UNDERSTANDING YOUR HEALTH INFORMATION AND MEDICAL RECORD

Each time you visit a hospital, physician, or other healthcare provider, they document information about you and your visit. Typically, this record is referred to as your medical record and contains your name, symptoms, health history and exam, test results, diagnoses, treatment given and a plan for future care or treatment. This medical record is used to plan your care and treatment and be a source of your health information as described below.

YOUR HEALTH INFORMATION RIGHTS

Your medical record is the physical property of West Suburban Cardiologists, however the information within your medical record belongs to you. Federal law provides you with the following rights regarding your health information that is contained in the medical record that West Suburban Cardiologists keeps about you.

· Right to obtain a copy of this Notice of Privacy Practices.

· Right to request certain restrictions on the uses and disclosures of your health information.

· Right to inspect or receive a copy of your health record.

· Right to request an amendment to your health record if you believe it contains an error.

· Right to obtain an accounting of disclosures of your health information.

· Right to request that we communicate with you about your health care at a confidential phone number or address.

· Right to revoke your written consent/authorization to use or disclose your health information except when the use or disclosure has already happened.

WEST SUBURBAN CARDIOLOGISTS’ RESPONSIBILITIES

· Maintain the privacy of your health information as required by law.

· Provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you.

· Do what is required by this Notice or that Notice that is in effect at the time West Suburban Cardiologists uses or discloses your health information.

· Notify you if we are unable to agree to your requested restriction on our disclosure of your health information.

· Agree to reasonable requests you may have to communicate your health information by an alternative way or at an alternative place.

We reserve the right to change our privacy practices and to use a new Notice of Privacy Practices for all health information we maintain about you and other patients. If West Suburban Cardiologists changes its practices, a new Notice of Privacy Practice form will be available upon your request, by mail or in person at this facility.

USE AND DISCLOSURE OF YOUR HEALTH INFORMATION:

West Suburban Cardiologists will use and disclose your health information contained within the West Suburban Cardiologists medical record to give you treatment, obtain payment for your treatment and operate our healthcare business.

EXAMPLES OF HOW YOUR HEALTH INFORMATION WILL BE USED OR DISCLOSED FOR TREATMENT, PAYMENT, AND OPERATIONS.

We will use your health information for treatment.

For example: Your physician, nurse or other members of your healthcare team will collect and document information about you in your health record. They will use this health information to choose the treatment they believe is best for you. Your physician will also document in your health record his or her expectation of the other members of your health care team. Nurses and other members of the team will document in your health record the actions they took and their observations of you. Your physician will then know how you are responding to the chosen treatment.

We will use your health information for payment.

For example: We will send you a bill that includes some of your health information or a copy of part or all of your health record to your third party payer such as your health insurance company or Medicare. The type of health information we will send includes your name and other identifying information, diagnosis, treatment, and the procedures and supplies provided during your treatment.

We will use your health information for our routine operations.

For example: Physicians, nurses and quality improvement professionals will use your health information to review the treatment you received and the outcomes of your treatment. They may also compare your treatment and outcomes to those of other patients like you. We compare cases to help us continually improve the quality and effectiveness of our healthcare services.

OTHER USES OF YOUR HEALTH INFORMATION

We receive your written authorization to use and/or disclose your health information.

We will use and/or disclose your health information to those persons or places for which you give us your written authorization or permission to do so. If you authorize us to use or disclose your information, you must complete our Release of Health Information. You may revoke your authorization in writing at any time except to the extent that we have already used or disclosed your health information as you authorized. If your health information includes Highly Confidential Information, we may only use and disclose such information for treatment, payment and operations as described above. Otherwise, unless a disclosure is allowed or required by federal or Illinois law, you must give us your written authorization to disclose your Highly Confidential Information. A person who can verify your identity must witness and cosign an Authorization to Release Health Information form about treatment for a mental illness or development disability. If we receive an Authorization to Release Health Information for health information maintained in psychotherapy notes, we will only be able to disclose such information as allowed by the law.

For the purposes described below.

