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10/27/2016         

Independence Center

Phone: ​​(847) 360-1020

Fax:     (847) 360-1065 

Email: ​  Cmoore@icwaukegan.org

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


I. WHO WILL FOLLOW THIS NOTICE: 


This Notice of Privacy Practices describes the practices of all Independence Center staff, any volunteers that we allow to work in our facilities, and any business associates affiliated with the Independence Center . 


II. OUR COMMITMENT TO YOUR PROTECTED HEALTH INFORMATION 


We understand that medical information about you and your health is personal and confidential, and we are committed to protecting that information. We create a record of each and every one of the services that you receive from the Independence Center . We need this record to provide you with quality care and to comply with legal requirements. All health records created and maintained by the Independence Center are subject to these regulations. 

This Notice is required to inform you of the ways in which we may use and disclose protected health information about you. This Notice also describes your rights and certain obligations we have regarding the use and disclosure of your protected health information. 


III. OUR LEGAL DUTY 


We are required by law to maintain the privacy of your protected health information. We are required by law to provide this Notice about our legal duties and your rights regarding your protected health information. We are required by law to abide by the privacy practices described in this Notice while it is currently in effect. We do reserve the right to make changes to our privacy practices and the terms of this Notice at any time, provided that the changes are permitted by applicable law. If we should make any significant changes to our privacy practices, we will change this Notice and post it prior to the changes taking effect. We will also make any revised Notices available upon request. We reserve the right to make changes to our privacy practices and the terms of this Notice effective for all protected health information that we created or received prior to issuing a revised notice. 


IV. HOW WE MAY USE AND DISCLOSE PROTECTED HEALTH INFORMATION ABOUT YOU 


The Independence Center will not disclose your protected health information to anyone, except with your authorization or as otherwise permitted or required by law. The following categories describe different ways that we may use and disclose protected health information. Not every use or disclosure in a category will be listed. In some instances the disclosure of protected health information may be further restricted by applicable state or federal laws. However, all means of use and disclosure of protected health information will fall within one of the categories: 

Treatment- We may use protected health information about you to provide, coordinate, or manage your treatment or services. For example, we may disclose protected health information about you to any or all Independence Center personnel who are involved in your treatment. These uses and disclosures are necessary to provide quality care and to evaluate the performance of our staff. 

Payment- We may use and disclose protected health information about you so that the treatment and services you receive may be billed to and payment collected from you, an insurance company, or a third party. For example, we may use and disclose protected health information about you to the Department of Human Services to receive Medicaid reimbursement for services rendered to you. 

Health Care Operations- We may use and disclose protected health information about you to operate our facility. For example, we may disclose protected health information about you to meet the requirements of state or federal grants awarded to the Independence Center . We may use or disclose protected health information about you to meet insurance requirements as well. 

Individuals Involved In Your Care or Payment For Your Care- We will discuss your treatment with any individual that you indicate provided that there is written authorization from you. 

Appointment Reminders- We may use and disclose protected health information about you to contact you as a reminder that you have an appointment for treatment. You may request the use of an alternative address or method of contact for communications involving protected health information. 

Fundraising- We may contact you to raise funds for the Independence Center if you provide written authorization to do so. 

Research- We may use and disclose protected health information about you for research purposes. We will obtain your written authorization if the researcher will have access to protected health information. 

As Required By Law- We will disclose protected health information about you if required to do so by federal, state or local laws. 

To Avert A Serious Threat To Health or Safety- We may use and disclose protected health information about you if such disclosure is necessary to prevent a serious threat to your health or safety or the health and safety of others as authorized by applicable federal or state laws. 







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V. SPECIAL SITUATIONS 

Public Health Activities- We may use or disclose protected health information about you for public health activities as authorized by applicable federal or state laws. 

Victims of Abuse, Neglect, or Domestic Violence- We may disclose protected health information about you to the Department on Aging if you are sixty years of age or older and there is sufficient evidence that you are the victim of abuse, neglect, or domestic violence within the past twelve months. 

