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 review it carefully.
It is the policy of Cardiac Thoracic & Endovascular Therapies, S.C. (CVEVT) to keep your protected health information confidential in accordance with Illinois law and the privacy rules of Health Insurance Portability and Accountability Act of 1996 (HIPAA). It is also our policy to inform you of when and how this information may be disclosed. This Notice describes the personal information we collect, and how and when we use or disclose that information. It also describes your rights as they relate to your protected health information.
When you visit CVEVT, a record is made of your visit, typically containing your symptoms, examination and test results, diagnosis and plan for future treatment. According to HIPAA, CVEVT may use or disclose this information without your authorization for treatment, payment or health care operations purposes. We have listed examples of each of these uses and disclosures below:
Information that the nurse or doctor obtains from you during your visit will be recorded in a medical record that CVEVT maintains. This information will be used by your doctor to determine the best
course of treatment for you. If you visit different physicians at CVEVT or are admitted to a hospital, those providers will be given access to your medical records to formulate your treatment plan.
A bill may be sent to you or a third-party payer in order to receive payment for services rendered by CVEVT. This bill may include identifying information as well as your diagnosis, procedures and supplies used.
3.) Health Care Operations
CVEVT could use the health information in your medical record to assess the outcome of your care and in other cases similar to yours in order to ensure continued quality of care.
We may also use or disclose medical information about you without your prior authorization for the following reasons: Disclosure to Family, Close Friends and Other Caregivers. We may disclose medical information about you to a family member, other relative, or a close personal friend who is involved in your medical care or to disaster relief authorities so that your family can be notified of your location and condition. If you are not present, or you are incapacitated or in an emergency situation, we may exercise our professional judgment to decide if a disclosure is in your best interest. Under these circumstances we would only disclose information that we believe is directly relevant to the person’s involvement with your health care.
We may also use or disclose medical information about you without your prior authorization for several other reasons. Subject to certain requirements, we may give out information about you for; Public Health Activities for the purpose of preventing or controlling diseases; Abuse and Neglect, to a government authority if we reasonably believe that you are a victim of abuse, neglect or domestic violence; Health Oversight Activities or Inspections, to a health care system; Judicial, Administrative and Law Enforcement purposes, for example, in response to a subpoena or a request by a law enforcement official, and we may also disclose your medical information for Research Studies, Funeral Arrangements, Organ and Tissue Donation, Workers’ Compensation purposes, your Health and Safety, and when it is Required by Law.
For any purpose other than those described above, we will only use or disclose your medical information when you give us your written authorization. For instance, we will obtain your written authorization before sending your medical information to your life insurance company or to the attorney representing the other party in litigation in which you are involved.
Marketing. We will obtain your written authorization prior to using your medical information to send you any marketable materials. We can provide you with marketing materials in a face-to-face encounter without obtaining your authorization. We are also allowed to give you promotional gifts of nominal value if we so choose, without obtaining your authorization. In addition, we may communicate with you about products or services relating to your treatment, case management or care coordination, or alternative treatments, therapies, providers or care settings without your authorization.
Highly Confidential Information. Federal and Illinois law requires special privacy protections for highly confidential information about you. Highly Confidential Information consists of medical information related to: Psychotherapy notes, mental health and development disabilities services, alcohol and drug abuse services, HIV/AIDS testing, venereal diseases, genetic testing, child abuse and neglect, domestic abuse of an adult with a disability, or sexual assault. In order for us to disclose your Highly Confidential Information for purposes other than those permitted by law, we must obtain your written authorization.
Although your medical record is the physical property of CVEVT, the information belongs to you. You have the right to:
If you would like more information on how to exercise these rights or would like to make such a request, please direct inquiries to CVEVT Privacy Officer at 309-680-5000.
CVEVT is required to:
CVEVT reserves the right to change this Notice at any time and make the new terms effective for all protected health information it maintains. If such changes are made, a new Notice will be available at CVEVT.
If you feel that your privacy rights have been violated, you have the right to file a complaint with CVEVT Privacy Officer or with the Office for Civil Rights. You will not be retaliated against for filing a complaint. To file such a complaint, please contact CVEVT Privacy Officer at 309-680-5000.
To file a complaint with the Office for Civil Rights, you must file the complaint within 180 days of when you knew or should have known that the act occurred. The address and phone numbers for OCR are:
U.S. Department of Health and Human Services
233 N. Michigan Ave., Suite 240
Chicago, IL 60601
The effective date of this Notice is April 14, 2003.
2420 West Nebraska Ave. Peoria, IL 61604 Tel: 309-680-5000 • Fax 309-680-1002