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.
This Notice is effective as of: April 15, 2013
Inspera Health and its affiliated network providers located in and outside of the United States respect patient confidentiality and only release medical information about you in accordance with federal and state laws. This notice describes our policies related to the use of the records of your care generated by Inspera Health. With some exceptions, we use or disclose only portions of your health information that are necessary to satisfy the need for which the information is being used or disclosed.
Privacy Contact. If you have any questions about this policy or your rights, please contact the Inspera Health Privacy Officer at email@example.com. In order to effectively provide you care, there are times when we will need to share your medical information with others beyond our practice. This includes:
- Treatment. We may use or disclose medical information about you to provide, coordinate, or manage your care or any related services, including sharing information with others outside our practice that we are consulting with or referring you to.
- Payment. Information will be used 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; training staff; conducting quality assessment and improvement activities; performing licensing, accreditation, or certification activities; and conducting or arranging for auditing functions, including fraud and abuse detection.
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.
- Governmental Requirements. We may disclose information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, and licensure. 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.
- 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 someone.
- Health Care Operations. Inspera Health is allowed to disclose your health information to its “business associates,” meaning individuals or companies that provide services to Inspera Health. This includes billing companies, software vendors, attorneys, and other service providers. Inspera Health requires that all business associates appropriately safeguard your information.
You have the following rights under state and federal law:
- Copy of Record. You are entitled to inspect the medical record our practice 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. You may revoke this consent at any time, but only to the extent no action has been taken in reliance on your prior authorization.
- Restriction on Record. You may ask us not to use or disclose part of the medical information. This request must be in writing. Inspera Health is not required to agree to your request if we believe it is in your best interest to permit use and disclosure of the information. The request should be submitted to Inspera Health Privacy Officer at firstname.lastname@example.org.
- 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. We also will be glad to provide you information by email if you request it. If you wish us to communicate by email you are also entitled to a paper copy of this privacy notice.
- Amending Record. If you believe that something in your record is incorrect or incomplete, you may request we amend it. To do this, contact Inspera Health Privacy Officer at email@example.com 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 our response will be added to your record.
- Accounting for Disclosures. You may request an accounting of any disclosures we have made related to your medical information (except for information we used for treatment, payment, or health care operations purposes), information that we shared with you or your family, or information that you gave us specific consent to release (including, but not limited, to information released pursuant to a property executed Authorization). It also excludes information we were required to release.
- Questions. If you have any questions, would like a copy of this Policy, or have any concerns you would like to discuss, please contact Inspera Health Privacy Officer at firstname.lastname@example.org.
- Complaints. If you believe that Inspera Health has violated your privacy rights, or you disagree with any action we have taken with regard to your health information, you may file a complaint with Inspera Health or contact the Secretary of Health and Human Services. We will not retaliate against you for filing a complaint. You also may contact the Secretary of Health and Human Services if you believe we have violated your privacy rights. We will not retaliate against you for filing a complaint.