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.

Access Community Health Network “ACCESS” is committed to maintaining the privacy and confidentiality of your health information.

This notice explains ACCESS’ privacy practices, as well as your rights regarding your health information. This notice will be followed by ACCESS health centers, its employees, physicians, other health care professionals,
residents, students, and contractors.

HOW ACCESS MAY USE OR DISCLOSE YOUR HEALTH INFORMATION
ACCESS may use and disclose (share) your health information for treatment, payment, and health care operation purposes.

Treatment. ACCESS may use and share your health information with other professionals who are treating you. For example, sharing information with other health care providers involved in your care, or for consultative and referring treatment purposes. Note, however, that we will ask you for written permission to disclose sensitive information.

Payment. ACCESS may use and share your health information to bill and get payment from health plans and other entities. For example, sharing your health information with your health insurance to obtain prior approval for services or to get paid for services provided.

Health care operations. ACCESS may use and share your health information to run our health network, improve your care and contact you when necessary. For example, using your health information for quality assessment and improvement activities, for education and training activities, and for contacting you for appointment reminders.

ACCESS is also allowed, and sometimes required to use or share your information in other ways. ACCESS will have to meet many conditions in the law before sharing your information for these purposes. For more information see:
www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html

Public health and safety. For the purposes of preventing disease, helping with product recalls, reporting adverse reactions to medications, reporting suspected abuse, neglect, or domestic violence; preventing or reducing a
serious threat to anyone’s health or safety.

Research purposes. Your medical information may be used for research purposes in accordance with state and federal law. This may include preparing for a research study, analyzing records as part of a project with Institutional Review Board (IRB) approval of a waiver of authorization, or studies involving decedent information.

Comply with the law. ACCESS will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law.

Organ and tissue donation requests. To organ procurement organizations for the purposes of organ, eye or tissue donation and transplantation.

Coroner, medical examiner, or funeral director requests. As needed to do their job.

Workers’ compensation. For workers’ compensation claims.

Law enforcement. For law enforcement purposes or with a law enforcement official.

Other governmental requests. With health oversight agencies for activities authorized by law. For special government functions such as military, national security, and presidential protective services.
Judicial and administrative proceedings. We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Business associates. With our business associates who provide services for or on our behalf. All our business associates are required to protect the privacy and security of your health information just as we do.

Substance use disorder. Substance use disorder treatment records, or testimony relaying the contend of such records, shall not be used or disclosed in civil, criminal, administrative, or legislative proceedings against the individual unless based on written consent, or a court order after notice and an opportunity to be heard is provided to the individual or the holder of the record. A court order authorizing use or disclosure must be accompanied by a subpoena or other legal requirement compelling disclosure before the requested record is used or disclosed.

Reproductive health. ACCESS is prohibited from using or disclosing reproductive health care information to identify, conduct an investigation or impose liability on a person for the mere act of seeking, obtaining, providing or facilitating reproductive health care, where such health care is lawful under the circumstances it was provided. For example, reproductive health care, such as contraception, is protected by the Constitution. Also, an individual travels to another state to receive reproductive health care, such as an abortion, that is lawful in the state where the health care was provided.

An attestation will be required from certain requestors, when a request for health information is potentially related to reproductive health care, that the use or disclosure is not for a prohibited purpose.

Other sensitive information. The use and disclosure of certain sensitive information may also be further restricted by other federal or state laws. This includes information related to alcohol and substance use disorder, genetics, mental health, and HIV/AIDS.

YOUR CHOICE ABOUT WHAT WE SHARE
For certain health information, you can tell us your choices about what we share.

In these cases, you have both the right and choice to tell us to:

• Share information with your family, close friends or others involved in your care or payment of care.
• Share information in a disaster relief situation.

If you are not able to tell us your preference, for example if you are unconscious, we may proceed and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety. We do not create or manage a Facility Directory.

In these cases, we will never share your information unless you give us written authorization:

• Marketing purposes
• Sale of your information
• Sharing of psychotherapy notes

Fundraising. In the case of fundraising, ACCESS may contact you for fundraising efforts, but you can tell us not to.

Information sharing through our electronic medical record. ACCESS uses an electronic medical record software called Epic, which allows ACCESS to electronically exchange health information with other health care providers including, but not limited to, CareEverywhere® and Carequality®. You have the right to opt-out of the electronic exchange of your health information by contacting the Privacy Officer as described in this notice.

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

YOUR RIGHTS
When it comes to your health information, you have certain rights. This section explains your rights and how to exercise them.

Request restrictions. You may request restrictions on how we use and disclosure your health information for purposes of treatment, payment, and our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.

If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Request confidential communications. You may request us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. We will say “yes” to all reasonable requests. 

Access, inspect and copy. You may request to inspect and obtain an electronic or paper copy of your medical record and other information we have about you. We will provide a copy or a summary of your health information, usually within 30 days of your request.

Request an amendment. You can ask us to correct your health information that you think is incorrect or incomplete.We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request an accounting. You have the right to request a list of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except for those about treatment, payment, and health care operations, and any other disclosures including those you have asked ACCESS to make. We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for an additional within 12 months.

Request a copy of this privacy notice. You have the right to get a copy of this notice electronically via email. If you have agreed to receive this notice via email, you also have the right to request a paper copy of this notice at any time.

Choose someone to act for you. If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure this person has the authority and can act for you before we take any action.

File a complaint if you feel your rights are violated. If you feel ACCESS has violated your rights, please contact us at the information listed at the end of this notice. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by mail: U.S. Department of Health and Human Services Office for Civil Rights 200 Independence Avenue, SW, Washington, DC 20201; by telephone at 1.877.696.6775; or visit www.hhs.gov/ocr/privacy/hipaa/complaints/. ACCESS will not retaliate against you for filing a complaint.

OUR RESPONSIBILITIES
ACCESS is required by law to maintain the privacy and security of your protected health information.

ACCESS will notify you if a breach occurs that may have compromised the privacy or security of your information. 

ACCESS must follow the duties and privacy practices described in this notice and give you a printed copy of this notice.

ACCESS will not use or share your information other than as described here unless you provide authorization in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

ACCESS reserves the right to change the terms of this notice and the changes will apply to all information ACCESS has about you. The new notice will be provided on your next visit, upon request, and will be available on ACCESS’ public website, www.achn.net.

CONTACT INFORMATION
If you wish to exercise your rights as listed in the notice, or have any questions, please contact ACCESS’ Privacy Officer at Access Community Health Network, 600 West Fulton Street, Suite 300, Chicago, IL 60661, Attn: Corporate Compliance Department - Privacy Officer, call the Compliance Hotline at 1.833.221.9955, or submit a report online at achn.navexone.com.

This notice is effective as of 1/1/2025.