Business Associates: We provide some services that require using or disclosing your health information to other contractors who are persons or companies that perform the actual service. The law refers to these contracts as our Business Associates. Examples of these Business Associates are billing and record copying companies that assist us with billing for our healthcare services or copying health records. We may disclose your health information to our Business Associates so that they can do the job we have contracted with them to do. We require that they use appropriate safeguards to ensure the privacy of your health information.

Health Oversight Activities and Specialized Government Functions: We may disclose your health information to an agency that oversees the healthcare system and ensures compliance with the rules of government health programs such as Medicare or Medicaid; to the U.S. Military or U.S. Department of State under certain circumstances.

Law Enforcement Officials and Court or Administrative Orders: We may disclose your health information to the police, other law enforcement officials, medical examiners or coroners, and to the courts or administrative proceedings as allowed or required by law, or required by a court order or other legal process.

Notification and Other Communications with Your Relatives, Close Friends or Caregivers: You or your legal representative must tell your physician, nurse, or other healthcare team member who are the relatives or other persons responsible for your care, living location and general condition who you want to receive communications about you. After learning who these persons are, we may, in our best judgement, use and disclose your health information, but not your Highly Confidential Information, to notify those persons(s) of what they need to know to care for you. In an emergency or other situation where you are not able to identify your chosen person(s) to receive communication about you, we may exercise our professional judgment to determine whether such a disclosure is in your best interests, who is the appropriate person(s) and what health information is relevant to their involvement with your healthcare.

Medical Examiner, Coroner, and Funeral Directors: We may disclose your health information to the medical examiner, coroner and funeral directors as necessary to carry out their duties and as allowed by law.

Organ, Eye and Tissue Organizations: We may disclose your health information to organizations that facilitate organ, eye and tissue procurement, banking or transplantation.

Public Health Activities: We may report your identity and other health information to: public health authorities for the purpose of controlling disease, injury or disability; to the U.S. Food and Drug Administration for regulating certain products or activities; to governmental authorities about suspected or known child abuse and neglect, adult abuse and neglect, or domestic violence; to a person exposed to a contagious disease or has the risk of contracting or spreading a disease, to your employer and governmental agencies as required by federal and state laws regarding work-related illness or injury; to prevent or lessen a serious or imminent threat to a person’s or the public’s health or safety; or, to a public or private entity that is authorized to assist in disaster relief efforts.

Research: We may use or disclose your health information for the purpose of healthcare research if the Board of Chicagoland Heart Foundation (affiliate of WSC) approves the research study.

Workers Compensation: We may disclose your health information as allowed or required by Illinois law relating to worker’s compensation or to other similar programs.

Other Communications with You: We may contact you to remind you of appointments with your physicians or other healthcare team members and to follow up on the services you received. Unless you notify your nurse or our front desk personnel that you object, we may also contact you about other health care services we offer that may benefit you.

Fundraising: Unless you notify your nurse or our front desk personnel that you object, we may disclose to Chicagoland Heart Foundation your name, address, phone number and dates of treatment. Chicagoland Heart Foundation may then contact you in their fundraising effort for West Suburban Cardiologists.

Marketing: After you give us your written consent/authorization, we may use your health information for the purpose of marketing West Suburban Cardiologists. You may notify us at any time that you object to us using your health information for this purpose.

If you object to using your health information for fundraising or marketing purposes, please contact us at 708-728-3215.

RIGHT TO FILE A COMPLAINT IF YOU BELIEVE YOUR PRIVACY RIGHTS HAVE BEEN VIOLATED, YOU MAY FILE A COMPLAINT WITH WEST SUBURUBAN CARDIOLOGISTS OR WITH THE DIRECTOR OF THE OFFICE OF CIVIL RIGHTS, U.S. SECRETARY OF HEALTH AND HUMAN SERVICES. WE WILL NOT RETALIATE AGAINST YOU IF YOU FILE A COMPLAINT WITH US OR WITH THE DIRECTOR. IF YOU WOULD LIKE TO REPORT A PRIVACY PROBLEM OR WANT FURTHER INFORMATION, PLEASE CONTACT NANCY MUELLER AT 708-482-3215.