Main: 815.398.9491 | Ortho Express: 779 .771.7000

Privacy Policy

Notice of Health Information Practices – OrthoIllinois, Clinic and Rehabilitation

NOTICE OF HEALTH INFORMATION PRACTICES

OrthoIllinois Clinic and Rehabilitation

This notice describes how information about you may be used and disclosed and how you can get access to this information. Please review carefully.

Introduction

At OrthoIllinois we are committed to treating and using protected health information about you responsibly. This Notice of Privacy Practices describes the personal information we collect, and how and when we use or disclose that information. It also describes your rights as they relate to your protected health information. This Notice is effective September 1, 2013, and applies to all protected health information as defined by federal regulations. We are required to abide by the terms of our Notice that is currently in effect.

Understanding Uses and Disclosures

Uses And Disclosures We May Make Without Written Authorization. We may use or disclose your health information for certain purposes without your written authorization, including the following:

Treatment. We may use or disclose your information for purposes of treating you. For example, we may disclose your information to another health care provider so they may treat you; to provide appointment reminders; or to provide information about treatment alternatives or services we offer.

Payment. We may use or disclose your information to obtain payment for services provided to you. For example, we may disclose information to your health insurance company or other payer to obtain reauthorization or payment for treatment.

Healthcare Operations. We may use or disclose your information for certain activities that are necessary to operate our practice and ensure that our patients receive quality care. For example, we may use information to train or review the performance of our staff or make decisions affecting the practice.

Other Uses or Disclosures. We may also use or disclose your information for certain other purposes allowed by 45 CFR § 164.512 or other applicable laws and regulations, including the following:

  • To avoid a serious threat to your health or safety or the health or safety of others.
  • As required by state or federal law such as reporting abuse, neglect or certain other events.
  • As allowed by workers compensation laws for use in workers compensation proceedings.
  • For certain public health activities such as reporting certain diseases.
  • For certain public health oversight activities such as audits, investigations, or licensure actions.
  • In response to a court order, warrant or subpoena in judicial or administrative proceedings.
  • For certain specialized government functions such as the military or correctional institutions.
  • For research purposes if certain conditions are satisfied.
  • In response to certain requests by law enforcement to locate a fugitive, victim or witness, or to report deaths or certain crimes.
  • To coroners, funeral directors, or organ procurement organizations as necessary to allow them to carry out their duties.

Disclosures We May Make Unless You Object. Unless you instruct us otherwise, we may disclose your information as described below.

• To a member of your family, relative, friend, or other person who is involved in your healthcare or payment for your healthcare. We will limit the disclosure to the information relevant to that person’s involvement in your healthcare or payment.

Uses and Disclosures With Your Written Authorization. Other uses and disclosures not described in this Notice will be made only with your written authorization, including most uses or disclosures of psychotherapy notes; for most marketing purposes; or if we seek to sell your information. You may revoke your authorization by submitting a written notice to the Privacy Contact identified below. The revocation will not be effective to the extent we have already taken action in reliance on the authorization.

Your Health Information Rights

You have the following rights concerning your health information. To exercise any of these rights, you may have to submit a written request to the Privacy Officer:

  • You may request additional restrictions on the use or disclosure of information for treatment, payment or healthcare operations. We are not required to agree to the requested restriction except in the limited situation in which you or someone on your behalf pays for an item or service in advance, and you request that the information which concerns such item or service not be disclosed to a health insurer.
  • We normally contact you by telephone or mail at your home address. You may request that we contact you by alternative means or at alternative locations. We will accommodate reasonable requests.
  • You may inspect and obtain a copy of records that are used to make decisions about your care or payment for your care, including an electronic copy. We may charge you a reasonable cost-based fee for providing the records. We may deny your request under limited circumstances, for example, if we determine that disclosure may result in harm to you or others.
  • You may request that your protected health information be amended. We may deny your request for certain reasons, for example, if we did not create the record or if we determine that the record is accurate and complete.
  • You may receive an accounting of certain disclosures we have made of your protected health information. You may receive the first accounting within a 12-month period free of charge. We may charge a reasonable cost-based fee for all subsequent requests during that 12-month period.
  • You may obtain a paper copy of this Notice upon request. You have this right even if you have agreed to receive the Notice electronically.

Our Responsibilities

  • We are obligated to maintain the privacy of the protected health information entrusted to us.
  • We reserve the right to change the terms of this Notice at any time, and to make the new Notice effective for all protected health information that we maintain.
  • If we materially change our privacy practices, we will post a copy of the current Notice in our reception area and on our website. You may obtain a copy of the operative Notice from our receptionist or Privacy Officer.
  • We will not use or disclose your health information without authorization, except as described in this notice.
  • We will also stop using or disclosing your health information after we have received a written revocation of the authorization from you, according to the procedures included in the authorization.
  • We will notify affected individuals following the breach of unsecured health information.

For More Information or to Report a Problem

If you have questions and would like additional information, please contact the practice at 815-398-9491.

