THIS NOTICE DESCRIBES HOW MEDICAL/PSYCHOLOGICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Effective Date: As of September 1, 2013; reflects 9/23/13 HIPAA requirements.
Chiariello Behavioral Health, ("the Practice") respects patient/client confidentiality and will only release confidential information about you in accordance with Illinois and federal law. This notice describes our policies related to the use of the records of your care generated by this Agency.
Privacy Contact. If you have any questions about this policy or your rights contact Dr. Samantha Chiariello, our Privacy Officer at 708.864.4920.
USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION
In order to effectively provide you care, there are times when we will need to share your confidential information with others beyond our Practice. This includes for:
Treatment. We may use or disclose treatment information about you to provide, coordinate, or manage your care or any related services, including sharing information with others outside our Practice that we are consulting with or referring you to with your written consent.
Payment. With your written consent, information will be used to obtain payment for the treatment and services provided. This will include contacting your health insurance company for prior approval of planned treatment or for billing purposes. You have a right to restrict certain disclosures of your protected health information if you pay out of pocket in full for the services provided to you.
Healthcare Operations. We may use information about you to coordinate our business activities. This may include setting up your appointments, reviewing your care, training staff.
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.
Follow Up Appointments/Care. We will be contacting you to remind you of future appointments or information about treatment alternatives or other health-related benefits and services that may be of interest to you. We will leave appointment information on your voice mail or leave an email or text message unless you tell us not to.
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. We are required to disclose information about the circumstances of your death to a coroner who is investigating it.
Governmental Requirements. We are required to share information, if requested with the U.S. Department of Health and Human Services to determine our compliance with HIPAA.
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. Additionally, if we are concerned that you may harm someone, under Illinois law, we have a right to breach confidentiality to warn that person of potential harm by you.
Marketing/Sharing Your Information. We will never promote through communications with you a product that we are being compensated to promote without giving you the opportunity to opt out of any marketing material. We also will never share data about you for any type of research or other purposes without your written consent.
You have the following rights under Illinois and federal law:
Copy of Record. You are entitled to inspect the record our Practice has generated about you. We will charge you a reasonable fee for copying and mailing your record in accordance with the medical record copying fees permitted under Illinois law.
Release of Records. You may consent in writing to 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 care. You may revoke this consent at any time, but only to the extent no action has been taken in reliance on your prior authorization. Except as described in this Notice or as required by Illinois or Federal law, we cannot release your protected health information without your written consent.
Restriction on Record. You may ask us not to use or disclose part of the clinical information. This request must be in writing. The Practice is not required to agree to your request if we believe it is in your best interest to permit use and disclosure of the information. The request should be given to the Privacy Contact.
Contacting You. You may request that we send information to another address or by alternative means. We will honor such request as long as it is reasonable and we are assured it is correct. We have a right to verify that the payment information you are providing is correct. We also will be glad to provide you information by email if you request it. If you wish us to communicate by email you are also entitled to a paper copy of this privacy notice.
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 and your statement and our response will be added to your record. If your record is released it will contain your statement of disagreement as part of the record.
Accounting for Disclosures. You may request an accounting of any disclosures we have made related to your confidential 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 by law. To receive information regarding disclosure made for a specific time period no longer than six years. Please submit your request in writing to our Privacy Contact. We will notify you of the cost involved in preparing this list.
Notification of Breach. You have a right to be notified if there is a breach of your unsecured protected health information. This would include information that could lead to identity theft. You will be notified if there is a breach or a violation of the HIPAA Privacy Rule and there is an assessment that your protected information may be compromised.
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 further information. You also may complain to the Secretary of U.S. Department of Health and Human Services if you believe our Practice has violated your privacy rights. We will not retaliate against you for filing a complaint.