Notice of Privacy Practices

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.

This notice describes the privacy practices of Illinois CancerCare and its entire staff. Illinois CancerCare will be referred to as Illinois CancerCare in this document. It also applies to all business associates with whom we may share information. It applies to your medical information, including your medical record, for all services provided to you in our clinics. We understand that your medical information is confidential and we are committed to maintaining its privacy. Federal law requires that we provide you with this Notice of our legal duties and privacy practices with respect to your medical information. We are required to abide by the terms of this Notice when we use or disclose your medical information.

How may we disclose Medical information about you?
Illinois CancerCare may use and disclose medical information about you without your prior authorization for the following reasons:

Treatment Purposes:
Health information may be used by staff members or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment.

Payment Purposes:
Your health information may be used to seek payment or send billing information to Medicare, Medicaid, your health insurer, HMO, or other company or program that will pay for your health care.

Heath Care Operations:
Your health information may be used as necessary to support the day-to-day activities and management of Illinois CancerCare. For example, we may use your medical information to evaluate the quality and competence of our staff. We may disclose medical information to our Patient advocates in order to resolve any complaints.

We may also disclose medical information to other health care providers when such medical information is required for them to treat you, receive payment for services they render to you or conduct certain health care operations, such as quality assessment and improvement activities and reviewing the quality and competence of health care professionals.

Law Enforcement:
Your health information may be disclosed to law enforcement agencies, without your permission, to support government audits and inspections, to facilitate law-enforcement investigations, and to comply with government mandated reporting.

Public health reporting:
Your health information may be disclosed to public health agencies as required by law. For example, we are required to report certain communicable diseases to the state’s public health department.

Disclosure of information to family, close friends and other caregivers:
Your health information may be disclosed to a family member, other relative, or a close personal friend who is involved in your medical care. Your health information may be disclosed to disaster relief authorities so that your family can be notified of your location and condition.

If you are not present or you are incapacitated or in an emergency situation, Illinois CancerCare may exercise our professional judgment to decide whether a disclosure is in your best interest. Under these circumstances, we would only disclose information that we believe is directly relevant to the person’s involvement with your health care.

Other Disclosures:
We may also use or disclose medical information about you without your prior authorization for several other reasons. Subject to certain requirements, we may give out medical information about you for any of the following reasons.

• Appointment reminders;
  Your health information will be used by our staff to send you appointment reminders in the mail or by leaving a message on the phone.
• Information about treatments:
  Your health information may be used to send you information on the treatment and management of your medical condition that you may find to be of interest. We may also send you information describing other health – related goods and service that we believe may interest you.
• We may disclose health information, to a governmental authority if we reasonably believe you are a victim of abuse, neglect or domestic violence.
• We may disclose health information to health oversight activities or inspections in other words to a health oversight agency that oversees the health care system.
• We may also disclose your medical information for *research studies, funeral arrangements, organ and tissue donations, worker’s compensation purposes, your health and safety, and when it is required by law.

Other uses and disclosures require your authorization:
Disclosure of your health information or its use for any purpose other than those listed above requires your specific written authorization. If you change your mind after authorizing a use or disclosure of your information you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision.

*Research:
The practice may contact you regarding new clinical trials for your diagnoses or health status based on screening of practice records. You would then have the choice to get further information and possible participate or decline to participate in any such new trials. The practice may disclose your health information to researchers conducting research with respect to which your written authorization is not required, as approved by an Institutional Review Board or privacy board, in compliance with governing law. The practice may also disclose your health information to staff and business associates for the purpose of “de-identifying” your patient records. That means that information such as your name, telephone number, address and other identifying information may be removed, coded, encrypted or otherwise eliminated or concealed so that the health information is no longer identifiable to the people using it for research. The practice may also receive compensation for providing such de-identified data for research purposes.

Individual Rights:
You have certain rights under the federal privacy standards. These include:

• The right to request restrictions on the use and disclosures of your protected health information.
• The right to receive confidential communications concerning your medical condition and treatment.
• The right to inspect and copy your protected health information.
• The right to amend or submit corrections to your protected health information.
• The right to receive an accounting of certain disclosures of your medical information of how and to whom your protected health information has been disclosed, however, it does not apply to disclosures that occurred prior to April 14, 2003.
• The right to receive a printed copy of this notice.

Illinois CancerCare’s Duties:
We are required by law to maintain the privacy of your protected health information and to provide you with this notice of privacy practices. We also are required to abide by the privacy policies and practices that are outlined in this notice.

Right to Revise Privacy Practices:
As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations. If we change this Notice, we will post the new Notice in waiting areas and on our Internet site at www.IllinoisCancerCare.com. You also may obtain any new Notice by contacting the Privacy Official.

Requests to Inspect Protected Health Information:
As permitted by federal regulation, we require that requests to inspect or copy protected health information be submitted in writing. You may obtain a form to request access to your records by contacting the receptionists, or the Privacy Official.

Complaints:
If you would like to submit a comment or complaint about our privacy practices, you can do so by sending a letter outlining your concerns to:

Peggy Ramsey
Privacy Official at
Illinois CancerCare
8940 N Wood Sage Rd.
Peoria, IL 61615

If you believe that your privacy rights have been violated, you should call the matter to our attention by sending a letter describing the cause of your concern to the same address above. You may also file written complaints with the Director, Office for Civil Rights of the U.S. Department of Health and Human Services. Our Privacy officer will provide you with the address.

You will not be penalized or otherwise retaliated against for filing a complaint.