South Shore Hospital is committed to providing you with the highest quality of care in an environment that protects your privacy and the confidentiality of your medical information. This notice describes how South Shore Hospital, its medical staff, employees, and volunteers can use or disclose your medical information and how you can get access to this information.
The Health Insurance Portability and Accountability Act (HIPAA) set forth certain legal requirements regarding how hospitals and healthcare providers must protect patients’ health information.
Each time you visit South Shore Hospital, a record of your visit is made and your healthcare providers document information about you and your visit. This record is referred to as your medical record and contains your name, symptoms, health history and exam, test results, diagnoses, treatment given and a plan for future care or treatment.
Complete primary care services, from routine check-ups and preventive care at five affiliated neighborhood clinics and affiliated physicians.
Excellent and personable physicians, nurses, and professional staff. Transportation Services for seniors and disabled patients at affiliated clinics and the hospital.
A brief summary of the uses and disclosures South Shore Hospital can make are included below:
- To medical staff and personnel who treat you and provide you with care
- To remind you about an appointment with us
- To family or friends involved in your care in certain situations
- To follow the rules of regulatory agencies regarding quality of care and effective use of resources
- To comply with legal requirements, subpoenas or court orders for mandatory reporting, such as cases involving child or elder abuse
- For research purposes in accordance with specific regulations which ensure the privacy of patient information
- To inform you about healthcare services that you may be interested in
- For payment purposes
- To include certain information in our hospital directory, such as your name and room number
- To share limited demographic information such as name, address and phone number for South Shore Hospital fundraising purposes
While your medical record is the physical property of South Shore Hospital, the information contained in the record belongs to the patient. You have important rights regarding your medical information.
You have a right to:
- Request a copy of your medical record
- Request an amendment to the medical information if you feel the information is wrong or incomplete
- Request to restrict or limit the information we use and share about you in certain circumstances
- Request to communicate with you in a certain way or address
- Request a list of persons and/or entities that have received your information for reasons other than treatment, payment, or healthcare operations
- Submit a complaint
Federal and Illinois law also provide you with the right to be informed about and require your written authorization before any health information, including highly confidential information, is disclosed, unless such disclosure is allowed or required by law. Examples of highly confidential information include mental health treatment information; substance abuse prevention, treatment or referral; developmental disability services; HIV/AIDS testing and treatment, venereal disease treatment, sexual assault treatment; and testing and treatment for genetic disorders.
South Shore Hospital is a not-for-profit community organization that exists to provide the safest, highest quality healthcare experience possible to our patients and their families.
Our vision is to be recognized as a compassionate healthcare provider dedicated to personal, clinical, and technological excellence. We strive to be the clear first choice in our surrounding communities for healthcare services through continuous improvement in our delivery system.
OUR RESPONSIBILITY TO YOU
South Shore Hospital is responsible for:
- Maintaining the privacy of your health information as required by law
- For providing you with notice as to our legal duties and privacy practices with respect to information we collect and maintain about you
- For doing what is required by law and this Notice, or a Notice that is in effect at the time South Shore Hospital uses or discloses your health information
- For notifying you if we are unable to agree to your requested restriction on disclosure of your health information
- For notifying you if we are unable to make an amendment to your record at your request
- For agreeing to reasonable requests to communicate your health information by an alternative method or at an alternative location
South Shore Hospital reserves the right to change our privacy practices and to use a new Notice of Privacy Practices for all health information we maintain about you and other patients. If the hospital changes its practices, a new Notice of Privacy Practices will be made available to you upon your request and will be posted at the physical site and on our website.
WHO WILL FOLLOW THIS NOTICE?
This notice describes the practices of South Shore Hospital and encompasses:
- All healthcare professionals, including students, allowed to enter and access information in your medical record
- All employees, physicians on the medical staff, and other South Shore Hospital personnel in all departments and units, and
- Any hospital volunteer who may help you while you are a patient at South Shore Hospital
We will share your information amongst ourselves so that we can carry out the treatment, payment, and healthcare operations as described.
USES & DISCLOSURES OF YOUR HEALTH INFORMATION
South Shore Hospital will use and disclose your health information contained within the medical record to give you treatment, obtain payment for your treatment, and operate our healthcare businesses.
- Health treatment: Your physician, nurse, or other members of your healthcare team will collect and document information about you in your medical record. We may disclose information to a physician or other healthcare provider who will be assuming your care, for immediate continuity of care. This health information will be used to choose the treatment they believe is best for you. Nurses and other members of the team will document in your medical record the actions they took and their observations made of you. Your physician will then know how you are responding to the chosen treatment. We will also share information about you with others outside of the hospital, such as home health agencies, visiting nurses, rehabilitation hospitals, and ambulance companies. This helps to ensure that everyone who cares for you has the information they need.
