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.
We are committed to protecting the confidentiality of your medical information, and are required by law to do so. Your medical information is anything about you that relates to your health care or payment for care for which your identity might be known. Typically, medical information contains, among other information, your name, symptoms, health history, examination and test results, diagnoses, current and future treatment, and billing-related information.
This notice describes how we may use your medical information within the Hospital and how we may disclose it to others outside the Hospital. This notice also describes the rights you have concerning your own medical information. Please review it carefully and let us know if you have questions. How will we use and disclose your medical information?
Treatment: We may use your medical information to provide you with medical services and supplies. We may also disclose your medical information to others who need that information to treat you, such as doctors, physician assistants, nurses, medical and nursing students, technicians, therapists, emergency service and medical transportation providers, medical equipment providers and others involved in your care. For example, we will allow your physician to have access to your Hospital medical record to assist in your treatment at the Hospital and for follow-up care.
We also may use and disclose your medical information to contact you to remind you of an upcoming appointment, to inform you about possible treatment options or alternatives, to tell you about health-related services available to you or to perform follow-up calls to monitor your care experience. If you do not want to be contacted for appointment reminders, or if you do not want to receive communications about treatment alternatives and options or health-related benefits or services, please advise the Hospital in writing at the address located in this Notice, and will not use or disclose your medical information for these purposes.
Patient Directory: In order to assist family members and other visitors in locating you while you are in the Hospital, the Hospital maintains a patient directory. This directory includes your name, room number, your general condition (such as fair, stable, or critical) and your religious affiliation (if any). We will disclose this information to someone who asks for you by name; we will disclose your religious affiliation only to clergy members. If you do not want to be included in the Hospital’s patient directory, please call the Switchboard. A simple form is also available.
Family Members and Others Involved in Your Care: We may disclose your medical information to a family member or friend who is involved in your medical care, or to someone who helps to pay for your care. We also may disclose your medical information to disaster relief organizations to help locate a family member or friend in a disaster. If you do not want the Hospital to disclose your medical information to family members or others who will visit you, you must talk to the R.N. You can reach our privacy officer using contact information listed below.
Business Associates: We may use or disclose your medical information to our business associates who perform services on our behalf, such as third-party billing companies or medical transcriptionists. The Hospital requires the business associate to protect the confidentiality of the medical information.
Payment: We may use and disclose your medical information so that the treatment and services you receive at the Hospital may be billed to and payment may be collected from you, an insurance company or a third party.
Hospital Operations: We may use and disclose your medical information if it is necessary to improve the quality of care we provide to patients or to run the Hospital. We may use your medical information to conduct quality improvement activities, to obtain audit, accounting or legal services or to conduct business management and planning. For example, we may look at your medical record to evaluate whether Hospital personnel, your doctors or other health care professionals did a good job.
Research: We may use or disclose your medical information for research projects, such as studying the effectiveness of a treatment you received. These research projects must go through a special process that protects the confidentiality of your medical information.
Required by Law: Federal, state, or local laws sometimes require us to disclose patients’ medical information. For instance, we are required to report child abuse or neglect and must provide certain information to law enforcement officials in domestic violence cases. We also are required to give information to the State Workers’ Compensation Program for work-related injuries.
Public Health: We also may report certain medical information for public health purposes. For instance, we are required to report births, deaths and communicable diseases to the state. We also may need to report patient reactions with medications or medical products to the FDA, or may notify patients of recalls of products they are using.
Public Safety: We may disclose medical information for public safety purposes in limited circumstances. We may disclose medical information to law enforcement officials in response to a search warrant or a grand jury subpoena. We also may disclose medical information to assist law enforcement officials in identifying or locating a person, to prosecute a crime of violence, to report deaths that may have resulted from criminal conduct and to report criminal conduct at the Hospital. We also may disclose your medical information to law enforcement officials and others to prevent a serious threat to health or safety of the public or another person.
Health Oversight Activities: We may disclose medical information to a government agency that oversees the Hospital or its personnel, such as the State Department of Health, the federal agencies that oversee Medicare, the Board of Medical Examiners or the Board of Nursing. These agencies need medical information to monitor the Hospital’s compliance with state and federal laws.
Coroners, Medical Examiners and Funeral Directors: We may disclose medical information concerning deceased patients to coroners, medical examiners and funeral directors to assist them in carrying out their duties.
Organ and Tissue Donation: If you are an organ donor, we may disclose medical information to organizations that handle organ, eye or tissue donation or transplantation.
Military, Veterans, National Security and Other Government Purposes: If you are a member of the armed forces, we may release your medical information as required by military command authorities or to the Department of Veterans Affairs. The Hospital may also disclose medical information to federal officials for intelligence and national security purposes, or for presidential Protective Services.
Inmates: If you are an inmate in a correctional institution or in the custody of a law enforcement official, we may disclose medical information about you to the correctional institution or law enforcement official as necessary so that their duties can be carried out under the law.
Judicial Proceedings: The Hospital may disclose medical information if the Hospital is ordered to do so by a court or if the Hospital receives a subpoena or a search warrant. You will receive advance notice about this disclosure in most situations so that you will have a chance to object to sharing your medical information.
