Notice of Privacy Practices

(Effective: April 14, 2003)

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

PLEASE READ IT CAREFULLY. 

The Health Insurance Portability and Accountability Act (HIPAA) is a federally mandated law.  It provides guidelines to health care providers about the privacy of your medical information and requires us to inform you of our privacy policies.

This privacy notice, provided by Prairie Cardiovascular Consultants, Ltd. (Prairie), is to inform our patients, in compliance with the HIPAA law, about the uses and/or disclosures and rights pertaining to their medical information.  You may be asked to acknowledge in writing your receipt of this notice. 

Medical information is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services or the payment for such services.

Our pledge to you

We are committed to protecting medical information about you.  We create a record of the care and services you receive to provide quality care and to comply with legal requirements.  This notice applies to all of the records of your medical care that we maintain, whether created by Prairie physicians and staff, your family doctor or other health care professionals.  These other physicians and health care professionals may have different policies or notices regarding their uses and disclosure of medical information.   

How we may use and disclose medical information about you

We may use and disclose medical information about you without your prior authorization:

We may use or disclose medical information without your prior authorization for several other reasons.  Subject to certain requirements, we may give out medical information about you without your prior authorization for public health purposes, abuse or neglect reporting, health oversight activities, government functions, research studies, funeral arrangements, organ and tissue donation, worker’s compensation, and emergencies.  We may disclose medical information when required by law, such as in response to judicial or administrative orders.

We may contact you about potential treatment options, health related benefits and services, and to support fundraising or marketing efforts.

We may contact you for appointment reminders, to schedule medical services, to inform you of test results, and payment status.

We may disclose medical information about you to a friend, family member or other person who is involved in your medical care.  We may do so by mail, telephone and other methods, including leaving information on an answering machine.  We may disclose medical information about you to disaster relief authorities so that your family can be notified of your location and condition.

We will use our professional judgment in determining what we disclose and to whom, based on our evaluation of your best interests.   

Other uses of medical information

In any other situation not covered by this notice, we will ask for your written authorization before using or disclosing medical information about you.  If you choose to authorize use or disclosure, you can later revoke that authorization by notifying us in writing of your decision except to the extent that disclosures have already been made based upon your original authorization.

Your rights regarding medical information about you

In most cases, you have the right to look at and obtain a copy of medical information in your record that we use to make decisions about your care by submitting a written request.  If you request copies, we may charge a fee for the cost of copying, mailing or other expenses.  If we deny your request to review or obtain a copy, you may submit a written request for a review of that decision.

If you believe that information in your record is incorrect or if important information is missing, you have the right to request that we amend the records by submitting a request in writing that provides your reason for requesting the amendment.  We may deny your request if the information was not created by us, if it is not part of the medical information maintained by us, or if we determine that the record is accurate.  You may appeal, in writing, our decision to deny your request.

You have the right to receive a list of disclosures of medical information for reasons other than treatment, payment, health care operations or where you specifically authorize a disclosure, by submitting a written request.  The request must state the time period desired for the list, which must be less than a 6-year period and starting after April 14, 2003.  You may receive the list in paper form.  The first disclosure list request in a 12-month period is free; other requests may be subject to a fee.  We will inform you of the cost before you incur any costs.

You have the right to obtain additional copies of the Prairie Notice of Privacy Practices upon request.

If this Notice was sent to you electronically, you have the right to a paper copy of it.

You have the right to request that medical information about you be communicated to you in a confidential manner, such as sending mail to an address other than your home, by notifying us in writing of the specific way or location for us to use to communicate with you.  We will accommodate all reasonable requests.

You have the right to request in writing restrictions on uses and disclosures of medical information about you for treatment, payment or healthcare operations or to persons involved in your care except when specifically authorized by you or for notification purposes.  We will consider your request but we are not legally required to accept it.  You may not limit the uses and disclosures we are legally required or allowed to make. 

All written requests or appeals, concerning your rights to medical information, should be submitted to your Prairie physician or the HIPAA Privacy Office listed at the end of this notice.

Who will follow this notice?

Prairie provides health care to our patients in partnership with physicians and other professionals and organizations.  The privacy practices in this notice will be followed by:

All employees of our organization, including staff at our affiliate sites with whom we may share information.

Any Business Associate of Prairie with whom we share medical information.

We are required by law to:

Take reasonable measures to keep medical information about you private.

Give you this notice of our legal duties and privacy practices with respect to medical information about you.

Follow the terms of the notice of privacy practice that is currently in effect.

Changes to this Notice

We may make changes to our privacy practices at any time.  Changes will apply to medical information we already maintain, as well as medical information obtained after the change.  If we make a significant change in our privacy practices, we will post a new Notice of Privacy Practices in waiting room areas.  You can request a copy of a current Notice of Privacy Practices at any time.  The effective date is listed on the cover. 

Questions or Complaints

If you are concerned that your privacy rights may have been violated, or you disagree with a decision we made about access to your records, you may contact our HIPAA Privacy Office or you may send a written complaint to the U.S. Department of Health and Human Services Office of Civil Rights.  Our HIPAA Privacy Office can provide you the address. You will not be penalized or retaliated against for filing a complaint in good faith.

If you have any questions, please contact our HIPAA Privacy Office at the address, phone number, or E-mail address listed below.

Prairie Cardiovascular Consultants, Ltd.

HIPAA Privacy Office

619 East Mason Street-Suite 4P57

PO Box 19420

Springfield, Illinois  62794-9420

217/788-0706

HIPAA@prairieheart.com

Form #327 4-14-03