- Payment: We will send a bill that includes some of your health information to you, to the person responsible for the bill, and to your third party payer (such as your Health Insurance Company, Medicaid, or Medicare). We may need to send a copy of part or all of your medical record to your third party payer. The type of health information includes your name, other identifying information, diagnosis, treatment, procedures performed, and supplies provided during your treatment.
- Hospital Operations: We may use your medical information to support the hospital’s business activities and to improve the quality or cost of care. Physicians, nurses, and quality improvement professionals will use your health information to review the treatment you received and its outcomes. We may also compare your treatment and outcomes to those of other patients like you. We compare cases to help us continually improve the quality and effectiveness of our healthcare services.
We may use your information to contact you:
- At the address and telephone numbers you provide us (including leaving messages at these numbers) about scheduled or cancelled appointments, registration/insurance updates, billing and/or payment matters, pre-procedure assessment or test results, etc.;
- With information about patient care issues, treatment choices, and follow-up care instructions; or
- For fundraising purposes to support South Shore Hospital and its mission, provided, however that such information is limited to demographic information only, such as name, address, phone number, age or gender. If you are contacted for fundraising purposes, you will be provided with information on how to remove yourself from the fundraising list.
South Shore Hospital may, without your written authorization, release your health information for the purposes described below:
Business Associates: We may also share your information with a “business associate” hired by the hospital to help us with our hospital operations and functions. All business associates must assure us in writing that they will safeguard your medical information in the same way that South Shore Hospitals does.
Hospital Directory: If you are admitted to South Shore, your name, room location, general condition (for example, “fair” or “stable”) and religion may be listed in the hospital’s directory at the information desk. We keep this information so your family, friends, and clergy can visit you in the hospital and generally know how you are doing.
Unless you object, we will include this limited information about you in the directory while you are a patient. Your room location and general condition will be released to people who ask for you by name.
Your religious affiliation will be given only to a member of the clergy, such as a priest, minister, or rabbi.
If you are receiving mental health or alcohol/substance abuse services on an inpatient behavioral health unit during this hospitalization, we will not disclose any information without your prior written authorization.
IF YOU OBJECT TO BEING IN THE HOSPITAL DIRECTORY, WE WILL NOT DISCLOSE YOUR INFORMATION TO ANYONE WHO ASKS FOR YOU.
Research: We may use or disclose your health information to identify you as a potential candidate for a research study that has been approved by an Institutional Review Board or for governmental research studies in which your identifiable information will not be released.
Individuals Involved in Your Care or Payment for Your Care: If people such as family members, relatives or close personal friends are helping to care for you or helping to pay your medical bills, we may release medical information to them. You or your legal representative must tell your physician, nurse, or other healthcare team members which of your relatives or other persons may receive information about you. After learning who these persons are, we may, in our best judgment, use and disclose your health information, except for your highly confidential information, to notify these person(s) of what they need to know to care for you.
In an emergency or other situation where you are not able to identify your chosen person(s) to receive communications about you, we may exercise our professional judgment to determine whether such a disclosure is in your best interest, the appropriate person(s) to whom to disclose the information, and what health information is relevant to their involvement with you healthcare. If we can reasonably do so while trying to respond to the emergency, we will try to find out if you want us to share this information.
We also may disclose your medical information to an organization, such as the American Red Cross, assisting in a disaster relief effort, so that your family can be notified about your condition, status, and location.
As Required by Law: In some instances, the hospital is required to report your medical information to legal authorities, such as law enforcement, court officials, and government agencies, in accordance with law, a court order, or other legal process. For example, your medical information may be disclosed if we are required to report abuse, neglect, domestic violence or certain physical injuries.
To Avert a Serious Threat to Health or Safety: As required by law and the standards of ethical conduct, we may disclose your medical information if we believe that it is necessary to prevent a serious threat to your health and safety or the health and safety of others. Any disclosure, however, would be made only to someone able to help prevent that threat.
Organ and Tissue Donation, Funeral Directors, Coroners: We may disclose your health information to funeral directors as necessary to carry out their duties and as allowed by law. We may also release your medical information to a coroner or medical examiner as necessary to identify a deceased person or to determine the cause of death.
We may release your medical information to organizations that obtain organs or handle organ, eye, or tissue transplantation. We also may release your information to an organ donation bank to arrange for organ or tissue donation and transplantation.
Lawsuits and Disputes: We may disclose your medical information in the course of a judicial and administrative proceeding, in response to an order of a court or other tribunal to the extent that such disclosure is authorized, and, in certain conditions, in response to a subpoena, discovery request, or other lawful process. Illinois law may require your written permission to disclose information in certain proceedings involving information obtained by certain providers, such as physicians or rape and crisis counselors.
