Notice of Privacy Practices

THIS DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Our Duty to Maintain the Confidentiality of Your Health Care Information.

The DuPage County Health Department understands that health care information about you is personal and that protecting your health care information is important. The DuPage County Health Department will create a record of the health care that you receive in order to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the health care records generated by the DuPage County Health Department, whether made by health care professionals or other personnel.

This notice will tell you about the way the DuPage County Health Department may use and disclose your health care information. This notice will describe your rights and our obligations regarding the use and disclosure of your health care information.

The DuPage County Health Department is required by law to:

• Keep private health care information that identifies you;

• Give you this notice of our legal duties and privacy practices with respect to health care information about you, and

• Follow the terms of the notice that is currently in effect.

How The Department May Use and Disclose Health Care Information About You.

You will be asked to sign an acknowledgement form before the start of your care in which you consent to the use and disclosure of your protected health care information for treatment, payment and health care operations.

The following categories describe some different ways the department may use and disclose your health care information. For each category of uses and disclosures, some examples have been given. Not every use or disclosure in each category will be listed.

For Treatment. The department may use your health care information to provide you with health care treatment or services. The department may disclose health care information about you to health care professionals or others who are involved in taking care of you. Different health care professionals may share information about you in order to coordinate the different things you may need, such as clinic visits and physician referrals. The department may also have to disclose health care information about you to people outside the DuPage County Health Department who may be involved in your health care or who provide services that are part of your health care needs. For example, the department may disclose a child’s immunization
record to other DuPage County Health Department staff, or to a public school nurse or to a physician’s office staff for follow up treatment and care. *

For Payment. The department may use and disclose health care information about you so that the treatment and services you received may be billed and payment may be collected from you, an insurance company or from another third party payer, such as Medicare or Medicaid. For example, Medicaid would need to know about a test or service you received so that they can pay
the department for that service. The department may also use or disclose information about you to determine if your insurance will cover the services provided or if you are income-eligible for the services under Medicare, Medicaid or your insurance plan.

For Health Care Operation Purposes. The Department may use or disclose your health care information for health care operations purposes. This may be necessary to insure that all of our clients receive quality health care. For example, the department may use health care information to review the department’s treatment and services or to evaluate the performance of health care professionals or other staff who provide care for you. The department may also disclose health care information to health care professionals or other DuPage County Health Department staff for review or learning purposes.*

*In some instances, the Illinois Mental Health and Developmental Disabilities Confidentiality Act, HIV/AIDS and STD laws require that the Department obtain your written permission before releasing information.

To Business Associates. There are a number of outside services that must be supplied to the department in order to provide health care treatment and services to you. For example, the department may require the services of various business associates including accountants, consultants or attorneys. When these types of services are contracted the department may disclose your health care information so that the business associates can perform the tasks asked of them. To protect your health care information, the department will require that our business associates appropriately safeguard your health care information.

Appointment Reminders. The department may use and disclose health care information to contact you as a reminder that you have an appointment for treatment or other health care services.

Individuals Involved in Your Care or Payment for Your Care. The department may release health care information about you to a friend or family member who you identify and who is involved in your health care. The department may also give health care information about you to someone who pays for your care. The department may also tell your family or friends about your general condition and that you are a resident in one of our residential programs. In addition, the department may disclose health care information about you to an entity in a disaster relief effort so that your family may be notified about your condition, status and location. *

Research. Under certain circumstances the department may use and disclose health care information about you for research purposes. All research projects, however, are subject to special approval processes. Before the department uses or discloses health care information for research purposes, the department will ask for your specific permission if the researcher is to have access to your name, address or other information which reveals who you are or if the information reveals who, at the DuPage County Health Department, is involved in your care.

To Avert a Serious Threat to Health or Safety. The department may use or disclose your health care information when necessary to prevent a serious threat to your health and safety or to the health and safety of another person or to the public. Any disclosure, however, would only be to someone or some entity able to help prevent the threat.

As Required by Law. The department will disclose health care information about you when required to do so by federal, state or local law.

Special Situations
Public Health Risks. The department may disclose health care information about you for public health activities. These activities generally include the following:

• To prevent or control disease, injury or disability;
   

• To report births and deaths;
   

• To report child abuse or neglect;
   

• To report reactions to medications or problems with a product;
   

• To notify people of recalls of products they may be using;
   

• To notify persons who may have been exposed to a disease or may be at risk of contracting or spreading a disease or condition;
   

• To notify the appropriate government authority if we believe a client has been the victim of abuse, neglect or domestic violence.

