We respect consumer confidentiality and only release information about you in Accordance with the Illinois and federal law. This notice describes our policies related to the use of the records of your services generated by this Organization.
Privacy Contact. If you have any questions about this policy or your rights contact Mike Poe, Assistant Executive Director of ARC Community Support Systems who serves as the Privacy Official for Protected Health Information policies and procedures. His address is ARC Community Support Systems, 618 West Main Street, Teutopolis, IL 62467.
USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION
In order to effectively provide you services, there are times when we will need to share information about you with others beyond our Organization. This includes:
Services. With your permission, we may use or disclose information about you to provide, coordinate, or manage your care or any related services, including sharing information with others outside our Organization that we are consulting with or referring you to.
Payment. Information will be used to obtain payment for the services provided. This may include contacting your health insurance company for prior approval of planned treatment or for billing purposes.
Information Disclosed Without Your Consent. Under Illinois and federal law, information about you may be disclosed without your consent in the following circumstances:
Emergencies. Sufficient information may be shared to address the immediate emergency you are facing.
As Required by Law. This would include situations where we have a subpoena, court order, or are mandated to provide public health information, such as communicable diseases or suspected abuse and neglect such as child abuse, elder abuse, or institutional abuse.
Coroners, Funeral Directors. We may disclose medical information to a coroner or medical examiner and funeral directors for the purposes of carrying out their duties.
Governmental Requirements. We may disclose information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections and licensure. We are also required to share information, if requested with the Department of Health and Human Services to determine our compliance with federal laws related to health care. We are also required to share information with the Illinois Department of Human Services.
Criminal Activity or Danger to Others. If a crime is committed on our premises or against our personnel we may share information with law enforcement to apprehend the criminal. We also have the right to involve law enforcement when we believe an immediate danger may occur to someone.
Fundraising. As a not for profit provider of services we need assistance in raising money to carry out our mission. We may contact you to seek a donation.
PATIENT RIGHTS
You have the following rights under Illinois and federal law:
Copy of Record. You are entitled to inspect the record our Organization has
generated about you. We may charge you a reasonable fee for copying and mailing your record.
Release of Records. You may consent in writing the release of your records to others, for any purpose you choose. This could include your attorney, employer, or others who you wish to have knowledge of your information. You may revoke this consent at any time, but only to the extent no action has been taken in reliance on your prior authorization.
Restriction on Record. You may ask us not to use or disclose part of the information. This request should be in writing or if you are unable to provide a written request, then the request may be made verbally. The request should be made to the Privacy Contact.
Amending Record. If you believe that something in your record is incorrect or incomplete, you may request we amend it. To do this contact the Privacy Contact and ask for the Request to Amend Health Information form. In certain cases, we may deny your request. If we deny your request for an amendment you have a right to file a statement you disagree with us. We will then file our response; your statement and our response will be added to your record.
Accounting for Disclosures. You may request an accounting of any disclosures we have made related to your information, except for information we used for treatment, payment, or health care operations purposes or that we shared with you or your family, or information that you gave us specific consent to release. It also excludes information we were required to release. To receive information regarding disclosure made for a specific time period no longer than six years and after April 14, 2003, please submit your request in writing to our Privacy Contact, if you are unable to provide this request in writing, you may make the request verbally. We will notify you of the cost involved in preparing this list.
Questions and Complaints. If you have any questions, or wish a copy of this Policy or have any complaints you may contact our Privacy Contact in writing at our office for further information, if you are unable to provide this request in writing, you may make the request verbally. You also may complain to the Secretary of Health and Human Services at the address below if you believe our Organization has violated your privacy rights. We will not retaliate against you for filing a complaint.
Office For Civil Rights, US Department of Health and Human Services, 200 Independence Avenue, S.W., Room 509 F, HHH Building Washington, D.C. 20201
Changes in Policy. The Organization reserves the right to change its Privacy Policy based on the needs of the Organization and changes in state and federal law.
