I. 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.
II. We have a legal duty to safeguard your Protected Health Information (PHI). We are legally required to protect the privacy of your health information.
We call this information protected health information, or PHI for short, and it includes information that can be used to identify you that we’ve created or received about your past, present, or future health or condition, the provision of health care to you, or the payment of this health care. We must provide you with this notice about our privacy practices that explains how, when, and why we use and disclose your PHI. With some exceptions, we may not use or disclose any more of your PHI than is necessary to accomplish the purpose of the use or disclosure. We are legally required to follow the privacy practices that are described in this notice. However, we reserve the right to change the terms of this notice and our privacy policies at any time. Any changes will apply to the PHI we already have. Before we make an important change to our policies, we will promptly change this notice and post a new notice in the hospital’s main reception area. You can also request a copy of this notice from the contact person listed in Section VI, below, at any time and can view a copy of the notice on our web site at www.premiersuburban.com.
III. How we may use and disclose your Protected Health Information We use and disclose health information for many different reasons.
For some of these uses or disclosures, we need your specific authorization. In the next pages, we describe the different categories of our uses and disclosures and give you some examples of each category.
A. Uses and disclosures relating to treatment, payment, or health care operations. We may use and disclose your PHI for the following reasons:
1. For your treatment. We may disclose your PHI to physicians, nurses, medical students, and other health care personnel who provide you with health care services or are involved in your care. For example, if you’re being treated for a knee injury, we may disclose your PHI to the rehabilitation department in order to coordinate your care.
2. To obtain payment for treatment. We may use and disclose your PHI in order to bill and collect payment for the treatment and services provided to you. For example, we may provide portions of your PHI to our billing department and your health plan to get paid for the health care services we provided to you.
3. For health care operations. We may disclose your PHI to certain third parties in order to operate this hospital. For example, we may use your PHI in order to evaluate the quality of health care services that you received or to evaluate the performance of the health care professionals who provided health care services to you. We may also provide your PHI to our accountants, attorneys, consultants, and others in order to make sure we’re complying with the laws that affect us.
4. Business associates. The hospital contracts with outside entities that perform business services for us, such as billing companies, management consultants, quality assurance reviewers, accountants or attorneys. In certain circumstances, we may need to share your health information with a business associate so it can perform a service on our behalf. We will have a written contract in place with the business associate requiring protection of the privacy and security of your health information.
5. Health Information Exchange (HIE). Your PHI may be made available electronically through a local, state or national Health Information Exchange (HIE). An HIE is an organization that allows health care providers in different places to access information about you so that each provider has a complete picture of your health. The information that may be provided to an HIE includes both medical and demographic information about you. If you do not want to participate in any HIE’s you may opt-out by contacting the Premier Suburban Medical Group at (815) 300-7764.
B. Certain uses and disclosures do not require your authorization. We may use and disclose your PHI without your authorization for the following reasons:
1. When a disclosure is required by federal, state, or local law, judicial or administrative proceedings, or law enforcement. For example, we make disclosures when a law requires that we report information to government agencies and law enforcement personnel about victims of abuse, neglect, or domestic violence; when dealing with gunshot and other wounds; or when ordered in a judicial or administrative proceeding.
2. For public health activities. For example, we report information about births, deaths, and various diseases to government officials in charge of collecting that information, and we provide coroners, medical examiners, and funeral directors necessary information relating to an individual’s death.
3. In a disaster situation. We may release your PHI to a public or private entity authorized by law or its charter to assist in disaster relief efforts. We may also disclose your PHI to other hospitals or to a public or private organization assisting in relief efforts for the purpose of notifying family members or others responsible for your care.
4. For health oversight activities. For example, we will provide information to assist the government when it conducts an investigation or inspection of a health care provider or organization.
5. For purposes of organ donation. We may notify organ procurement organizations to assist them in organ, eye, or tissue donation and transplants.
6. For research purposes. In certain circumstances, we may provide PHI in order to conduct medical research.
7. To avoid harm. In order to avoid a serious threat to the health or safety of a person or the public, we may provide PHI to law enforcement personnel or persons able to prevent or lessen such harm.
8. For specific government functions. We may disclose PHI of military personnel and veterans in certain situations. And we may disclose PHI for national security purposes, such as protecting the President of the United States or conducting intelligence operations.
9. For workers’ compensation purposes. We may provide PHI in order to comply with workers’ compensation laws.
10. Appointment reminders and health-related benefits or services. We may use PHI to provide appointment reminders or give you information about treatment alternatives or other health care services or benefits we offer.