If you believe your privacy rights have been violated, you can file a complaint with the practice’s Privacy Officer at the phone number above or with the Office for Civil Rights, US Department of Health and Human Services. There will be no retaliation for filing a complaint with either the Privacy Officer or the Office for Civil Rights. The address for the OCR is listed:

Office for Civil Rights

U.S. Department of Health and Human Services

200 Independence Avenue, S.W.

Room 506F, HHH Building

Washington, DC 20201

Notice of Health Information Practices – Surgery Center, LLC

TO: NOTICE OF HEALTH INFORMATION PRACTICES

Surgery Center

This notice describes how information about you may be used and disclosed and how you can get access to this information. Please review carefully.

Introduction
At OrthoIllinois Surgery Center, we are committed to treating and using protected health information about you responsibly. This Notice of Heath Information Practices describes the personal information we collect, and how and when we use or disclose that information. It also describes your rights as they relate to your protected health information. This Notice is effective January 1, 2003, and applies to all protected health information as defined by federal regulations.

Understanding Your Health Record/Information
Each time you visit OrthoIllinois Surgery Center, a record of your visit is made. Typically this record contains your symptoms, examination, and test results, diagnoses, treatment and a plan for future care of treatment. This information, often referred to as your health or medical record, serves as:

  • A basis for your care and treatment,
  • A means of communication,
  • A legal document describing the care you received,
  • A means by which you or a third-party payer can verify that services billed were actually provided,
  • A tool in educating health professionals,
  • A source of information for public health officials charged with improving the health of this state and the nation,
  • A source of data for our planning and marketing,
  • A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve.

Understanding what is in your record and how your health information is used helps you to: ensure its accuracy; better understand who, what, when, where, and why others may access your health information; and make more informed decisions when authorizing disclosure to others.

Your Health Information Rights
Although your health record is the physcial property of OrthoIllinois Surgery Center, the information belongs to you. You have the right to:

  • Obtain a paper copy of this notice of information practices upon request, for a charge,
  • Inspect and copy your health record as provided for in 45CFR 164.524,
  • Amend your health record as provided in 45 CFR 164.528,
  • Obtain an accounting of your health information as provided in 45 CFR 164.528
  • Request communications of your health information by alternative means or at alternative locations
  • Request a restriction on certain uses and disclosures of your information as provided by 45 CFR 164.522, and
  • Revoke your authorization to use of disclose health information except to the extent that action has already been taken.

Our Responsibilities
OrthoIllinois Surgery Center is required to:

  • Maintain the privacy of your health information,
  • Provide you with this notice as to our legal duties and privacy practices with respect to information we collect and maintain about you,
  • Abide by the terms of this notice,
  • Notify you if we are unable to agree to requested restriction and,
  • Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will mail a revised notice to the address you’ve supplied us, or if you agree, we will email the revised notice to you.

We will not use or disclose your health information without authorization, except as described in this notice. We will also discontinue to use or disclose your health information after we have received a written revocation of the authorization according to the procedures included in the authorization.

For More Information or to Report a Problem
If you have questions and would like additional information, please contact the practice at 815-484-6992. If you believe your privacy rights have been violated, you can file a complaint with the practice’s Privacy Officer, or the Office for Civil Rights, US Department of Health and Human Services. There will be no retailiation for filing a complaint with either the Privacy Officer or the Office for Civil Rights. The address for the OCR is listed:

Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 506F, HHH Building
Washington, DC 20201

Examples of Disclosures for Treatment, Payment and Health Operations

We will use your health information for treatment.

For example: Information obtained by a nurse, physicians, or other member of your health care team will be recorded in your record and used to determine the course of treatment that should work best for you. Your physician will document in your health record his or her expectations of the members of your health care team. Members of your health care team will then record the actions they took and their observations. In that way, the physician will know how you are responding to treatment.

We will also provide your physician or subsequent health care provider with copies of various reports that should assist him or her in treating you once you are discharged from this practice’s care.

We will use your health information for payment.

For Example: A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.

We will use your health information for regular health operations.

For example: Members of the medical staff, the risk or quality improvement manager, or members of the quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the health care and service we provide.

Business Associates: There are some services provided in our organization through contracts with business associates. Examples include physician services in the emergency department and radiology, and certain laboratory tests. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we’ve 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.

Communication with Family: Health professionals, using their best judgement, may disclose to a family member, or other relative, close personal friend or any other person you identify, health information relevent to that person’s involvement in your care or payment related to your care.

Marketing: We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements product and product defects, or post-marketing surveillance information to enable product recalls, repairs or replacements.

Workers’ Compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers’ compensation or other similar programs established by law.

Public Health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury or disability.

Correctional Institution: Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health and safety of other individuals.

Law Enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.

Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work-force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one of more patients, workers or the public.

Notice of Privacy Policies Effective 5/04/07.

OrthoIllinois Surgery Center
(815) 381-7400
www.orthoillinois.com
346 Roxbury Road
Rockford, IL 61107

© OrthoIllinois, formerly known as Rockford Orthopedic Associates 2017