773 W. Lincoln Blvd.
Freeport, Illinois 61032
(815) 599-7050 or
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THE INFORMATION. PLEASE REVIEW IT CAREFULLY.
What Is Covered by this Notice?
This Notice describes the way your health information may be used and disclosed by us, and describes your rights and our obligations concerning your protected health information.
This Notice covers the health care services provided by healthcare providers on staff and in any affiliated FHN location or other treatment sites.
Although not all of the physicians or other providers on our Medical Staff are employees of FHN, they are part of the FHN health care arrangement, and may share health information about you as is necessary for treatment, payment, or health care operations.
Your doctors and other health care providers may have independent private practices, and may have a separate Notice of Privacy Practices which would apply to the services and practices of such independent offices or outside treatment sites.
How We May Use and Disclose Your Health Information
For treatment, payment, and health care operations: FHN and your health care providers may use or disclose your health information in order to provide you treatment, to obtain payment for such treatment, and for health care operations, which are activities related to the provision of health care.
For example, we may use or disclosure your health information for treatment purposes in order to provide, coordinate, or manage health care and related services among your health care providers, such as when one physician refers you to another health care provider or requests a consultation by a specialist.
We may use or disclose your health information for payment purposes, such as to bill your insurance company or Medicare in order to obtain reimbursement for the health care services provided you.
We may use or disclose your health information for health care operations purposes, such as for improving quality of care, reducing health care costs, conducting training programs and other activities such as for health system accreditation or provider licensing or credentialing activities.
We may contact you to raise funds for FHN; you have the right to opt out of receiving such communications.
For the facility directory: In the event you need to be admitted to FHN Memorial Hospital, we may include in the hospital directory your name, location, a general description of your condition, and your religious affiliation. We may release this information to clergy members or, except for religious affiliation, to any person who asks for you by name, unless you request us not to. If you are incapacitated or involved in an emergency upon admission, we may use or disclose this information for the hospital directory if we determine it is in your best interest to do so and you had not previously requested us not to.
For involvement in your care and notification purposes: We may disclose to a family member, other relative, close personal friend, or any other person you identify, your health information that is directly relevant to such personís involvement in your health care or payment related to your health care.
We may use or disclose your health information to notify, or assist in the notification of, a family member, your personal representative, or another person responsible for your care, of your location, general condition, or death.
We may disclose your health information to entities assisting in disaster relief efforts for the purpose of coordinating with such entities the notifications described above.
If you are present and able to make health care decisions, we may use or disclose your health information as described above unless you request us not to or we reasonably infer that you do not object. If you are not present or are unable to agree or object to the uses and disclosures described above due to incapacity or an emergency circumstance, we will determine whether disclosure is in your best interest, and if so, only disclose information that is directly relevant to the other person's involvement. These limitations apply to disclosures to disaster relief entities only to the extent that we determine that they do not interfere with the ability to respond to emergency circumstances.
We will use our judgment and experience in determining whether to allow a person to act on your behalf to pick up filled prescriptions, medical supplies, X-rays, or other forms of your health information.
If you pass away, we may disclose to a family member, or to another relative, close personal friend, or any other person you identify who was involved in your care or payment for your health care prior to your death, your health information relevant to such person's involvement, unless you had previously requested us not to.
Additional disclosures made pursuant to law or for public health purposes: There are a number of situations in which we may use or disclose certain health information about you without requesting your authorization to do so, such as for public health activities and where the law authorizes such uses and disclosures of your health information. Such disclosures may involve situations such as for reporting obligations (such as for victims of abuse), for health oversight activities (such as for audits, inspections, or compliance activities), for judicial or administrative proceedings (such as when called for by court order or subpoena), for law enforcement purposes (such as for mandatory reporting as covered by federal or state statutes), for coroners and funeral directors, for certain research activities involving institutional review board waiver of authorization approval, for disclosures necessary to avert serious threats to health or safety, for certain government functions (such as relating to the military or national security) and for workersí compensation purposes as authorized by State law.
We may use or disclose health information that excludes direct identifiers of you or your relatives, employers, or household members.
We may use, or disclose to a related foundation or to a business associate, certain health information about you for the purpose of raising funds for FHN's own benefit.
We may use or disclose your health information incident to a use or disclosure otherwise permitted under this Notice or required by law, limited to the minimum necessary to accomplish the intended purpose.
We are required to disclose your health information to the Secretary of Health & Human Services in connection with an investigation into our compliance with the HIPAA Privacy Rule.
We will abide with laws requiring disclosure of information. If a certain use or disclosure is addressed by more than one law, we will abide by the more stringent law.