C. Three Uses and Disclosures Require You to Have the Opportunity to Object.
1. Patient directories. We may include your name, location in this facility, general condition, and religious affiliation in our patient directory for use by clergy and visitors who ask for you by name unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergencies.
2. Disclosures to family, friends, or others. We may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent maybe obtained retroactively in emergency situations.
3. Disclosure to the media. We may release a brief one-word description of your condition to the media if the person requesting the information identifies you by name unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergencies.
D. All other uses and disclosures require your prior written Authorization.
In any other situation not described in Sections III A, B, and C, above, we will ask for your written authorization before using or disclosing any of your PHI. If you choose to sign an authorization to disclose your PHI, you can later revoke that authorization in writing to stop any future uses and disclosures (to the extent that we haven’t taken any action relying on the authorization).
IV. What rights you have regarding your PHI You have the following rights with respect to your PHI:
A. The right to request limits on uses and disclosures of your PHI. You have the right to ask that we limit how we use and disclose your PHI. We will consider your request but are not legally required to accept it. If we accept your request, we will put any limits in writing and abide by them except in emergency situations. You may not limit the uses and disclosures that we are legally required or allowed to make.
B. The right to choose how we send PHI to you. You have the right to ask that we send information to you to an alternate address (for example, sending information to your work address rather than your home address) or by alternate means (for example, email instead of regular mail). We must agree to your request so long as we can easily provide it in the format you requested.
C. The right to see and get copies of your PHI. In most cases, you have the right to look at or get copies of your PHI, including an electronic copy, that we have, but you must make the request in writing. If we don’t have your PHI but we know who does, we will tell you how to get it. We will respond to you within 30 days after receiving your written request. In certain situations, we may deny your request. If we do, we will tell you, in writing, our reasons for the denial and explain your right to have the denial reviewed. If you request copies of your PHI, we will charge you a fee for the costs of copying, mailing or other supplies associated with your request. Instead of providing the PHI you requested, we may provide you with a summary or explanation of the PHI as long as you agree to that and to the cost in advance. To acquire a copy of your PHI, please contact Premier Suburban Medical Group at (815) 300-7764.
D. The right to get a list of the disclosures we have made. You have the right to get a list of instances in which we have disclosed your PHI. The list will not include uses or disclosures that you have already consented to, such as those made for treatment, payment, or health care operations, directly to you, to your family, or in our facility directory. We will respond within 60 days of receiving your request. The list will include the date of the disclosure, to whom PHI was disclosed (including their address, if known), a description of the information disclosed, and the reason for the disclosure. We will provide the list to you at no charge, but if you make more than one request in the same year, we will charge you a fee for each additional request. Insurance Billing Restriction. If you agree to pay for a service 100% out of pocket and do not want your insurance company to be billed or provided PHI related information to the service, you must notify Premier Suburban Medical Group of the restriction. This request will only apply for Premier Suburban Medical Group billing and will not apply for third-party billers such as radiologists and physicians. You must contact each third party billing entity separately if you want the restriction in place.
E. The right to correct or update your PHI. If you believe that there is a mistake in your PHI or that a piece of important information is missing, you have the right to request that we correct the existing information or add the missing information. You must provide the request and your reason for the request in writing. We will respond within 60 days of receiving your request. We may deny your request in writing if the PHI is (i) correct and complete, (ii) not created by us, (iii) not allowed to be disclosed, or (iv) not part of our records. Our written denial will state the reasons for the denial and explain your right to file a written statement of disagreement with the denial. If you don’t file one, you have the right to request that your request and our denial be attached to all future disclosures of your PHI. If we approve your request, we will make the change to your PHI, tell you that we have done it, and tell others that need to know about the change to your PHI.
F. Right to be notified of a breach. PSMG is committed to safeguarding your health information and proactively works to prevent health information breaches from occurring. If a breach of unsecured health information occurs, we will notify you in accordance with applicable state and federal laws.
G. Right to a copy of this notice. You have a right to a copy of this notice. It is available in registration areas and on our website.
V. How to complain about our Privacy Practices
If you think that we may have violated your privacy rights, or you disagree with a decision we made about access to your PHI, you may file a complaint with the person listed in Section VI below. You also may send a written complaint to the Secretary of the Department of Health and Human Services, 200 Independence Avenue, S.W., Washington, DC 20201. We will take no retaliatory action against you if you file a complaint about our privacy practices.
VI. Person to Contact for Information about this notice or to complain about our Privacy Practices
If you have any questions about this notice or any complaints about our privacy practices or would like to know how to file a complaint with the Secretary of the Department of Health and Human Services, please contact the Premier Suburban Medical Group at (815) 300-7764.
VII. Effective date of this notice
This notice went into effect in December 2020.