Sensitive Information: Some types of medical information are particularly sensitive. The law, with some exceptions, may require that the hospital obtains your written authorization, or, in some instances, a court order to disclose that information. Sensitive medical information includes that which may deal with genetics, HIV/AIDS, mental health, alcohol and substance abuse, artificial insemination, and sexual assault.
Information Used in Disciplinary Proceedings: Illinois law may require your written permission if certain medical information is to be used in various review and disciplinary proceedings of certain healthcare professionals by state authorities.
Inmates: If you are an inmate in a correctional facility or in the custody of a law enforcement official, we may disclose your health information to the correctional facility or law officer so that duties can be carried out under the law.
Worker’s Compensation: We may disclose your health information as allowed or required by Illinois law relating to workers’ compensation benefits for work-related injuries or illness, or to other similar programs.
Public Health Activities: We may be required to report your medical information to authorities to help prevent or control disease, injuries or disability. This may include using your medical information to report certain diseases, injuries, and birth and death information. This also may include reporting certain drug reactions with products or notification of product recalls. These reports will be made in compliance with state and federal law and will be limited to the requirements of the law.
We may report your identity and other health information as follows:
- to public health authorities for the purpose of controlling disease, injury, or disability;
- to the U.S. Food and Drug Administration for regulating certain products or activities;
- to governmental authorities about suspected or known child abuse and neglect, elder adult abuse and neglect, or domestic violence;
- to a person exposed to a contagious disease or who has the risk of contracting or spreading a disease;
- to your employer and governmental agencies as required by federal and state laws regarding work-related illness or injury so that your workplace may be monitored for safety;
- to prevent or lessen a serious or imminent threat to a person’s or the public’s health or safety; or
- to a public or private entity that is authorized to assist in disaster relief efforts
Health Oversight Activities: We may disclose your medical information to local, state, or federal governmental authorities responsible for the oversight of medical matters as authorized by law, such as to agencies that administer public health programs, Medicare, and Medicaid, and under certain circumstances to the U.S. Military or the U.S. Department of State.
USES & DISCLOSURES NOT COVERED IN THIS NOTICE
Other uses and disclosures of your medical information will be made only with your written authorization, unless otherwise permitted or required by law. If you provide us with authorization to use or disclose your medical information, you may revoke that permission in writing at any time. If you revoke your authorization, we will no longer use or disclose medical information about you for the reasons covered by your written permission. However, revocation will be effective except to the extent that action has been taken in reliance on this consent.
YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION
You have certain rights regarding the medical information South Shore Hospital maintains about you.
Right to Inspect and Copy: You have the right to see and obtain a copy of your medical record. To see and/or obtain copies of this information, you must submit your request in writing to the Health Information Management Department. The Authorization of Disclosure of Health Information form is available in South Shore Hospital’s Health Information Management Department, located at 8012 S. Crandon Ave., Chicago, Illinois 60617.
If you request a copy of your medical record, we may charge you a reasonable fee for the costs of copying, mailing, or other expenses associated with complying with your request.
Some information, such as psychotherapy notes, may not be included in the copy you are provided.
Right to Amend: If you feel that medical information in your medical record is wrong or that information is missing, you may ask us to make an amendment to that information. You have the right to request an amendment as long as the information is kept by or for South Shore Hospital and was created by a member of South Shore Hospital. If the medical information is kept by another hospital or provider, we cannot act on your request and you will have to contact them directly. Your request for an amendment must be made on the Medical Record Amendment Request form available in South Shore Hospital’s Health Information Management Department, located at 8012 S. Crandon Ave., Chicago, Illinois 60617.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. We may also deny your request if you ask us to amend information that:
- was not created by South Shore Hospital, unless the person or entity that created the information is no longer available to make the amendment;
- is not part of the medical information kept by or for South Shore Hospital;
- is not part of the information you would be permitted to see and copy; or
- is accurate and complete as deemed by your healthcare provider
If your request is denied, we will provide you with notice in writing of the denial and the reason for the denial. You have the right to write a rebuttal statement and ask that the rebuttal statement be included in your medical record.
Right to an Accounting of Disclosures: You have the right to ask us for an accounting of disclosures, which is a list of the individuals or entities who have received your medical record from South Shore Hospital. However, the accounting will not include disclosures that were provided to:
- You or your personal representative
- Provide or arrange care for you
- Pay for your healthcare services
- South Shore Hospital for its operations, and/or
- Others with your permission
Your request must be made in writing to the Health Information Management Department, located at 8012 S. Crandon Ave., Chicago, Illinois 60617.
