THIS NOTICE DESCRIBES HOW MEDICAL
INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET
ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
are committed to protecting the confidentiality of your medical
information, and are required by law to do so. This notice describes
how we may use your medical information within the Hospital and how we
may disclose it to others outside the Hospital. This notice also
describes the rights you have concerning your own medical information.
Please review it carefully and let us know if you have questions.
HOW WILL WE USE AND DISCLOSE YOUR MEDICAL INFORMATION?
We may use your medical information to provide you with medical
services and supplies. We may also disclose your medical information to
others who need that information to treat you, such as doctors,
physician assistants, nurses, medical and nursing students,
technicians, therapists, emergency service and medical transportation
providers, medical equipment providers, and others involved in your
care. For example, we will allow your physician to have access to your
Hospital medical record to assist in your treatment at the Hospital and
for follow-up care.
We also may use and disclose
your medical information to contact you to remind you of an upcoming
appointment, to inform you about possible treatment options or
alternatives, to tell you about health-related services available to
you, or to perform follow-up calls to monitor your care experience.
In order to assist family members and other visitors in locating you
while you are in the Hospital, the Hospital maintains a patient
directory. This directory includes your name, room number, your general
condition (such as fair, stable, or critical), and your religious
affiliation (if any). We will disclose this information to someone who
asks for you by name; we will disclose your religious affiliation only
to clergy members. If you do not want to be included in the Hospital’s
patient directory, please notify the Privacy Official, in writing. A
simple form is also available.
Family Members and
Others Involved in Your Care: We may disclose your medical information
to a family member or friend who is involved in your medical care, or
to someone who helps to pay for your care. We also may disclose your
medical information to disaster relief organizations to help locate a
family member or friend in a disaster. If you do not want the Hospital
to disclose your medical information to family members or others who
will visit you, you must talk to the Privacy Official. You can reach
our Privacy Official using contact information listed on the last page
of this notice.
Payment: We may
use and disclose your medical information to get paid for the medical
services and supplies we provide to you. For example, your health plan
or health insurance company may ask to see parts of your medical record
before they will pay us for your treatment.
We may use and disclose your medical information if it is necessary to
improve the quality of care we provide to patients or to run the
Hospital. We may use your medical information to conduct quality
improvement activities, to obtain audit, accounting or legal services,
or to conduct business management and planning. For example, we may
look at your medical record to evaluate whether Hospital personnel,
your doctors, or other health care professionals did a good job.
We may use or disclose your medical information for research projects,
such as studying the effectiveness of a treatment you received. These
research projects must go through a special process that protects the
confidentiality of your medical information.
Required by Law:
Federal, state, or local laws sometimes require us to disclose
patients’ medical information. For instance, we are required to report
child abuse or neglect and must provide certain information to law
enforcement officials in domestic violence cases. We also are required
to give information to the State Workers’ Compensation Program for
We also may report certain medical information for public health
purposes. For instance, we are required to report births, deaths, and
communicable diseases to the State. We also may need to report patient
problems with medications or medical products to the FDA, or may notify
patients of recalls of products they are using.
We may disclose medical information for public safety purposes in
limited circumstances. We may disclose medical information to law
enforcement officials in response to a search warrant or a grand jury
subpoena. We also may disclose medical information to assist law
enforcement officials in identifying or locating a person, to prosecute
a crime of violence, to report deaths that may have resulted from
criminal conduct, and to report criminal conduct at the Hospital. We
also may disclose your medical information to law enforcement officials
and others to prevent a serious threat to health or safety.
Health Oversight Activities:
We may disclose medical information to a government agency that
oversees the Hospital or its personnel, such as the State Department of
Health, the federal agencies that oversee Medicare, the Board of
Medical Examiners or the Board of Nursing. These agencies need medical
information to monitor the Hospital’s compliance with state and federal
Coroners, Medical Examiners and Funeral Directors:
We may disclose medical information concerning deceased patients to
coroners, medical examiners and funeral directors to assist them in
carrying out their duties.
Organ and Tissue Donation: We may disclose medical information to organizations that handle organ, eye or tissue donation or transplantation.
Military, Veterans, National Security and Other Government Purposes:
If you are a member of the armed forces, we may release your medical
information as required by military command authorities or to the
Department of Veterans Affairs. The Hospital may also disclose medical
information to federal officials for intelligence and national security
purposes, or for presidential Protective Services.
The Hospital may disclose medical information if the Hospital is
ordered to do so by a court or if the Hospital receives a subpoena or a
search warrant. You will receive advance notice about this disclosure
in most situations so that you will have a chance to object to sharing
your medical information.
Information with Additional Protection:
Certain types of medical information have additional protection under
state or federal law. For instance, medical information about
communicable disease and HIV/AIDS, and evaluation and treatment for a
serious mental illness is treated differently than other types of
medical information. For those types of information, the Hospital is
required to get your permission before disclosing that information to
others in many circumstances.
