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 DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

PLEASE REVIEW IT CAREFULLY.

I. Access Community Health Network (ACCESS) MAY USE OR DISCLOSE YOUR HEALTH INFORMATION
Federal law requires ACCESS to maintain the privacy of individually identifiable health information and to provide you with notice of its legal duties and privacy practices with respect to such information. ACCESS must abide by the terms and conditions of this Privacy Notice and ACCESS may revise this Privacy Notice from time to time.

The January 25, 2013, Omnibus Final Rule requires ACCESS to immediately notify affected individuals of breach of unsecured PHI, but in no case later than 60 days after breach discovery or when the breach should have been known.

A. USES OR DISCLOSURES OF HEALTH INFORMATION FOR TREATMENT, PAYMENT & HEALTH CARE OPERATIONS
ACCESS may use your individually identifiable health information for treatment, payment and health care operations. Examples of treatment, payment and health care operations include:

“Treatment” could include consulting with or referring your case to another health care provider. The type of health information that ACCESS could use or disclose includes, but is not limited to, such health conditions as blood type, diagnosis of your condition or pregnancy status. ACCESS may use or disclose your individually identifiable health information for its own provision of treatment or may disclose such information for the treatment activities of another health care provider.

“Payment” could include ACCESS efforts to obtain reimbursement from you or a responsible third party for services that ACCESS has provided to you.

ACCESS may use or disclose your individually identifiable information for its own payment or for the payment and activities of another health care provider or health plan or health care clearinghouse. Genetic information is protected and most health plans are prohibited from using the information for underwriting purposes.

“Health care operations” could include activities such as quality assessment and improvement activities and audits. As part of ACCESS treatment of you and operation of a health care organization, ACCESS may contact you, by phone or by mail, to provide appointment reminders or to provide information about treatment alternatives or other health-related services that may be of interest to you. ACCESS may also contact you for fundraising purposes.

ACCESS may use or disclose your individually identifiable health information for its own health care operations or for limited health care operations of a health plan, health care clearinghouse, or health care provider that is subject to certain federal health information privacy laws. The entity that receives this information must have or have had a treatment relationship with you and the information we disclose must pertain to that relationship. Limited health care operations include credentialing and training activities, and health care fraud and abuse detection or compliance activities.

B. USES OR DISCLOSURES ACCESS MAY MAKE WITHOUT YOUR AUTHORIZATION
In addition to treatment, payment and health care operations, and unless this Privacy Notice recites a more stringent restriction in Section C, the law permits or requires ACCESS to make, use or disclose individually identifiable health information without your written authorization: (i) for certain public health activities and purposes, including reporting of adverse product events to the Food and Drug Administration, (ii) to report suspected abuse, neglect or domestic violence, (iii) to submit information to health oversight agencies for oversight activities, such as audits, authorized by law, (iv) in the course of judicial and administrative proceedings, (v) for law enforcement purposes, (vi) to a medical examiner, coroner or funeral director, (vii) to assist an organ procurement organization or organ bank in facilitating organ or tissue donation and transplantation, (viii) to further research, provided that ACCESS complies with federal requirements, (ix) to avert a serious and imminent threat to public health safety, (x) for specialized government functions, including activities related to the military, veterans, or national security, (xi) to comply with workers’ compensation or similar laws. ACCESS will make the above uses or disclosures of information in accordance with applicable law.

In addition, ACCESS may use or disclose your individually identifiable health information as follows:

Business Associates: There are some services provided in ACCESS through contracts with business associates which are vendors, professionals and others who perform some treatment, payment or health care operations function on behalf of ACCESS or who otherwise provide services and have access to or use your protected health information. Business Associates may also include entities that maintain or store PHI, even if they do not view the PHI. Examples include physician services in the radiology department, laboratory tests, and a copy service we use when making copies of your health record. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we have asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information by requiring that they enter into an appropriate agreement with ACCESS. The January 25, 2013 Omnibus Final Rule requires Business Associates to immediately notify affected individuals of breach of unsecured PHI, but in no case later than 60 days after breach discovery or when the breach should have been known.

Notification: Unless you object, health professionals, using their best judgment, may use or disclose information to notify or assist in notifying a family member, personal representative, or any person responsible for your care, of your location, and general condition. If you are unable to object, we may exercise our professional judgment to determine if a disclosure is in your best interest and disclose only information that is directly relevant to the person’s involvement with your health care.

Communication with family: Unless you object, health professionals, using their best judgment, may use or disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care. If you are unable to object, we may exercise our professional judgment to determine if a disclosure is in your best interest and disclose only information that is directly relevant to the person’s involvement with your health care. Parents and others can give permission, without difficulty, to share proof of a child’s immunization with schools, and permit access to deceased patients’ information to family members and others.