Additional Disclosures Will Be Made Only with Your Written Authorization
In situations involving a use or disclosure of your health information which is not mentioned above, we will first obtain written Authorization from you to do so. Specifically, a written Authorization is required for most uses and disclosures of psychotherapy notes about you, most uses and disclosures of your health information for marketing, and disclosures that constitute the sale of your health information.
If you give us such Authorization, you have the ability to later revoke it in writing, with certain exceptions such as to the extent that we have already acted upon the Authorization. For directions regarding the procedure for revoking an Authorization, you should contact a staff member at any FHN location.
Your Rights with Respect to Your Own Health Information
Under the law, you have the right to ask that we restrict certain types of uses and disclosures of your health information described above, specifically, those involving treatment, payment or health care operations, and those concerning facility directory and disclosures to family, friends, and for notification purposes. We are not required to agree to a requested restriction, except in the case of a request to restrict disclosure of your health information to a health plan if the disclosure is for carrying out payment or health care operations and is not otherwise required by law, and the health information pertains solely to a health care item or service for which you or someone on your behalf has paid FHN in full. To make such a request you may contact a staff member at any FHN location to obtain a REQUEST FOR RESTRICTION OF USES AND DISCLOSURES form.
You have the right to ask that we communicate with you in a confidential nature, such as by contacting you through a certain telephone number or by sending you information to a specific address. Such requests must be reasonable and must be made in writing, and may be made by contacting a staff member at any FHN location to obtain a REQUEST FOR CONFIDENTIAL COMMUNICATIONS form. Depending on the request, it may be necessary to charge you for costs associated with your request.
You have the right to request access to inspect and obtain a copy of your medical records, billing records, and other health information used to make decisions concerning you. Such requests must be in writing, and may be made by contacting a staff member at any FHN location to obtain a PATIENT REQUEST TO ACCESS OR COPY HEALTH INFORMATION form. We may charge you a fee for supplying the requested information. In addition, there are situations in which we may legally need to deny your request. In the event of such a denial, we will notify you of the reasons, and advise you of further steps you may take concerning further review or complaint.
You have the right to ask that we amend health information that we maintain about you if you believe such records are not accurate or complete. Such requests must be made in writing, and may be made by contacting a staff member at any FHN location to obtain a PATIENT REQUEST FOR AMENDMENT OF HEALTH INFORMATION form. If we accept your request, we will append and link such additional or clarifying information to your records. If not, we will notify you of the reasons, and advise you of further steps you may take concerning the disputed information or further complaint.
You have the right to receive an accounting, or listing, of certain types of disclosures of your protected health information made by us and by any business associates we have asked to perform a function on our behalf. However, this right and accounting does not include most routine types of disclosures that are made for health care operations, such as disclosures made for treatment, payment, or health care purposes, to disclosures made to you, to disclosures made pursuant to your written Authorization, to disclosures made for facility directory or to family, friends and persons involved in your care, to disclosures made for national security or intelligence, to disclosures made to correctional institutions or law enforcement officials, or to disclosures that were made prior to 4/14/03. All requests for an accounting of disclosures must be made in writing, and may be made by contacting a staff member at any FHN location to obtain a PATIENT REQUEST FOR ACCOUNTING OF DISCLOSURES form. You may request an accounting for up to the 6-year period prior to your request, and we may charge you for more than one request in any twelve-month period.
You have the right to obtain a paper copy of our Notice of Privacy Practices upon request.
Our Obligations to You
We are required by law to maintain the privacy of your protected health information, to provide you with this Notice explaining our legal duties and privacy practices with respect to your health information, to notify you following a breach of your unsecured health information, and to abide by the terms of this Notice currently in effect.
We may change the terms of our Notice of Privacy Practices, and such changes will apply to all protected health information maintained, including information which was created or received prior to the date of such revised Notice.
In the event we materially change the terms of our Notice of Privacy Practices, we will post any revised Notice at all FHN locations and on our website www.fhn.org and you may obtain a copy of any revised Notice through the office of our Privacy Official.
Concerns or Complaints
We are committed to upholding your privacy rights. If you at any time become concerned that your privacy rights may have been violated or otherwise disagree with a decision concerning access to or the handling of your health information, we ask that you provide us an opportunity to address your concerns by contacting the office of our FHN Privacy Official at 815-599-6000. If you prefer to inquire or make a complaint in writing, you may send such correspondence to the attention of our Privacy Official at FHN, 1045 W. Stephenson St., Freeport, IL, 61032.
You may also send a written complaint to the Secretary of Health & Human Services, 200 Independence Avenue, S.W., Washington, DC 20201 if you believe that your privacy rights have been violated.
You will not be penalized or retaliated against for making such inquiries or complaints.
Contact Person for Further Information
Should you have any questions or you would like further information concerning matters contained in our Notice of Privacy Practices, please contact the office of our FHN Privacy Official at 815-599-6000.
September 23, 2013