NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW PROTECTED HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Effective Date: April 14, 2003
We respect client confidentiality and only release protected health information about you in accordance with the Illinois and federal law. This notice describes our policies related to the use of the records of your care generated by Pioneer Center.
Privacy Contact. If you have any questions about this policy or your rights contact the Privacy Contact, (815) 344-1230 or firstname.lastname@example.org.
This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. This Notice also describes your rights regarding protected health information we maintain about you and a brief description of how you may exercise these rights. This Notice further states the obligations we have to protect your health information.
“Protected health information” (PHI) means protected health information (including identifying information about you) we have collected from you or received from your health care providers, health plans, your employer or a health care clearinghouse. It may include information about your past, present or future physical or mental health or condition, the provision of your health care, and payment for your health care services.
We are required by law to maintain the privacy of your protected health information and to provide you with this notice of our legal duties and privacy practices with respect to your protected health information. We are also required to comply with the terms of our current Notice of Privacy Practices.
USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION
In order to effectively provide you care, there are times when we will need to share your protected health information with others outside our agency. We will obtain your written consent to do so. This includes:
Treatment. We may use or disclose protected health information about you to provide, coordinate, or manage your care or any related services, including sharing information with others outside our agency that we are consulting with or referring you to.
Payment. Information will be used or disclosed to obtain payment for the treatment and services provided. This will include contacting your health insurance company for prior approval of planned treatment or for billing purposes.
Healthcare Operations. We may use information about you to coordinate our business activities. This may include setting up your appointments, reviewing your care, and/or training staff.
Information Disclosed Without Your Consent. Under Illinois and federal law, information about you may be disclosed without your consent in the following circumstances:
Emergencies. Sufficient information may be shared to address the immediate emergency you are facing.
Follow Up Appointments/Care. We will be contacting you to remind you of future appointments or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
As Required by Law. This would include situations where we have a subpoena, court order, or are mandated to provide public health information, such as communicable diseases or suspected abuse and neglect such as child abuse, elder abuse, or institutional abuse.
Coroners, Funeral Directors, and Organ Donation. We may disclose protected health information to a coroner or medical examiner and funeral directors for the purposes of carrying out their duties. When organs are donated sufficient information will be provided to the program as necessary to facilitate the organ or tissue donation.
Governmental Requirements. We may disclose information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections and licensure. There also might be a need to share information with the Food and Drug Administration related to adverse events or product defects. We are also required to share information, if requested with the Department of Health and Human Services to determine our compliance with federal laws related to health care. If you are a member of the armed forces, we may disclose your protected health information as required by military command authorities, or to determine your eligibility for benefits provided by the Department of Veteran Affairs.
Criminal Activity or Danger to Others. If a crime is committed on our premises or against our personnel we may share information with law enforcement to apprehend the criminal. We also have the right to involve law enforcement when we believe an immediate danger may occur to yourself or others.
Fundraising. As a non-profit provider of health care services we need assistance in raising money to carry out our mission. We may contact you to seek a donation. If you do not want us to contact you for fundraising purposes, you must notify the Privacy Contact in writing. Please state clearly that you do not want to receive any fundraising solicitations from us.
Research. We may disclose your protected health information with your consent to researchers when their research has been approved by an Institutional Review Board or a similar privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.
Uses and disclosures not described above in this Notice of Privacy Practices will only be made with your written permission, called a “release”. You have the right to revoke a release at any time. If you revoke your release we will not make any further uses or disclosures of your health information under that release, unless we have already taken an action relying upon the uses or disclosures you previously authorized.
You have the following rights under Illinois and federal law:
Copy of Record. You are entitled to inspect the client record our agency has generated about you. We may charge you a reasonable fee for copying and mailing your record.
Release of Records. You may consent in writing to release your records to others, for any purpose you choose. This could include your attorney, employer, or others who you wish to have knowledge of your care. Your release must be specific as to the protected health information to be released. You may revoke this consent at any time, but only to the extent no action has been taken in reliance on your prior authorization.
Contacting You. You may request that we send information to another address or by alternative means. We will honor such request as long as it is reasonable and we are assured it is correct. We have a right to verify that the payment information you are providing is correct.
Amending Record. If you believe that information in your record is incorrect or incomplete, you may request we amend it. To do this contact the Privacy Contact and ask for the Request to Amend Health Information form. In certain cases, we may deny your request. If we deny your request for an amendment you have a right to file a statement that you disagree with us. We will then file our response and your statement and these documents will be added to your record.
Accounting for Disclosures. You may request an accounting of any disclosures we have made related to your protected health information, except for information we used for treatment, payment, or health care operations purposes or that we shared with you or your guardian, or information that you gave us specific consent to release. It also excludes information we were required to release. To receive information regarding any disclosures made for a specific time period no longer than six years and after April 14, 2003, please submit your request in writing to the Privacy Contact.
Questions and Complaints. If you have any questions, wish a copy of this policy or have any complaints you may contact the Privacy Contact in writing at our office for further information. You also may complain to the Secretary of Health and Human Services if you believe our agency has violated your privacy rights. We will not retaliate against you for filing a complaint.
Office for Civil Rights U.S. Department of Health and Human Services 200 Independence Avenue, S.W. Room 509F, HHH Building Washington, D.C. 20201 OCR Hotlines-Voice: 1-800-368-1019 Website: http://www.hhs.gov/ocr/
Pioneer Center for Human Services has created this privacy statement in order to demonstrate our firm commitment to privacy. The following discloses our information gathering and dissemination practices for this website.
We will not give or sell a donor’s contact information including their email address.
This site contains links to other sites including affiliated organizations, sponsor companies and others, and Pioneer Center is not responsible for the privacy practices or the content of such websites.
Our site uses donation forms from donors to support our program. We collect the donor’s contact information (like their email address). Contact information from the order form is used to send acknowledgements, donation receipt letters, and information about Pioneer Center to our donors. The donor’s contact information is also used to get in touch with them when necessary. Credit Card information that is collected is used to charge the user donations. It is never divulged to any outside party.
This site is run on a secure server and has security measures in place to protect the loss, misuse and alteration of the information under our control.
This site gives users the following options for removing their information from our database to not receive future communications. You can send email to email@example.com or you can mail your opt-out request to:
4001 Dayton Street, McHenry, IL 60050
You can also call the following telephone number: 815.344.1230.
We do not send emails to people that do not have a relationship with our organization. This relationship can start in the following ways:
- Opted in to one of our email lists either at one of our sites or one of our partner sites.
- Made a donation to one of our programs.
- Purchased a ticket for one of our events.
- Entered a drawing or contest either online or in-person at a live event contacting the website.
If you have any questions about this privacy statement, the practices of this site, or your dealings with this website, you can contact:
Pioneer Center for Human Services
4001 Dayton Street, McHenry, IL 60050