Your Rights Regarding Your Health Care Information
You have the following rights regarding the health care information the department maintains about you:

Right to Inspect and Copy. You have the right to inspect and copy the health care information that may be used to make decisions about your treatment and care. In order to inspect and copy the health care information that may be used to make decisions about your treatment and care, you must submit your request in writing to our Privacy Officer at the address listed at the end of this document. If you request a copy of the information you will be charged a fee for any costs involved in copying and mailing your request. Requests will be processed in accordance with timelines and deadlines established by law.*

In some instances, the Illinois Mental Health and Developmental Disabilities Confidentiality Act, the HIV/AIDS and STD laws require that the Department obtain your written permission before releasing
information.

The department may deny your request to inspect and copy the health care information that may be used to make decisions about your treatment and care under certain limited circumstances. If you are denied access to health care information, under certain circumstances, you may request that the denial be reviewed. In that case, another health care professional chosen by the DuPage County Health Department will review your request and the subsequent denial. The person making this review will not be the person who denied your original request. The DuPage County Health Department will comply with the review decision.

Right to Amend. If you feel the health care information the department has about you is incorrect or incomplete, you may ask to amend the information. You have a right to request an amendment for as long as the information is kept.

To request an amendment, your request must be made in writing and submitted to our Privacy Officer at the address listed at the end of this document. Additionally, you must provide a reason that supports your request for amendment.

The department may deny your request for an amendment if it is not in writing or does not include a reason to support the request for an amendment. In addition, the department may deny your request if you ask to amend information that:

• Was not created by the department, unless the person or entity that created the information is no longer available to make the amendmen(s);
   

• Is not part of the health care information kept by the DuPage County Health Department;
   

• Is not part of the information which you would be permitted to copy or inspect; or
   

• Is accurate and complete.

Right to an Accounting of Disclosures. You have a right to request an accounting of non-routine disclosures. To request an “accounting of disclosures” you must submit your request in writing to our Privacy Officer at the address listed at the end of this document. Your request for an “accounting of disclosures” must state a time period The department will charge a fee for the costs of obtaining, reproducing and mailing an accounting of non-routine disclosures”.

Right to Request Restrictions. You have the right to request a restriction or limitation be placed on the health care information the department uses or discloses about you for treatment, payment or health care operations. Yo u also have the right to restrict the information the department discloses about you to someone who is involved in your care or involved with the payment for your care, such as a family member or friend. The department is not required to agree to your request. If the department does agree, the department will comply with your request unless the information is needed to provide you with
emergency treatment.

To request restrictions you must make your request in writing to our Privacy Officer at the address listed at the end of this document. In your request you must tell us (1) what information you want to limit; (2) whether you want us to limit use, disclosure or both; and (3) to whom you want the limits to apply.

Right to Request Confidential Communications. You have the right to request the department communicate with you about health care information in a certain way or at a certain location. For example, you can request that the department only communicates with you by mail or contacts you only at work.

To request confidential communications, you must make you request in writing to our Privacy Officer at the address listed at the end of this document. The department will not ask you the reason for your request. We will attempt to accommodate all reasonable requests. Your written request must specify how or where you wish to be contacted.

Right to a Paper Copy of this Notice. You have the right to a paper copy of this notice at any time.

Other Uses of Health Care Information. Other uses and disclosures of health care information not covered by this notice or the laws that apply to the department will be made only with your written permission. If you provide the departmentpermission to use or disclose health care information about you, you can revoke that permission in writing at any time. If you revoke your permission the department will no longer use or disclose that health care information. You understand that the department is unable to take back any disclosure already made with your permission. The department is also required to retain our records of the care we provide to you.

*In some instances, the Illinois Mental Health and Developmental Disabilities Confidentiality Act, the HIV/AIDS and STD laws require that the Department obtain your written permission before releasing information.

Complaints. If you believe your privacy rights have been violated, you may file a complaint with the DuPage County Health Department or with the Secretary of the Department of Health and Human Services. To file a complaint with the DuPage County Health Department, contact our Privacy Officer at the address listed at the end of this document. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

Changes to This Notice. The department will abide by the terms of this notice but reserve the right to revise this notice as necessary. The department will post a dated copy of the current notice that will be effective for any current and future health care information the department already has about you. You may request a current copy of the 'Notice of Privacy Practices'
from our Privacy Officer by mail or request a copy from our staff at your next visit.

Privacy Officer: DuPage County Health Department, 111 North County Farm Road, Wheaton, Illinois 60187.

Effective: February 14, 2005