Privacy Policy

NOTICE OF PRIVACY PRACTICES (Effective Date: April 14, 2003)


We respect client confidentiality and only release information about you in accordance with state and federal laws. This notice describes our policies related to the use of the records of your care generated by this agency.

PRIVACY CONTACT: If you have any questions about this policy or your rights, contact the Director of Operations at 217-342-5502, extension 1017.

Use and Disclosure of Protected Health Information

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

  • Treatment. We may use or disclose 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 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 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 disease or suspected abuse and neglect such as child abuse, elder abuse, or institutional abuse.
  • Coroners, Funeral Directors, and Organ Donation. We may disclose 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.
  • 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 health care services, we need assistance in raising money to carry out our mission. We reserve the right to contact you if we choose to seek donations.

Patient Rights

You have the following rights under Illinois and federal law:

  • Copy of Record. You are entitled to inspect your 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. 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 information. This request must be in writing. The agency 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 given to the Privacy Contact.
  • Contacting You. You may request that we send information to another address or by alternative means. We will honor such requests 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 something 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 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 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 our Privacy Contact. We will notify you of the cost involved in preparing this list.
  • Questions and Complaints. If you have any questions, or wish a copy of this Policy or have any complaints, you may contact our 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.
  • 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.

Release of HIV Information

All information concerning HIV status provided or obtained will be held in strictest confidence as outlined by the Illinois AIDS Confidentiality Act.