounting of disclosures." This is a list of the disclosures we made of medical information about you to external organizations that is not included in this notice or part of treatment, payment, and healthcare operations.
To request this list or accounting of disclosures, you must submit your request in writing to the Department of Health Information. Your request 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, electronically). The first list you request within a 12-month period will be free. For additional lists, 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.
Right to Request Restrictions.
You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or healthcare operations.
We are not required to agree to your request.
To request restrictions, you must submit your request in writing to the Department of Health Information. In your request, you must tell us (1) what information you want to limit: (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.
Right to Request Confidential Communications.
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. We will accommodate to the best of our abilities all requests for such confidential communication.
To request confidential communications, you must make your requests in writing to the Department of Health Information. We may refuse to accommodate your request if you have not provided information as to how payment, if applicable, will be handled and specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice.
You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.
Changes to This Notice.
- You may obtain a copy of this notice at our website, www.pekinhospital.org.
- To obtain a paper copy of this notice, request a copy from any staff member of the Department of Health Information (Medical Records).
Progressive Health Systems reserves the right to change this notice. We reserve the right to make the revised or changed notice effective for personal health information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in the hospital as well as our website at www.pekinhospital.org. You may also contact our Health Information Department anytime throughout the year for a complete written or electronic copy to be sent directly to you. The notice will contain on the first page, in the top right-hand corner, the effective date. In addition, each time you register at or are admitted to the hospital for treatment or healthcare services as an inpatient or outpatient, we will offer you a copy of the current notice in effect.
If you believe your privacy rights have been violated, you may file a complaint with Progressive Health Systems or with the Secretary of the Department of Health and Human Services. To file a complaint with Progressive Health Systems, contact the Department of Regulatory Compliance/ Patient Relations/Medical Staff Services at 600 South 13th Street, Pekin, Illinois, 61554, at (309) 353-0826. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
Other Uses of Medical Information.
Other uses and disclosures of medical information not covered by applicable laws or this notice will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission and that we are required to retain our records of the care that we provided to you.
© 2013 Pekin Hospital | 600 S. 13th St. | Pekin, IL 61554 | (309) 347-1151