Patient Privacy Policy

Our Duties Regarding Your Healthcare Information

We are required by law to:

• Maintain the privacy of your healthcare information;
• Provide you with this notice of our legal duties and healthcare information privacy practices; and
• Abide by the terms of this notice.

Your Rights Regarding Your Healthcare Information

Right to Inspect and Obtain Copies:
You have a right to inspect and obtain copies of your healthcare information that we maintain. Usually this includes medical and billing records. Under Federal law, this right does not include psychotherapy notes or healthcare information compiled in reasonable anticipation of litigation, administrative action, or administrative proceeding. You must make your request in writing and we may charge a standard fee for the costs of copying, mailing or other supplies associated with your request.

We may deny your request to inspect and obtain copies in certain limited circumstances. If you are denied access to your healthcare information, you will be notified in writing.

Right to Request Restrictions:
You have a right to request in writing a restriction on the healthcare information that we use or disclose for treatment, payment or healthcare operations. You also have the right to request in writing a limit on the healthcare information we disclose to someone who is involved in your care or the payment for your care, like a family member. You also have a right to restrict certain disclosures of protected health information to a health plan where you pay out of pocket in full for the health care item or service.

In your written request, you must tell us: the information you want to limit; whether you want to limit our use, disclosure or both; and to whom you want the limits to apply (for example, disclosures to your spouse). We are not required to agree to additional restrictions, but if we do, we will abide by our agreement (except in an emergency).

Right to Amend:
If you believe the healthcare information we have is incorrect or incomplete, you may submit in writing a request to amend the information. You must provide a reason that supports your written request. You have the right to request an amendment for as long as the information is kept by or for us.

We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

• Was not created by us;
• Is not part of the healthcare information kept by or for us;
• Is not part of the healthcare information that you would be permitted to inspect and obtain copies;
• Is accurate and complete.

Right to Revoke Authorization:
If you give us an authorization, you may revoke it at any time. Your revocation will not affect any use or disclosure permitted by your authorization while it was in effect.

Right to Request Confidential Communications:
You have the right to request that we communicate your healthcare information to you by alternative means or at an alternative location. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

Right to Request an Accounting:
You have the right to request in writing an accounting of certain disclosures of your healthcare information that we made, if any. This right applies to disclosures for purposes other than treatment, payment, and healthcare operations or as otherwise permitted or required by law. You have a right to receive specific information about these disclosures that occur after April 14, 2003. The right to receive this information is subject to certain exceptions, restrictions and limitations.

Right to Be Notified of a Breach:
You have the right to receive notifications of breaches of your unsecured protected health information.

Right to a Copy of This Notice:
You have the right to obtain a copy of this notice at any time.

Health information exchange. We may share information that we obtain or create about you with other health care providers or other health care entities, such as your health plan or health insurer, as permitted by law, through health information exchanges (HIE). For example, information about your past medical care and current medical conditions and medications can be available to us, other care providers or a hospital, if they participate in the HIE as well. Exchange of health information can provide faster access, better coordination of care and assist providers and public health officials in making more informed decisions. Health records will be available to the HIE unless an individual elects to opt-out. An individual who wishes to opt-out of participation in the HIE should contact the Health Information Services Department to request this restriction. An individual’s decision to opt-out of HIE participation will not adversely affect his or her ability to receive care. However, it may affect the information available to the provider. It does not affect the sharing of health information for treatment through more traditional methods, such as having records faxed or mailed. After choosing to opt-out of HIE participation, an individual may later decide to opt back in by contacting the Health Information Services Department.

Contact for Questions and/or Concerns

If you want more information about our privacy practices or have questions or concerns, please contact:

Compliance
Christie Clinic
101 West University Avenue
Champaign, IL 61820-3909
Phone : 217-366-1200

If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made about access to your healthcare information or in response to a request you made to amend or restrict the use or disclosure of your healthcare information or to have us communicate with you by alternative means or at alternative locations, you may complain to us using the contact information listed above.
You also may submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services upon request. We support your right to the privacy of your healthcare information. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.