Information Sharing through our Electronic Medical Record. We use an electronic medical record software called Epic, which has a number of programs that allow ACCESS to electronically exchange medical information with other healthcare providers including but not limited to CareEverywhere® and Carequality®. These programs facilitate the electronic sharing and exchange of medical and other individually identifiable health information among health care providers. Through these programs, we may electronically disclose demographic, medical, billing, and other health-related information about you to other healthcare providers and electronically request such information from them for purposes including but not limited to facilitating or providing treatment, arranging for payment for health care services or otherwise conducting or administering health care operations.

Disaster Relief: We may use or disclose information for disaster relief purposes.

Incidental Uses and Disclosures: We are permitted to use and disclose information incidental to another use or disclosure of your protected health information permitted or required under law.

Limited Data Sets: We may use or disclose a limited data set (i.e., in which certain identifying information has been removed) of your protected health information for purposes of research, public health, or health care operations. Any recipient of that limited data set must agree to approximately safeguard your information.

C. MORE STRINGENT PROTECTION FOR YOUR HEALTH INFORMATION
In certain cases, Illinois law provides more stringent privacy protection of your health information than this Privacy Notice recites above. For example, in some cases, Illinois requires that you provide permission for the use or disclosure of your individually identifiable health information. In those cases, ACCESS must follow the state law even though certain federal health information privacy laws may not require permission. State law provides more stringent protection in the following areas:

If you are a patient with high blood pressure, your physician may not release your medical records to the Illinois High Blood Pressure Registry without your written permission.

If you are a patient of an advanced practice nurse, neither ACCESS nor the nurse may reveal your medical records to the Advanced Practice Nursing Board or the Department of Professional Regulation without your written permission in instances in which (i) the Advanced Practice Nursing Board has taken a final adverse action against the nurse, (ii) the nurse has surrendered his or her license while under disciplinary investigation by the Advanced Practice Nursing Board, or (iii) ACCESS has terminated or restricted the nurse’s organized professional staff clinical privileges for disciplinary violations related to your treatment. However, please note that the nurse or ACCESS may reveal your name or other means of identifying you as a patient without your written permission and may release such information as otherwise described in this Privacy Notice.

If you are a patient who has been subject to artificial insemination with semen donated by a man not your husband, ACCESS may not permit anyone besides you to inspect any papers or records pertaining to the artificial insemination without a court order.

If you are a patient of a podiatrist, ACCESS may not reveal your medical records to the Podiatric Medical Licensing Board without your written permission in instances in which your treatment is the subject of a report concerning a podiatrist who is impaired by reason of age, drug or alcohol abuse or physical or mental impairment and who is under supervision or is in a program of rehabilitation. However, please note that ACCESS may include your name, address and telephone number in its periodic reports to the Podiatric Medical Licensing Board concerning the impaired podiatrist if the Podiatric Medical Licensing Board requires ACCESS to do so and may release such information as this Privacy Notice may otherwise describe.

If you are a patient of a physician, ACCESS may not reveal your medical records to the Medical Disciplinary Board without your written permission in instances in which your treatment is the subject of a report relating to a physician’s professional conduct or capacity, including reports regarding a physician who is impaired by reason of age, drug or alcohol abuse or physical or mental impairment. However, please note that ACCESS may include your name or other means of identifying you in its reports to the Medical Disciplinary Board without your permission and may release such information as this Privacy Notice may otherwise describe. ACCESS may also provide copies of your hospital or medical records in cases involving your death or permanent bodily injury, provided that the law requires ACCESS to report such events to the Department of Professional Regulation, and the Department of Professional Regulation or the Medical Disciplinary Board has subpoenaed such records.

If you are a patient of a physician, the physician may not disclose any information that he or she may have acquired while attending to you in a professional capacity that was necessary to enable him or her to professionally serve you, without your permission, or in the case of your death or disability, without the permission of your personal representative, except that the physician may disclose such information for certain proceedings.

If you are a patient of a physician or other health care provider, either you or your guardian may waive your right to the privacy and confidentiality of your individually identifiable health information. However, if you refuse to do so, the physician or other health care provider may not deny services to you.

If you are or have been a recipient of an HIV test, ACCESS may only disclose your test results in a manner which identifies you to those persons you (or your legally authorized representative) have designated in writing, except that ACCESS may disclose your test results to you or your legally authorized representative or to certain person(s) for certain reasons listed under Section I.B of this Notice. Please note that a recipient of your test results may not disclose this information except as this Privacy Notice may describe.

