THIS NOTICE OF PRIVACY PRACTICES DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
During your treatment at Children’s Respiratory and Critical Care Specialists, doctors, nurses and others will collect and create information about your health and medical history. This information is called Protected Health Information or PHI.
This Notice describes Children’s Respiratory’s legal duties and privacy practices as well as your rights related to your protected health information.
Most of the patients at Children’s Respiratory are children. When we refer to “you” or “your” in this Notice, we refer to the patient. When we refer to types of disclosures of information to “you,” we mean disclosures to the patient, the patient’s guardian or the personal legally authorized to receive information about the patient.
Children’s Respiratory Duties
Children’s Respiratory is required by law to:
• Maintain the privacy of your protected information.
• Provide you with a copy of this Notice.
• Abide by the terms of our current Notice.
• Notify you in the event your unsecured protected health information has been breached.
Your Privacy Rights
Inspect and copy: You may review or receive a copy of your medical records, unless the law otherwise protects the information you are requesting. This request must be made in writing. If your request to review or receive a copy of your medical record is denied, you have the right to have the denial reviewed by a health care professional. Children’s Respiratory reserves the right to charge you for copying, consistent with limits established by state and federal law.
Update or amend medical records: If you feel that the health and medical information Children’s Respiratory has about you is incorrect or incomplete, you may ask us to update or amend it. This request must be made in writing. If your request is denied, you can write a statement of disagreement with the denial that we will include with your health and medical information.
Confidential/alternative communication: You may request that Children’s Respiratory provide you with your health and medical information in a confidential manner. For example, you may request that Children’s Respiratory not leave a voicemail message or that we send appointment reminders, bills and other mailings to a special address. You must make this request in writing and specify a means of communication. Children’s Respiratory must agree to any reasonable request that you make. However, we may ask you to give us information about how you will pay your bills.
Restrict use and disclosure: You may request that Children’s Respiratory not use your health and medical information in certain ways or for certain purposes. You may also request that we not provide your health and medical information to certain people. Children’s Respiratory must agree to your request if the restriction is to your health plan and you have paid for an item or service out of pocket and in full. For all other requests, Children’s Respiratory has the right to refuse your request. Even if Children’s Respiratory agrees to a restriction, we may still use or disclose your medical information in situations requiring emergency treatment. If this happens, we will ask the person(s) who receive(s) your information to not further use or disclose the information.
Accounting of disclosures: Sometimes Children’s Respiratory must share your health and medical information with others, usually because we are required by law to do so. To find out with whom, if anyone, we have shared your health and medical information, submit a request in writing, and indicate what period of time you want to know about. This period of time is limited to the previous six years. The list will not include disclosures that we are not required to track, such as disclosures for the purposes of treatment, payment or health care operations; disclosures that you have authorized us to make; or those made directly to you or to friends or family members involved in your care
Revoke your written authorization: If you have authorized the use or disclosure of your medical information, you may take back that authorization, in writing, at any time. If you do so, Children’s Respiratory will no longer use or share your medical information for the reason listed on your written authorization. This does not apply to information we have already shared with your permission.
Copy of the Notice: You have the right to a paper copy of this Notice upon request, even if you have agreed to receive the Notice electronically.
Use and Disclosure of Your Medical Information
Children’s Respiratory primarily uses your health and medical information for treatment, payment, and health care operations. Examples of these uses and disclosures include:
Treatment: To provide, coordinate, and manage care and treatment. For example, a Children’s Respiratory physician may share your health or medical information with another physician for consultation or a referral.
Payment: To bill for and receive payment for the services we provide and to other health care providers for their payment activities. For example, we will disclose information in order to verify insurance companies, Medicare or Medical Assistance.
Health care operations: To help run our facilities and for quality assessment and improvement activities. For example, we may use health information to review our services and the staff.
Other uses and disclosures
Appointment reminders and other health information:
Children’s Respiratory may contact you, including sending a text message or leaving a voice mail, regarding the date, time, location, and nature of an appointment and any pre-appointment instructions. If you object to this, please let us know so we can accommodate your request. In addition, we may share information with you about new or alternative treatments or other health care services that may be of interest to you.
Directory: Unless you notify us that you object, or we are otherwise prohibited by law, we may use your name, location in the facility, general condition, and religious affiliation for directory purposes. This information may be provided to members of the clergy, and, except for religious affiliation, to other people who ask for you by name.
Family members or other responsible people: Children’s Respiratory may give information to a family member or friend involved in your health care while you are a patient at Children’s Respiratory. If you are not able to give your permission, we will decide what, if any, information to share. We may also share information with a person or persons helping to pay for your care.
In each of these cases, you may limit what health information we share. For example, we may provide limited medical information to allow another family member to pick up a prescription for you.
Research: Under certain circumstances, we may use and disclose health information about you for research purposes. In some cases, we will disclose your health information for research purposes only with your authorization. In other cases where there is only a minimal risk to your privacy, as determined through our research project approval process, we may disclose information about you without your authorization. All research projects are subject to a special approval process, which evaluates each proposed research project and its use of medical information. We will only disclose information about you for research without your authorization when the special approval process results in a determination that there in only a minimal risk to your privacy, and we have initiated processes to protect your privacy to the greatest extent possible.
Fundraising: Children’s Respiratory may use your health information to notify you about fundraising campaigns or other charitable events to raise money for Children’s or Children’s Respiratory. If you receive a mailing or are otherwise contacted for fundraising purposes, you will be informed how you may ‘opt-out’ of any further fundraising communications.
Marketing and Sale of Your Health Information: Children’s Respiratory may use or disclose your health information as part of marketing efforts. As part of the authorization process, we will let you know if we received any direct or indirect compensation for the marketing or disclosure of your medical information. Your authorization is needed except for face-to-face communications to you or for promotional gifts of nominal value.
Special Situations: These situations include when required by law, for public health activities; to report suspected abuse, neglect, or domestic violence; for health oversight activities; for judicial and administrative proceedings to the extent permitted by law; for law enforcement purposes, as permitted or required by law; to coroners, medical examiners, and funeral directors, as permitted by law, for organ donation purposes; to avert a serious threat to health or safety; for certain specialized government functions, such as military discharge and national security and intelligence; for workers’ compensation purposes; or to government agencies or private disaster relief or disaster assistance organizations engaged in disaster relief activities.
Business Associates: Some services are provided by or to Children’s Respiratory through contracts with business associates. Examples include attorneys, consultants, collection agencies, and accreditation organizations. We may disclose information about you to our business associate so that they can perform the job we have contracted them to do. To protect the information that is disclosed, each business associate is required to sign an agreement to appropriately safeguard the information and not to redisclose unless specifically permitted or required by law.
For more information
If you want more information about your privacy rights, are concerned that Children’s Respiratory has violated your privacy rights, or you disagree with a decision that we made about access to or disclosure of your medical information, you may contact us.
Filing a complaint will not affect the quality of services you receive from Children’s Respiratory and you will not be retaliated against for doing so. You may also file a complaint with:
Office for Civil Rights
U.S. Department of Health and Human Services
233 North Michigan Avenue, Suite 240 Chicago, IL 60601
(312) 886-2359 or 1-800-368-1019 OCRComplaint@hhs.gov
Children’s Respiratory reserves the right to make changes to this Notice. The changes will apply to information we already have about you and information we receive about you in the future. We will provide an updated Notice to you when you request one.
The effective date of this Notice is April 14, 2003. Updated and effective May 16, 2016.