Information with Additional Protection: Certain types of medical information have additional protection under state or federal law. For instance, medical information about communicable disease and HIV/AIDS, mental health or alcohol/substance abuse services as an inpatient, and evaluation and treatment for a serious mental illness is treated differently than other types of medical information. For those types of information, the Hospital is required to get your permission before disclosing that information to others in many circumstances.
Other Uses and Disclosures: If the Hospital wishes to use or disclose your medical information for a purpose that is not discussed in this Notice, the Hospital will seek your permission. If you give your permission to the Hospital, you may take back that permission any time, unless we have already relied on your permission to use or disclose the information. If you ever would like to revoke your permission, please notify the Director of Health Information Management in writing. What are your rights?
Right to Request Your Medical Information: You have the right to look at your own medical information and to get a copy of that information. (The law requires us to keep the original record.) This includes your medical record, your billing record and other records we use to make decisions about your care. To request your medical information, write to the Director, Health Information Management to copy the information. We will tell you in advance what copying and mailing will cost. You can look at your record at no cost. We may deny your request to see and/or obtain copies of your medical information in very limited circumstances. If you are denied access to your medical information, you may request that the denial be reviewed. A licensed health care professional chosen by the Hospital will review your request and denial. The person conducting the review will not be the person who denied your request. We will comply with the decision that is the outcome of the review.
Right to Request Amendment of Medical Information You Believe Is Erroneous or Incomplete: If you examine your medical information and believe that some of the information is wrong or incomplete, you may ask us to amend your record, as long as the information is kept by or for the Hospital. We cannot act on your request for medical information kept by another hospital or provider; you must contact them directly. To ask us to amend your medical information, write to the Director, Health Information Management and state the reasons for the 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. We are not obligated to make all requested amendments, but will give each request careful consideration.
Right to Get a List of Certain Disclosures of Your Medical Information: You have the right to request an accounting of certain disclosures we make of your medical information. The listing will not cover medical information that was given to you or your personal representative or to others with your permission. In addition, it will not cover medical information that was given in order to provide or arrange care for you; facilitate payment for your health care services; and/or assist the Hospital in its operations. If you would like to receive such a list, write to the Director, Health Information Management. We will provide the first list to you free, but we may charge you for any additional lists you request during the same year. We will tell you in advance what this list will cost. The list will include only the disclosures made for the time period indicated in your request, but may not exceed a six-year period or include dates before April 14, 2003.
Right to Request Restrictions on How the Hospital Will Use or Disclose Your Medical Information for Treatment, Payment or Health Care Operations: You have the right to request us not to make uses or disclosures of your medical information to treat you, to seek payment for care or to operate the Hospital. We are not required to agree to your request, but if we do agree, we will comply with that agreement unless information is needed to provide you emergency treatment. If you want to request a restriction, write to the Privacy Official and describe your request in detail.
Right to Request Confidential Communications: You have the right to ask us to communicate with you in a way that you feel is more confidential. For example, you can ask us not to call your home, but to communicate only by mail or email. To do this, write to the Privacy Officer. You can also ask to speak with your health care providers in private outside the presence of other patients—just ask them! We will not ask you the reason for your request, and we will accommodate all reasonable requests.
Right to a Paper Copy: If you have received this notice electronically, you have the right to a paper copy at any time. You may download a paper copy of the notice from our website, at www.weisshospital.com
, or you may obtain a paper copy of the notice from the Admitting Department. Changes to this Notice
From time to time, we may change our practices concerning how we use or disclose patient medical information, or how we will implement patient rights concerning their information. We reserve the right to change this Notice and our privacy practices when permitted or as required by law. If we change these practices, we will publish a revised Notice of Privacy Practices. You can get a copy of our current notice of Privacy Practices at any time by contacting the Privacy Officer. Which health care providers are covered by this notice?
This Notice of Privacy Practices applies to the Hospital and its personnel, volunteers, students and trainees. The Notice also applies to other health care providers that come to the Hospital to care for patients, such as physicians, physician assistants, therapists, other health care providers who are not employed by the Hospital, emergency service providers, medical transportation companies and medical equipment and suppliers who come to the Hospital. The Hospital may share your medical information with these providers for treatment purposes, to get paid for treatment or to conduct health care operations. These health care providers will follow this Notice for information they receive about you from the Hospital. These other health care providers may follow different practices at their own offices or facilities. A list of these health care providers is available for your review in the Admitting Office or by contacting the Nursing Administrative Coordinator. Do you have any complaints?
If you have questions about this notice or wish to file a complaint with us, you may contact:
Local Privacy Official: (708) 783-5681
Privacy Official: (800) 854-6413
Compliance (confidential) hotline: (800) 300-9876
Or you may write to the address listed below.
You may also file a complaint with the federal government at the OCR/DHHS –
Office of Civil Rights/Department of Health and Human Services. We will not penalize you or retaliate against you in any way for filing a complaint in good faith. Do you have questions?
The Hospital is required by law to give you this Notice and to follow the terms of the Notice that is currently in effect. If you have any questions about this Notice, or have further questions about how the Hospital may use and disclose your medical information, please contact the Privacy Official.
Effective date: December 14, 2012.
Privacy Official Contact Information:
Attn: Privacy Official
Address: Weiss Memorial Hospital
4646 N. Marine Drive, Chicago, IL 60640
Phone: (708) 783-5681
Fax: (773) 564-5829