If you are or have been a recipient of genetic testing, ACCESS may only disclose the genetic testing and information derived from genetic testing to you and to those persons you (or your legally authorized representative) have designated in writing to receive that information, except that ACCESS may disclose the results of your genetic test to (i) you or your legally authorized representative; (ii) persons for certain reasons listed under Section I.B of this Notice; and (iii) your parent or legal guardian if you are a minor under 18 years of age if, in the professional judgment of your health care provider, notification would be in your best interest and your health care provider has first sought unsuccessfully to persuade you to notify your parent or legal guardian, or if your health care provider believes that you have not provided notification to your parent or legal guardian as you had previously agreed. Further, a recipient of your test results may not disclose this information except as the Genetic Information Privacy Act may otherwise allow. The law defines “genetic testing” as “a test of a person’s genes, gene product, or chromosomes for abnormalities or deficiencies, including carrier status, that (i) are linked to physical or mental disorders or impairments, (ii) indicate a susceptibility to illness, disease, impairment, or other disorders, whether physical or mental, or (iii) demonstrate genetic or chromosomal damage due to environmental factors. “Genetic testing” does not include routine physical measurements; chemical, blood and urine analyses that the medical community widely accepts as standard use in clinical practice; tests for use of drugs; and tests for the presence of the human immunodeficiency virus. This paragraph does not apply to results of genetic testing that indicate that you are, at the time of the test, afflicted with a disease, whether or not currently symptomatic.

If you are a minor under 18 years of age who is the recipient of genetic testing, the health care provider who ordered the test may not notify your parent or legal guardian of your test results without your written permission. However, please note that the health care provider may disclose such information to your parent or legal guardian if, in the professional judgment of the health care provider, notification would be in your best interest and the health care provider has first sought unsuccessfully to persuade you to notify your parent or legal guardian, or the health care provider has reason to believe that you have not made the notification as you had previously agreed.

If you are a client of a rape crisis counselor, the rape crisis counselor may not disclose any confidential communications or testify as a witness as to any confidential communications without the written permission of either you or your authorized representative. However, please note that a rape crisis counselor may disclose confidential communications without your written permission if his or her failure to do so would likely result in a clear, imminent risk of serious physical injury or the death of you or another person.

If you are a client of a victim aid organization, no counselor, employee, volunteer or personnel may disclose any statement or the contents of any statement that you make relating to the crime or its circumstances during the course of therapy or consultation without your written permission, unless a court order requires disclosure of that information for a judicial proceeding.

If you are the victim of sexual assault, ACCESS may not release your evidence collection kit to the Illinois State Police without your written permission, or if you are a minor under the age of 13, without the written permission of your parent, guardian, appropriate representative of the Department of Children and Family Services, or an investigating Law Officer.

If you are a victim of a sexual assault and ACCESS takes photographs of your injuries, ACCESS may not release the photographs without your written permission, or if you are a minor, without the written permission of your parent or guardian. If you are a minor and your parent or guardian refuses to grant permission, ACCESS must give all existing photographs and negatives to your parent or guardian.

If you are a resident of a community living facility, a nursing home facility, a skilled nursing or intermediate care facility, an intermediate care facility for the developmentally disabled, a sheltered care facility, or a veterans’ home, ACCESS may not allow any person who is not directly involved in your care to be present during a discussion of your case or health status, a consultation on your condition, or your examination or treatment, without your permission, which may be oral or written. Please note that we interpret “any person who is not directly involved in your care” to mean those individuals other than facility personnel (or contractors) directly responsible for rendering care to you at the facility. Thus, these individuals would include your family members and significant others who are “not directly involved in your care.” These individuals would also include facility personnel not directly involved in the rendering of care, such as the housekeeping staff in most circumstances.

If you are a patient of a home health agency, ACCESS may not allow the Department of Public Health to observe the home health agency’s care of you in your home without your oral or written permission.

If you are a minor under 18 years of age who is the recipient of an HIV test, and a Western Blot Assay or a more reliable test has confirmed that your results are positive, the health care provider who ordered the test may not notify your parent or legal guardian of your test results without your written permission. However, please note that the health care provider may disclose such information to your parent or legal guardian if, in the professional judgment of the health care provider, notification would be in your best interest and the health care provider has first sought unsuccessfully to persuade you to notify your parent or legal guardian, or if the health care provider believes that you have not provided notification to your parent or legal guardian as you had previously agreed.