Health Oversight Activities- We may disclose protected information about you to a health oversight agency for activities authorized by the law. Health oversight agencies include government agencies that oversee health care administration and certifying organizations. These oversight activities may include audits, investigations, inspections and certification. 

Judicial Proceedings- We may disclose protected health information about you in response to a court or administrative order if you are involved in a lawsuit or dispute. We may disclose protected health information about you in response to subpoenas, discovery request or other lawful process. 

Specific Law Enforcement Activities- We may disclose protected health information requested by a law enforcement official under the following circumstances when permitted by state or federal law: 


In response to a court order, subpoena, warrant, summons or similar process
To identify or locate a suspect, fugitive, material witness or missing person
About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement 
About a death we believe may be the result of criminal conduct 
In emergency circumstances to report a crime, the location of the crime or victims or the identity, description or location of the person who committed the crime 
About crimes that occur on our premises 


Workers’ Compensation- We may disclose protected health information about you to comply with workers’ compensation laws and other similar legally established programs. 

Coroners and Medical Examiners- We may disclose protected health information about you to a coroner or medical examiner in response to an authorized request. 

National Security and Intelligence Activities- We may disclose protected health information about you to authorized federal officials for intelligence, counterintelligence and other national security activities authorized by law. 

Inmates- We may disclose protected health information about you if you are an inmate of a correctional institution or in the custody of a law enforcement official to the correctional institution or law enforcement official. This disclosure would be necessary for the institution to provide you with proper health care and to protect your health and safety and the health and safety of others and the institution.

VII. YOUR RIGHTS 

You have the right to request restrictions on certain uses and disclosures of your protected health information. You may request that we not use or disclose any part of your protected health information for purposes of treatment, payment or health care operations. You may also request that we not disclose any part of your protected health information to family members or other representatives involved in your care. Requested restrictions must be made in writing to the Privacy Officer listed below. We will make reasonable efforts to honor all requests, however we are not required to agree to a requested restriction. 

You have the right to receive confidential communications of protected health information. You may request to receive confidential communications from us regarding your protected health information via alternative means or at an alternative location. We will accommodate all reasonable requests. All requests need to be made to the Privacy Officer listed below. 

You have the right to inspect and copy your protected health information. You may inspect and obtain a copy of any protected health information about you that we generate for as long as we maintain the information so long as access to that information is not prohibited by state or federal law. According to federal law you may not inspect or copy psychotherapy notes, information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that law prohibits access to. 

You have the right to amend your protected health information. You may request an amendment of protected health information about you as long as we maintain the information. A request for amendment must be made in writing and submitted to the Privacy Officer. The written request must include a reason that supports your request. We may deny your request if it exceeds statutory guidelines. 

You have a right to receive an accounting of disclosures we have made of your protected health information. You may request a list of disclosures we made of protected health information about you. You must submit your request in writing to the Privacy Officer listed below. The request must state a time period which may not exceed six years in length or include dates prior to April 14, 2003. 

You have the right to obtain a paper copy of this Notice at any time upon request. 

VIII. CHANGES TO THIS NOTICE 

We reserve the right to make changes to this Notice at any time. This Notice is not a legal contract. We reserve the right to make the revised or changed Notice effective for protected health information that we create or obtain about you prior to or after any changes take effect. We will post a copy of the current Notice at each of our properties and on our website. A copy of the current Notice will be offered to all new members joining our program, and will be available to all existing members upon request. 

IX. QUESTIONS AND COMPLAINTS 

If you have any questions or complaints about our privacy practices please contact us at the number below. If you believe that your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. To file a complaint with the Independence Center , you must submit the complaint in writing and address it to the Privacy Officer. We support your right to protect the privacy of your health information. We will not retaliate in any way or refuse services if you choose to file a complaint with us or with the U.S. Department of Health and Human Services. 

X. WHO TO CONTACT FOR MORE INFORMATION 

PRIVACY OFFICER 
Independence Center 
2025 Washington St . 
Waukegan , IL 60085 
Phone: (847) 360-1020
Fax: (847) 360-1065
http://www.icwaukegan.org
SNaqvi@icwaukegan.org

Privacy Policies


Notice of Privacy Practices