At drwillchicago, we take your privacy very seriously! Below you will find our Privacy Policy and our HIPAA Notification.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS DOCUMENT CAREFULLY.
Uses and Disclosures
Here are some examples of how we are allowed to disclose your private health care information for treatment, payment, or clinic operations:
1. Your health care provider or staff member may disclose your health information including all of your clinical records to another health care provider or hospital if it is necessary to refer you to them for diagnosis, assessment, or treatment of your health condition.
2. Our insurance and billing staff may disclose your examination and treatment records and your billing records to another party, such as an insurance carrier, HMO, PPO, merchant service, another individual or your employer, to resolve payment issues or if they are potentially responsible for the payment of your services.
3. Your health care provider and members of the practice staff may use your health information, examination and treatment records and your billing records for quality control purposes, to assert a legal defense or refute a claim, or for other administrative purposes to efficiently and effectively run our practice.
4. Your health care provider and members of the practice staff may use your name, address, telephone number, and clinical records to contact you to provide appointment reminders, information about your treatment alternatives, marketing practices, or other health related information that may be of interest to you. 164.250 (b)(1)(iii)(A). If you are not available to receive your appointment reminder by phone, a message will be left with the voicemail at the number you provided. If you selected a different preferred communication style other than phone, a message will be left with or sent to that communication method. Please be aware, not all communication methods are considered secure such as e-mail, text messages, etc.
Permitted Uses and Disclosures Without Your Consent or Authorization
Under federal law, we are also permitted or required to use or disclose your health information without your consent or authorization in these following circumstances:
1. If we are providing health care services to you based on the orders of another health care provider.
2. If we provide health care services to you as an inmate.
3. If we provide health care services to you in an emergency.
4. If we are required by law to treat you and we are unable to obtain your consent after attempting to do so.
5. If there are substantial barriers to communication, but in our professional judgement, we believe that you intend for us to provide care to you.
Other than in the above two sections, any additional use or disclosure of your health care information will only be made with your written authorization.
Your Right of Revocation
You may revoke your authorization to us at any time; however, your revocation must be in writing and mailed to our office. Under two circumstances, we will not be able to honor your revocation request:
1. If we have already released your health care information before we receive your request to revoke your authorization. 164.508 (b)(5)(i).
2. In you were required to give your authorization as a condition of obtaining third-party payment, the third-party payer may have the right to your health information if they decide to contest your claims.
If you wish to revoke your authorization, please write to us at:
Will Llewellyn, DC
5015 N Paulina St Ste 340
Chicago, IL 60640
Your Right to Inspect or Copy Your Health Information
You have the right to inspect or copy your health information for seven (7) years from the date that the record was created or as long as the information remains in our files. We require your request to inspect or copy your health information to be in writing.
Your Right to Amend Your Health Information
You have the right to request amendment to your health information for seven (7) years from the date that the record was created or as long as the information remains in our files. We require your request to amend your records be in writing and for you to give us reason to support the change you are requesting to your information. If we are unable to amend your information as requested, a written explanation, sent to your last address on file or another address as directed by you, will be provided.
Your Right to Accounting of the Disclosures Made
You have the right to request that we give you an accounting of the disclosures we have made of your health information for the last six (6) years before the date of the request. The accounting will include all the disclosures except:
1. Those disclosures required for your treatment, to obtain payment for services, or run our practice.
2. Those disclosures made to you.
3. Those disclosures necessary to maintain a directory of the individuals in our facility or to the individuals involved in your care.
4. Those disclosures for national security or intelligence purposes.
5. Those disclosures made to correctional or law enforcement officers.
6. Those disclosures that are made prior to the effective date of the HIPAA privacy law.
Your Right to Paper Copy
If you have agreed to receive privacy notices by e-mail or other electronic means, you may request a paper copy of this notice at any time.
Our Duties and Obligations
We are required by law to maintain the privacy of your health information. We are also required to provide you with this notice of our legal duties and our privacy practices with respect to your health information.
We must abide by the terms of this notice while it in in effect. However, we reserve the right to change the terms of our privacy notices. If we make change to the terms of our privacy agreement, we will notify you in writing when you come in for treatment or by mail sent to the last address on file. If we make a change in our privacy terms, the change will apply for all your health information in our files.
Re-Disclosure by Other Parties
Information that we use or disclose may be subject to re-disclosure by the person to whom we provide the information and may no longer be protected by the federal privacy rules.
Our Privacy Pledge
We have and always will respect your privacy. Other than the uses and disclosures described above, we will not sell or provide any of your health information to outside organizations.
Contact Us
If you would like additional information about our privacy policies, you may contact us at:
Will Llewellyn, DC
5015 N Paulina St Ste 340
Chicago, IL 60640
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW THIS DOCUMENT CAREFULLY
The department of Health and Human Services has established a "Privacy Rule" to help insure that personal health care information is protected for privacy. The Privacy Rule was also created to provide a standard for certain health care providers to obtain their patients consent for uses and disclosures of health information about the patient to carry out treatment, payment or health care operations.
As our patient, we want you to know that we respect the privacy of your personal medical records and will do all that we can to secure and protect that privacy. We strive to always take reasonable precautions to protect privacy. When it is appropriate and necessary we provide the minimum necessary information to only those we feel need your health care information and information about your treatment, payment or health care operations. These entities are most often not required to obtain consent.
We also want you to know that we support your full access to your personal medical records. We may have indirect treatment relationships with you (such as laboratories that only interact with physicians and not patients) and may have to disclose personal health information for treatment, payment, or health care operations. These entities are most often not required to obtain patient consent.
You may refuse to consent to the use of disclosure of your personal health information, but this must be in writing. Under this law, we have the right to refuse to treat you should you choose to refuse to disclose your Personal Health Information (PHI). If you choose to give consent in this document, at some future time you may request to refuse all or part of your PHI. You may not revoke actions that have already been taken which relied on this or previously signed consent.
If you have any objections to this form, please ask to speak with our HIPAA Compliance Officer.
You have the right to review our privacy notice, to request restriction and revoke consent in writing after you have reviewed our privacy policy notice.
Furthermore, you understand that there may be security cameras inside the clinic or on the clinic property.
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