The list will include only the disclosures made for the time period indicated in your request, but may not exceed a six-year period or include dates before April14, 2003. The first list you request within a 12-month period will be free, but we may charge you for the costs associated with providing additional lists.
Right to Request Restrictions: You have the right to ask us to restrict or limit the medical information we use or disclose about you for treatment, payment, or healthcare operations. We are not required to agree to your request. If we do agree, we will comply unless the information is needed to provide emergency treatment. Your request for restrictions must be made in writing with South Shore Hospital’s Health Information Management Department, located at 8012 S. Crandon Ave., Chicago, Illinois 60617.
Right to Confidential Communications: You have the right to ask South Shore Hospital to communicate with you about medical matters in a certain way or at a certain location. For example, you may ask that we contact you only by sending materials to a P.O. Box instead of your home address. We will not ask the reason for your request and will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted. To request confidential communication, you must make your request in writing to South Shore Hospital’s Health Information Management Department, located at 8012 S. Crandon Ave., Chicago, Illinois 60617.
Right to a Copy of this Notice: Upon your request, you may at any time obtain a paper copy of this notice, even if you agreed earlier to receive this notice electronically. To do so, please contact our Admitting Department at 773.356.5204. You may also access a copy of this notice on our website at www.southshorehospital.com.
HEALTH INFORMATION EXCHANGE
In order to improve upon the continuity of your care, South Shore Hospital is a participant in the MetroChicago Health Information Exchange. By having accurate and up-to-date information readily available, authorized health care providers can make better decisions about their patient’s care and treatment. The MetroChicago Health Information Exchange (HIE) allows authorized care providers to securely exchange medical information to ensure that patients receive safer, quality health care faster.
YOU WILL AUTOMATICALLY BE OPTED-IN TO THE HIE UNLESS YOU DECIDE YOU DO NOT WISH TO PARTICIPATE. YOU HAVE THE RIGHT TO OPT-OUT OF PARTICIPATING IN THE HIE AND MUST DO SO IN WRITING.
Your choice to opt-out of the MetroChicago HIE will not affect your ability to receive medical care. You may opt-out of participation in the HIE in writing in the Admitting Department upon registration, or with the Health Information Management Department after discharge. However, please note, if you opt-out, the MetroChicago HIE will block access to all of your health information through its system, even for emergency treatment. Despite opting-out, your information may still be disclosed through MetroChicago HIE to meet legal requirements such as public health reporting.
Due to special requirements by law, if you are a patient on either the Medical Detox Unit or Chemical Dependency Unit, you will automatically be opted out of the HIE due to special confidentiality laws regarding these types of personal health information.
For more information, you may contact the Admitting Department, the HIM Department, or visit the MetroChicago Health Information Exchange website at: https://www.mchc.com/solutions/technology/metrochicago-health-information-exchange/
CHANGES TO THIS NOTICE
We reserve the right to change our privacy practices, procedures, and our notice. We also reserve the right to make the revised privacy policies, procedures, and notice effective for medical information we already have about you, as well as any information we receive in the future. We will post a copy of the current notice around South Shore Hospital and the Notice will contain the new effective date.
QUESTIONS AND COMMENTS
If you have any questions regarding your privacy rights or the information in this notice, please call our Compliance Officer at 773.356.5198.
If you believe South Shore Hospital has violated your privacy rights in this notice, you may file a complaint internally with South Shore via our Patient Representative at 773.356.5200.
You may also report a complaint to the Office of Civil Rights, U.S. Department of Health and Human Services
- By telephone at 877.696.6775
- 200 Independence Ave., SW,
- Washington, D.C. 20201.
- Or by visiting their website at: hhs.gov/ocr/privacy/hipaa/complaints/
You may also report a complaint to the Healthcare Accreditation Facilities Program via
- Their interactive form available on their website at: http://www.hfap.org/resources/complaintinformation.aspx
Healthcare Facilities Accreditation Program c/o Complaint Department
142 E. Ontario Street
Chicago, IL 60611
- Fax: Attn: Complaint Dept., 312.202.8298
If you are a patient of the Chemical Dependency Unit or Med Detox Unit, you may also report a complaint to the Joint Commission via
- Their interactive form available on their website at: http://www.jointcommission.org/report_a_complaint.aspx
Office of Quality and Patient Safety
The Joint Commission
One Renaissance Blvd
Oakbrook Terrace, IL 60181
- Email: firstname.lastname@example.org
Filing a complaint will not affect the treatment or services you receive from South Shore Hospital and there will never be any retaliation against you for filing a complaint.
Effective: 3/03 Revised: 05/15