Other Uses and Disclosures:
If the Hospital wishes to use or disclose your medical information for
a purpose that is not discussed in this Notice, the Hospital will seek
your permission. If you give your permission to the Hospital, you may
take back that permission any time, unless we have already relied on
your permission to use or disclose the information. If you ever would
like to revoke your permission, please notify the Privacy Official in
WHAT ARE YOUR RIGHTS?
Right to Request Your Medical Information:
You have the right to look at your own medical information and to get a
copy of that information. (The law requires us to keep the original
record.) This includes your medical record, your billing record, and
other records we use to make decisions about your care. To request your
medical information, write to the Privacy Official. If you request a
copy of your information, we will charge you for our costs to copy the
information. We will tell you in advance what this copying will cost.
You can look at your record at no cost.
Right to Request Amendment of Medical Information You Believe Is Erroneous or Incomplete:
If you examine your medical information and believe that some of the
information is wrong or incomplete, you may ask us to amend your
record. To ask us to amend your medical information, write to the
Right to Get a List of Certain Disclosures of Your Medical Information:
You have the right to request a list of many of the disclosures we make
of your medical information. If you would like to receive such a list,
write to the Privacy Official. We will provide the first list to you
free, but we may charge you for any additional lists you request during
the same year. We will tell you in advance what this list will cost.
to Request Restrictions on How the Hospital Will Use or Disclose Your
Medical Information for Treatment, Payment, or Health Care Operations: You
have the right to request us not to make uses or disclosures of your
medical information to treat you, to seek payment for care, or to
operate the Hospital. We are not required to agree to your request, but
if we do agree, we will comply with that agreement. If you want to
request a restriction, write to the Privacy Official and describe your
request in detail.
Right to Request Confidential Communications:
You have the right to ask us to communicate with you in a way that you
feel is more confidential. For example, you can ask us not to call your
home, but to communicate only by mail. To do this, write to the Privacy
Official. You can also ask to speak with your health care providers in
private outside the presence of other patients—just ask them!
Right to a Paper Copy:
If you have received this notice electronically, you have the right to
a paper copy at any time. You may download a paper copy of the notice
from our Web site, at www.macneal.com, or you may obtain a paper copy
of the notice from the Privacy Official.
CHANGES TO THIS NOTICE
time to time, we may change our practices concerning how we use or
disclose patient medical information, or how we will implement patient
rights concerning their information. We reserve the right to change
this Notice and to make the provisions in our new Notice effective for
all medical information we maintain. If we change these practices, we
will publish a revised Notice of Privacy Practices. You can get a copy
of our current notice of Privacy Practices at any time by contacting
the Privacy Official.
WHICH HEALTH CARE PROVIDERS ARE COVERED BY THIS NOTICE?
Notice of Privacy Practices applies to the Hospital and its personnel,
volunteers, students, and trainees. The Notice also applies to other
health care providers that come to the Hospital to care for patients,
such as physicians, physician assistants, therapists, other health care
providers who are not employed by the Hospital, emergency service
providers, medical transportation companies, and medical equipment and
suppliers who come to the Hospital. The Hospital may share your medical
information with these providers for treatment purposes, to get paid
for treatment, or to conduct health care operations. These health care
providers will follow this Notice for information they receive about
you from the Hospital. These other health care providers may follow
different practices at their own offices or facilities. A list of these
health care providers is available for your review in the Admissions
Office by contacting the Privacy Official.
DO YOU HAVE CONCERNS OR COMPLAINTS
tell us about any problems or concerns you have with your privacy
rights or how the Hospital uses or discloses your medical information.
If you have a concern, please contact
Local Privacy Official 708-783-9100 X7800
National Privacy Official 1-800-854-6413
Corporate Compliance Hotline – Washington DC 1-800-300-9876
for some reason the Hospital cannot resolve your concern, you may also
file a complaint (in writing) with the federal government at the
OCR/DHHS regional office.
We realize patients,
their family members, or visiting friends may experience problems or
have concerns about patient care and safety in the hospital. If any
aspect of your stay or care have not met your expectations, please ask
to speak with the manager of the area serving you. If that individual
does not resolve the issue to your satisfaction please contact the
Nursing Supervisor or Hospital Administrator on Duty by calling
Should you continue to remain
concerned after contacting the Nursing Supervisor or the Hospital
Administrator on Duty you may choose to contact the Joint Commission's
Office of Quality Monitoring by either calling 1-800-994-6610 or
We will not penalize you or retaliate against you in any way for filing a complaint with the federal government.
DO YOU HAVE QUESTIONS?
Hospital is required by law to give you this Notice and to follow the
terms of the Notice that is currently in effect. If you have any
questions about this Notice, or have further questions about how the
Hospital may use and disclose your medical information, please contact
the Privacy Official.
Effective date: April 14, 2003.
Privacy Official Contact Information:
Name: MacNeal Health Network - HIPAA Privacy Officer
Mailing Address: 3249 South Oak Park Avenue, Berwyn IL. 60402
Phone: 708-783-9100 X7800