If you are a minor who has sought counseling regarding your own drug or alcohol abuse, or that of a family member, from a physician who provides diagnosis or treatment or any licensed clinical psychologist or professional social worker with a master’s degree or any qualified employee of (i) an organization that is a licensee or a recipient of funding by the Department of Human Services, or (ii) agencies or organizations operating drug abuse programs that are licensees or recipients of funding by the Federal Government or the State of Illinois or any qualified person who is an employee or works in association with any public or private alcoholism or drug abuse program licensed by the State of Illinois, and you have come into contact with a sexually-transmitted disease, these professionals may not inform your parent, parents, guardian, or other responsible adult of your condition or treatment without your written permission. However, please note that these professionals may disclose such information to your parent, parents, guardian, or other responsible adult without your written permission if such action is, in the person’s judgment, necessary to protect your safety or that of a family member or other individual.

If you are a client of a hearing instrument dispenser, ACCESS may not allow the Department of Public Health to inspect your client records without the written permission of you or your guardian.

If you are a resident of a long-term care facility for persons under the age of 22, ACCESS may not allow any person who is not involved in your care to be present during a discussion of your health status, a consultation on your condition, or your examination or treatment, without your permission, which may be oral or written.

If you are a client of a clinical psychologist, the psychologist may not disclose any information he or she may have acquired while attending to you in a professional capacity if the psychologist did not ensure that you understood the possible uses or distributions of the information and without your permission, or in the case of your death or disability, without the permission of your personal representative, except that the clinical psychologist may disclose such information for certain proceedings.

If you are a recipient of mental health or developmental disability services, ACCESS may not disclose your mental health or developmental disability information (not including personal/psychotherapy notes) without your written permission except to persons for certain reasons listed under Section I.B of this Notice. With respect to certain of the exceptions listed in Section I.B., Illinois law only permits limited mental health or developmental disability information to be disclosed.

If you are a minor of at least 12 years of age but under 18 years of age who receives mental health or developmental disability services, your parent or guardian may inspect and copy your records if you are informed and do not object or if the therapist does not find that there are compelling reasons to deny access. Should your parent or guardian be denied access by either you or the therapist, your parent or guardian may petition a court for access.

If you are a client of a clinical social worker, the social worker may not disclose any information he or she may have acquired while attending to you in a professional capacity without your written permission, except (i) in the course of reporting, conferring or consulting with administrative supervisors, colleagues or consultants who share professional responsibility, (ii) in the case of your death or disability, with the written permission of your personal representative, to a person with authority to sue on your behalf, or the beneficiary of an insurance policy on your life, health or physical condition; (iii) when a communication reveals that you intend to commit certain crimes or harmful acts; (iv) when you waive the privileged nature of communication by bringing public charges against the social worker; or (v) when the social worker acquires the information during an elder abuse investigation.

If you are a client of a clinical licensed professional counselor, licensed clinical professional counselor, marriage and family therapist or associate marriage and family therapist, the counselor or therapist may not disclose any information he or she may have acquired while attending to you in a professional capacity without your written permission, except (i) in the course of reporting, conferring or consulting with administrative supervisors, colleagues or consultants who share professional responsibility; (ii) in the case of your death or disability, with the written permission of your personal representative, to a person with authority to sue on your behalf, or the beneficiary of an insurance policy on your life, health or physical condition; (iii) when a communication reveals that you intend to commit certain crimes or harmful acts; or (iv) when you waive the privileged nature of communication by bringing public charges against the counselor or therapist. NOTE: References in this Privacy Notice to health care professionals include only those professionals employed or contracted by ACCESS.

D. MARKETING AND FUNDRAISING
We will need your written authorization to use and disclose your limited PHI for marketing and fundraising purposes, except if the marketing is a face-to-face communication or if it involves a promotional gift of nominal value. The sale of an individual’s health information is prohibited without their permission. “Marketing” includes a communication about a product or service that encourages you to purchase or use the product or service. It also includes an arrangement whereby ACCESS discloses your PHI to another entity, in exchange for compensation, and the other entity communicates about its own product or service to encourage purchase or use of that product or service. Marketing does not include our describing a health-related product or service (or payment for such product or service) that we provide. Marketing also does not include our communication regarding your treatment, or to direct or recommend to you alternative treatments, therapies, health care providers, or settings of care.

E. NO OTHER USES OR DISCLOSURES WITHOUT YOUR WRITTEN AUTHORIZATION
ACCESS may not make any other uses and disclosures of your individually identifiable health information without your written authorization. You may revoke your authorization at any time if you provide ACCESS with a written notice.

