Adams County Health Department
www.co.adams.il.us
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.
The Adams County Health
Department (ACHD) creates a medical record of your health information in order
to treat you, receive payment for services delivered, and to comply with
certain policies and laws. The uses and
disclosures described in this Notice are applicable to the health department
and all of the workforce (collectively “we”) who are
part of this Joint Notice of Privacy Practices while they are delivering
services at a health department facility or on behalf of the health
department. This Joint Notice does not
apply to service providers who are not part of the health department when they deliver
services elsewhere or only on their own behalf.
We are required by federal
and state law to maintain the privacy of your “protected health information”
(PHI). We are also required by law to
provide you with this Notice of our legal duties and privacy practices. In addition, the law requires us to ask you
to sign an Acknowledgment that you received this Notice.
This is a list of some of the types of uses and disclosures of PHI that
may occur:
Treatment: We obtain medical information about you in
treating you. This medical information
is called “protected health information” or “PHI”. Your PHI is used by us to treat you. For example, we refer to PHI in treating you
at the health department. We may also
send your PHI to another physician or counselor to which we refer you for
treatment. We may also use your PHI to
contact you to tell you about alternative treatments, or other health-related
benefits we offer. If you have a friend
or family member involved in your care, we may give them PHI about you.
Payment: We use your PHI to obtain
payment for the services that we render.
For example, we send PHI to Medicaid, Medicare, or your insurance plan
to obtain payment for our services.
Health Care
Operations:
We use your PHI for our operations. For
example, we may use your PHI in determining whether we are giving adequate
treatment to our clients. From
time-to-time, we may use your PHI to contact you to remind you of an
appointment.
Legal Requirements: We may use and disclose your PHI as required
or authorized by law. For example, we
may use or disclose your PHI for the following reasons:
Public Health: We may use and disclose your health care information to
prevent or control disease, injury or disability, to report births and deaths,
to report reactions to medicines or medical devices, to notify a person who may have been exposed
to a disease, or to report suspected cases of abuse, neglect or domestic
violence.
Health
Oversight Activities: We may use and disclose your PHI to state agencies and federal
government authorities when required to do so.
We may use and disclose your health information in order to determine
your eligibility for public benefit programs and to coordinate delivery of those
programs. For example, we must give PHI
to the Secretary of Health and Human Services in an investigation into our
compliance with the federal privacy rule.
Judicial and
Administrative proceedings: We may use and disclose your PHI in judicial and administrative
proceedings. Efforts may be made to
contact you prior to a disclosure of your PHI by the party seeking the
information.
Law Enforcement: We may use and disclose your PHI in order to comply with requests
pursuant to a court order, warrant, subpoena, summons, or similar process. We may use and disclose PHI to locate someone
who is missing, to identify a crime victim, to report a death, to report
criminal activity at our offices, or in an emergency.
Avert a
Serious Threat to Health or Safety: We may use or disclose your PHI to stop you or
someone else from getting hurt.
Work-Related
Injuries:
We may use or disclose PHI to an employer if the employer is conducting medical
workplace surveillance or to evaluate work-related injuries.
Coroners,
Medical Examiners, and Funeral Directors: We may use or disclose PHI to a coroner or
medical examiner in some situations. For
example, PHI may be needed to identify a deceased person or determine a cause
of death. Funeral directors may need PHI
to carry out their duties.
Armed Forces: We may use or disclose the PHI of Armed Forces personnel to the
military for proper execution of a military mission. We may also use and disclose PHI to the
Department of Veterans Affairs to determine eligibility for benefits.
National
Security and Intelligence: We may use or disclose PHI to maintain the safety of the President or
other protected officials. We may use or
disclose PHI for the conduct of national intelligence activities.
Correctional
institutions and custodial situations: We may use or disclose PHI to correctional
institutions or law enforcement custodians for the safety of individuals at the
correctional institution, those that are responsible for transporting inmates,
and others.
Research: You will need to sign an
Authorization form before we use or disclosure PHI for research purposes except
in limited situations. For example, if
you want to participate in research or a clinical study, an Authorization form
must be signed.
Fundraising: If we undertake any fundraising activities,
we may contact you about the fundraising activity. We do not engage in marketing activities, and
need your authorization to do so.
Your Rights: You
have certain rights under federal privacy laws relating to your PHI. Some of these rights are described below:
Restrictions: You have a right to request
restrictions on how your PHI is used for purposes of treatment, payment and
health care operations. We are not
required to agree to your request.
Communications: You have a right to receive confidential
communications about your PHI. For
example, you may request that we only call you at home. If your request is reasonable, we will
accommodate it.
Inspect and
Access: You have a right to inspect information used
to make decisions about your care. This
information includes billing and medical record information. You may not inspect your record in some
cases. If your request to inspect your
record is denied, we will send you a letter letting you know why and explaining
your options.
You may copy
your PHI in most situations. If you
request a copy of your PHI, we may charge you a fee for making the copies and
mailing them to you, if you ask us to mail them.
Amendments of
your Records:
If you believe there is an error in your PHI, you have a right to request that we amend your
PHI. We are not required to agree with
your request to amend.
Accounting of
Disclosures: You have a right to receive an accounting of
disclosures that we have made of your PHI for purposes other than treatment,
payment, and health care operations, or release made pursuant to your
authorization.
Copy of
Notice: You have a right to obtain a paper copy of
this Notice, even if you originally received the Notice electronically. We have also posted this Notice at the health
department offices.
Complaints: If you feel that your privacy rights have
been violated, you may file a complaint with the health department by calling
our Privacy Officer at (217)222-8440. We
will not retaliate against you for filing a complaint. You may also file a complaint with the
Secretary of Health and Human Services in
We maintain a facility
directory so that if family or friends ask us about your condition, we can tell
them general information and the fact that you are here. If you do not want us to tell anyone you are
here, please tell us now.
We are required to abide
with terms of the Notice currently in effect, however,
we may change this Notice. If we
materially change this Notice, you can get a revised Notice on our website at www.co.adams.il.us., or by stopping by our office to pick up
a copy. Changes to the Notice are
applicable to the health information we already have.
If we seek help from
individuals or entities who are not part of this Notice in our treatment, payment,
or health care operations activities, we will require those persons to follow
this Notice unless they are already required by law to follow the federal
privacy rule.