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SOUTH
SHORE HOSPITAL
PRIVACY
POLICY
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.
HOW SOUTH SHORE HOSPITAL MAY USE OR DISCLOSE YOUR HEALTH INFORMATION
Federal
law requires South Shore Hospital 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. South Shore Hospital must
abide by the terms and conditions of this Privacy Notice,
as South Shore Hospital may revise this Privacy Notice from
time to time.
A.
USES OR DISCLOSURES OF HEALTH INFORMATION FOR TREATMENT, PAYMENT
& HEALTH CARE OPERATIONS
South
Shore Hospital 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
South Shore Hospital could use or disclose includes, but is
not limited to, such health conditions as blood type, diagnosis
of your condition or pregnancy status. South Shore Hospital
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 South Shore Hospital’s efforts to obtain
reimbursement from you or a responsible third party for services
that South Shore Hospital has provided to you. South Shore
Hospital 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.
“Health
care operations” could include activities such as quality
assessment and improvement activities and audits of the process
of billing you or a third party for health care services South
Shore Hospital provides to you. As part of South Shore Hospital’s
treatment of you and operation of a health care organization,
South Shore Hospital 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. South Shore Hospital may also
contact you for fundraising purposes. South Shore Hospital
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 which 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 various
quality assessment and improvement activities, credentialing
and training activities, and health care fraud and abuse detection
or compliance activities.
B.
USES OR DISCLOSURES SOUTH SHORE HOSPITAL 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 South Shore Hospital
to make, use and/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 South Shore Hospital 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. South Shore Hospital will make the above
uses and/or disclosures of information in accordance with
applicable law.
In addition,
South Shore Hospital may use and/or disclose your individually
identifiable health information as follows:
Business
associates: There are some services provided in South Shore
Hospital through contracts with business associates which
are vendors, professionals and others who perform some treatment,
payment or health care operations function on behalf of South
Shore Hospital or who otherwise provide services and have
access to or use your protected health information. Examples
include physician services in the emergency department and
radiology,
certain 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 South Shore Hospital.
Directory:
Unless you object, we will use your name, location in the
facility, general condition, and religious affiliation for
directory purposes. This information may be provided to members
of the clergy and, except for religious affiliation, to other
people who ask for you by name. If you are unable to object,
we may use and disclose this information consistent with your
prior expressed preference, if known, and the health professional’s
judgment.
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, 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.
Disaster
Relief: We may use or disclose information for disaster relief
purposes.
Incidental
Uses and Disclosures: We are permitted to use and disclose
information incident 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 appropriately safeguard
your information.
C. MORE STRINGENT PROTECTION FOR YOUR HEALTH INFORMATION
In certain
cases, Illinois law provides more stringent privacy protections
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 these cases, South Shore
Hospital 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 South
Shore Hospital 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)
South Shore Hospital 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 South Shore Hospital 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 of a podiatrist, South Shore Hospital may not
reveal your medical records to the Podiatric Medical Licensing
Board without your written permission in instances in which
your treatment is a 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 South Shore Hospital 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 South Shore
Hospital to do so and may release such information as this
Privacy Notice may otherwise describe.
If you
are a patient of a physician, South Shore Hospital may not
reveal your medical records to the Medical Disciplinary Board
without your written permission in instances in which your
treatment is a 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 South Shore
Hospital 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. South Shore Hospital may also
provide copies of your hospital or medical records in cases
involving your death or permanent bodily injury, provided
that the law requires South Shore Hospital 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, South Shore Hospital
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 South Shore Hospital
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 redisclose this information
except as this Privacy Notice may describe.
If you
are or have been a recipient of genetic testing, South Shore
Hospital 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 South
Shore Hospital 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 redisclose 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, South Shore Hospital 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 South Shore Hospital
takes photographs of your injuries, South Shore Hospital 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, then South Shore Hospital
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, South
Shore Hospital 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 direcctly 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, South Shore Hospital
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 resident of a long-term care facility for persons under
the age of 22, South Shore Hospital 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, South Shore Hospital 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. Illinois law restricts redisclosure of mental health
or developmental disability information.
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 communications 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 that South Shore Hospital
employs.
D.
MARKETING
We will
need your written authorization to use and disclose your PHI
for marketing purposes, except if the marketing is a face-to-face
communication or if it involves a promotional gift of nominal
value. “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
the Plan 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 or include in our plan of benefits.
For example, we may communicate to you (without your authorization)
about our provider network replacement of, or enhancements
to, our health plan, and health-related products or services
available only to our plan participants that add value to,
but are not part of our plan of benefits. Marketing also does
not include our communication for your treatment or for case
management or care coordination purposes, 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
South
Shore Hospital 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 written notice to South Shore Hospital.
II. YOUR
RIGHTS
Federal
and state law 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 South
Shore Hospital 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. South Shore Hospital reserves the right to condition
your request on the receipt of information regarding how you
desire South Shore Hospital to handle payment and/or 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 South Shore Hospital to agree to the requested
restrictions unless the restriction request is a reasonable
restriction on communication.
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 an anticipation of use in a civil,
criminal, or administrative proceeding and certain other health
information which the law restricts South Shore Hospital from
disseminating. 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, acupuncturist or 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 disables, 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.
Your Right
to Amend. You also have the right to amend your individually
identifiable health information, unless South Shore Hospital
did not create such information or unless South Shore Hospital
determines that your medical record is accurate and complete
in its existing form.
Your Right
to an Accounting. You have the right to request and receive
an accounting of disclosures of your individually identifiable
health information that South Shore Hospital has made in either
the six (6) years prior to the request date, or during the
period between the request date and the date that federal
law required South Shore Hospital to comply with federal privacy
regulations, whichever is more recent. Such an accounting
may not include disclosures made to carry out treatment, payment
or health care operations, to create an accurate patient directory
or notify persons involved in your care, to ensure national
security, to comply with the authorized requests of law enforcement,
to inform you of the content of your medical records, or those
disclosures which you have previously authorized pursuant
to a validly executed authorization form.
If you
would like more information on how to exercise these rights,
please contact South Shore Hospital’s Chief Privacy
Officer at (773) 356-5398.
F. The
right to Get This Notice by E-Mail. You have the right to
get a copy of this notice by e-mail. Even if you have agreed
to receive notice via e-mail, you also have the right to request
a paper copy of this notice.
III. GRIEVANCES
OR FURTHER INQUIRIES
If you
believe that South Shore Hospital has violated your privacy
rights with respect to individually identifiable health information,
you may file a complaint with South Shore Hospital and the
Department of Health and Human Services. To file a complaint
with South Shore Hospital, please contact Sharon Harman at
8012 S. Crandon Avenue,
Chicago, Illinois 60617. South Shore Hospital will not retaliate
against you for filing a complaint. You may also contact the
above office for a copy of this Privacy Notice or for further
information regarding its contents.
AMENDMENTS
South
Shore Hospital reserves the right to amend the terms of this
Privacy Notice at any time and to apply the revised Privacy
Notice to all individually identifiable health information
that it maintains. If South Shore Hospital amends this Privacy
Notice, you will be provided with a revised copy at your next
visit to South Shore Hospital, or upon your request. The revised
Privacy Notice will also be available on South Shore Hopsital’s
website, www.southshorehospital.com
This
Privacy Notice is effective on January 01, 2003
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