II. YOUR RIGHTS
Federal and state laws protect your right to keep your individually identifiable health information private. Your Right to Receive Confidential Communications and to Request Restrictions. You may request that you receive communications from ACCESS regarding individually identifiable health information by alternative means or at alternative locations. You must make your request for confidential communications in writing and must submit this request to the office listed below. ACCESS reserves the right to condition your request on the receipt of information regarding how you desire ACCESS to handle payment and on the availability of an alternative address or method of contact that you may request. You may request other restrictions on certain uses and disclosures of protected health information for purposes of treatment, payment, and health care operations; however, the law does not require ACCESS to agree to the requested restrictions unless the restriction request is a reasonable restriction on communication.

When individuals pay out-of-pocket, in full, they can instruct their provider not to share information about their treatment with their health plan.

Your Right to Inspect and Copy. You generally have the right to inspect and obtain a copy of any protected health information in your medical record, with the exception of psychotherapy notes, information compiled in anticipation of use in a civil, criminal, or administrative proceeding and certain other health information which the law restricts ACCESS from disseminating. The patient may receive electronic copies of their health information within 3 business days. However, if you are a patient of certain types of providers or facilities, you may have a right to access your patient records or information on an unqualified basis. Specifically, the following:

If you are a patient at a facility that performs mammograms, you have the right to access your original mammograms and copies of your patient reports on an unqualified basis.

If you are a patient of a naprapath or acupuncturist, you have the right to access your patient records on an unqualified basis, upon written request.

If you are a patient of a hospital, you have the right to access your patient records on an unqualified basis, upon written request.

If you are a patient of a physician, you have the right to access your medical data on an unqualified basis upon request.

If you are a resident of a community living facility, you have the unqualified right to inspect and copy your clinical records that the facility or your physician maintains.

If you are a resident of a facility that provides intermediate care for the developmentally disabled, you have the unqualified right to inspect and copy all of your clinical and other records concerning your care, to the extent that the facility maintains such records.

If you are a resident of a nursing home, you have the unqualified right to obtain from your physicians, or the physicians attached to the facility, complete and current information concerning your medical diagnosis, treatment and prognosis in terms and language that you can reasonably be expected to understand. You, and your guardian or parent if you are a minor, also have the unqualified right to inspect and copy your clinical records or other records concerning your care that the nursing home or your physician maintains.

If you are a resident of a sheltered care facility, you have the unqualified right to obtain from your physicians, or the physicians attached to the facility, complete and current information concerning your medical diagnosis, treatment and prognosis in terms and language that you can reasonably be expected to understand. You, and your parent or guardian if you are a minor, also have the unqualified right to inspect and copy your medical records that the facility or your physician maintains.

If you are a resident of a veterans’ home, you, and your parent or guardian if you are a minor, have the unqualified right to inspect and copy your medical records that the facility or your physician maintains.

If you are a resident of a skilled nursing facility or an intermediate care facility, you have the unqualified right to obtain from your physicians, or the physicians attached to the facility, complete and current information concerning your medical diagnosis, treatment and prognosis in terms and language that you can reasonably be expected to understand. You, and your guardian or representative or parent if you are a minor, also have the unqualified right to inspect and copy your medical records that the facility or your physician maintains.

If you are a resident of a supportive residence, you, and your guardian or representative or parent if you are a minor, have the unqualified right to inspect and copy your medical records that the facility or your physician maintains.

If you are a resident of an assisted living or shared housing establishment, you have an unqualified right to access your personal files that the establishment maintains.

If you are a resident of a long-term care facility for persons under the age of 22, you have the unqualified right to obtain from your physicians, or the physicians attached to the facility, complete and current information concerning your medical diagnosis, treatment and prognosis in terms and language that you can reasonably be expected to understand. You, and your guardian or representative or parent if you are a minor, also have the unqualified right to inspect and copy your clinical records and other records concerning your care that the facility or your physician maintains.

If you are a resident of a board and care home, you have the unqualified right to access your records that the establishment maintains as those records relate to your quality of life in the board and care home.

If you are a resident of a supportive living facility, you have the unqualified right to access your records.

If you are a recipient of mental health or developmental disabilities services and if you are age 12 or older, you have an unqualified right to inspect and copy your records. The following persons also have this right: (i) your guardian if you are age 18 or older; (ii) an appointed agent under a power of attorney for health care which authorizes record access; (iii) your parent or guardian if you are under age 12; (iv) your parent or guardian if you are, at least, age 12 but under age 18 and if certain conditions are satisfied; and (v) a guardian ad litem representing you in any judicial or administrative proceeding if you are age 12 or older.

Your Right to Amend. You also have the right to amend your individually identifiable health information, unless ACCESS did not create such information or unless ACCESS determines that your medical record is accurate and complete in its existing form.