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"The Effort And Determination Of A Few Have Led To A Lifetime Of Hope For Many"

Evadeen Coleman
Coleman Tri-County Services




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Privacy Policy

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NOTICE OF PRIVACY PRACTICE


THIS NOTICE DESCRIBES HOW MEDICAL / REHABILITATION 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 individual confidentiality and only release medical information about you in accordance with the Illinois and federal law. This notice describes our polices related to the use of the records of your care generated by this practice.

Privacy Contact: If you have any questions about this policy or your rights, please contact your Program Director.



USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION

In order to effectively provide you care, there are times when we will need to share medical information with others beyond our agency. This includes information for:

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 another outside our agency 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 billing to the Department of Human Services of Illinois.

Healthcare Operations: We may use information about you to coordinate our agency activities. This may include setting up your staffings, reviewing your chart, and 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 Appointment / Care: We will contact you to remind you of future appointments or information about treatment alternatives or 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 Donations: We may disclose medical information to a coroner or medical examiner and funeral directors for the purpose 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 or rehabilitation.

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.

Fundraising: As a not for profit provider of rehabilitation services, we need assistance in raising money to carry out our mission. We may contact you to seek a donation.



INDIVIDUAL RIGHTS

You have the following rights under Illinois and federal law:

Copy of Record: You are entitled to inspect your case record our agency has generated about you. We may charge you a reasonable fee for copying and mailing your record.

Release of Record: You may consent in writing to release you 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 of Record: 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 mailing address information you are providing is correct.

Amending Record: If you believe that something in your record is incorrect or incomplete, you may request we amend it. To do this, contact your Program Director, 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 the right to file a statement 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 or that we shared with you or your family, or information that you gave us specific consent to release. It also excludes information we were required to release. To receive information regarding disclosure made for a specific time period no longer than six years and after April 14, 2003, please submit your request in writing to your Program Director. We will notify you of the cost involved in preparing this list.

Questions and Comments: If you have any questions, or with a copy of this Policy or have any complaints, you may contact your Program Director in writing at our office for further information. You may also 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.

Changes in Policy: The Agency reserves the right to change its Privacy Policy based on the needs of the Agency and changes in state and federal law.

NOTE: See the Agency Personnel Policies for further rights and Grievance Procedures.

Coleman Tri-County Services, Inc, abides by the Confidentiality Act of 1979.



RIGHTS OF INDIVIDUALS

Individuals have a right to adequate notice of the uses and disclosures of Personal Health Information (PHI) that may be made by Coleman Tri-County Services, Inc. and of the individualís rights and Coleman Tri-County Services, Inc.ís legal duties with respect to protected health information.

This Notice of Privacy Practices summarizes all the rights of the Individual related to his identifiable health information.

The individual has the following rights:

1. Right to Request Restrictions of Uses and Disclosures of PHI. Coleman Tri- County Services, Inc. must permit an individual to request that Coleman Tri-County Services, Inc. restrict the following:
(a.) Uses or disclosures of PHI to carry out treatment, payment, or health care operations.
(b.) Listing an individual in its directory of individuals in the Agency. (The person has the right to object to this information being shared with clergy.)
(c.) Sharing information with the individualís family member, relative, or close personal friend.

Coleman Tri-County Services, Inc. is not required to agree to that above restriction, but if it does, it may not use PHI in violation of such restriction except for emergency treatment.

2. To request to receive communications of PHI by alternative means or at alternative locations. This must be permitted if the individual clearly states that the disclosure of all or part of that information could endanger the individual. Coleman Tri-County Services, Inc. can condition the provision of a reasonable accommodation on assurances of how payment will be handled for the communication of information.

3. Right of copy of record. This right currently exists for all individuals under various Illinois statues, including those seeing general health care providers, receiving specialized care for mental health, substance abuse, or AIDS treatment. An individualís access may be denied if the PHI was obtained from someone other than another provider under a promise of confidentiality and the access requested would be reasonably likely to reveal the source of the information.

4. Denial of Access. Although there are various circumstances where HIPAA allow the Provider access to deny, these provisions are preempted by Illinois law, which allows the individual access to his (or her) record in almost all circumstances.

5. Timely Access. Under HIPAA, copies of records are to be provided within 30 days.

6. Right to Amend PHI. The individual has a right to have the Agency amend PHI as long as it is maintained in the designated record set. The Agency can deny making the amendment based on :
(a.) The record was not created by the Agency, or
(b.) The information is not part of the designated record set, or
(c.) The information is accurate and complete.

The Agency is to act within 60 days of the request of the Request for Amendment of Record Form. The Agency can deny an amendment. The individual can disagree with the denial, and then submit a statement, and Agency can submit a rebuttal statement, and the Agency can submit rebuttal statement. This can all become a part of the record.

Generally, if the individual is disputing something in his (or her) record, and it is questionable, then the Agency should include in the record the individualís comments and make that part of the record. If Coleman Tri-County Services, Inc. accepts amending the record, then the Agency should also notify others identified by the individual as having received the PHI and needing the amendment.

7. Accounting for Disclosures of PHI. The individual has a right to receive an account of the disclosures made of his PHI for a period of six years prior to the date the accounting is requested. This does not include giving an accounting when the disclosures were for:
(a.) Used to carry out treatment, payment, and services provided operations.
(b.) Release due to a patientís authorization.
(c.) To persons involved in the individualís care.
(d.) That occurred prior to the compliance date for Coleman Tri-County Services, Inc.
(e.) Disclosures that are part of a limited data set.
(f.) Disclosures that are merely incidental to another permissible use disclosures.

The six years begin to run forward starting with the effective date of April 14, 2003 or the first date of program service provide after April 14, 2003.

The accounting must include the date of the disclosure and who it was released to and a brief description of the PHI that was disclosed. This will be kept in the HIPAA file.



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