Organizations Covered by this Notice

These organizations are each participants in an organized healthcare arrangement with Christie Clinic. As such, we may share your healthcare information and the healthcare information of others we service with each other as needed for treatment, payment or healthcare operations relating to our organized healthcare arrangement. The list of covered entities includes but is not limited to:

Christie Clinic, LLC

Christie Clinic Pathology, LLC

Christie Clinic ASC, LLC

The list of our covered entities may be subject to change without notice. Please see our website at www.christieclinic.com for the most current information on the list of our covered entities.

Uses and Disclosures of Healthcare Information Without Your Authorization

The following categories describe different ways that we may use and disclose your healthcare information without your written authorization. For each category, we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose healthcare information without written authorization fall within one of the categories. We use and disclose medical information about you for treatment, payment, and healthcare operations.

Treatment: We may use or disclose your healthcare information to a physician or other health care provider in order to provide treatment to you.

Payment: We may use and disclose your healthcare information to obtain payment for services we provide to you. We may disclose your healthcare information to another healthcare provider or entity subject to the federal Privacy Rules so they can obtain payment.

Healthcare Operations: We may use and disclose your healthcare information in connection with our healthcare operations. Healthcare operations include:

• quality assessment and improvement activities;
• reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing or credentialing activities;
• medical review, legal services, and auditing, including fraud and abuse detection and compliance;
• business planning and development; and
• business management and general administrative activities, including management activities relating to privacy, customer service, resolution of internal grievances, and creating de-identified medical information or a limited data set.

We may disclose your healthcare information to another entity that has a relationship with you and is subject to the federal Privacy Rules, for their healthcare operations.

Research: As part of building a healthy community, we conduct research. There are special processes required by law that are designed to provide added protections for people involved in research including privacy issues which we follow. There are times when your health information may be reviewed by a research staff or one of your providers if it is believed you might be interested in or benefit from a research study. Information about you might be kept in a secure research database. We will not disclose your health information outside of Christie Clinic for research purposes without your written permission or making sure your privacy is protected.

On Your Authorization: You may give us written authorization to use your healthcare information or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect. Unless you give us a written authorization, we cannot use or disclose your healthcare information for any reason except those described in this notice.

To Your Family and Friends: We may disclose your healthcare information to a family member, friend or other person to the extent necessary to help with your healthcare or with payment for your healthcare. We may use or disclose your name, location, and general condition or death to notify, or assist in the notification of (including identifying or locating), a person involved in your care.

Before we disclose your healthcare information to a person involved in your healthcare or payment for your healthcare, we will provide you with an opportunity to object to such uses or disclosures. If you are not present, or in the event of your incapacity or an emergency, we will disclose your healthcare information based on our professional judgment of whether the disclosure would be in your best interest.

We will also use our professional judgment and our experience with common practice to allow a person to pick up filled prescriptions, medical supplies, x-rays or other similar forms of healthcare information.

Disaster Relief: We may use or disclose your medical information to a public or private entity authorized by law or by its charter to assist in disaster relief efforts.

Health Related Services: We may use your healthcare information to contact you with information about health-related benefits and services or about treatment alternatives that may be of interest to you. We may disclose your healthcare information to a business associate to assist us in these activities.

Public Benefit: We may use or disclose your healthcare information as authorized by law for the following purposes deemed to be in the public interest or benefit:

• as required by law;
• for public health activities, including disease and vital statistic reporting, child abuse reporting, FDA oversight, and to employers regarding work-related illness or injury;
• to report adult abuse, neglect, or domestic violence;
• to health oversight agencies;
• in response to court and administrative orders and other lawful processes;
• to law enforcement officials pursuant to subpoenas and other lawful processes, concerning crime victims, suspicious deaths, crimes on our premises, reporting crimes in emergencies, and for purposes of identifying or locating a suspect or other person;
• to coroners, medical examiners, and funeral directors;
• to organ procurement organizations;
• to avert a serious threat to health or safety;
• in connection with certain research activities;
• to the military and to federal officials for lawful intelligence, counterintelligence, and national security activities;
• to correctional institutions regarding inmates; and
• as authorized by state worker’s compensation laws.

Fundraising: We may use your health information or share it with our related foundations to contact you regarding our fundraising activities. You have the right to opt out of receiving fundraising communications. You may do so by contacting the Privacy officer.

Health information exchange. We may share information that we obtain or create about you with other health care providers or other health care entities, such as your health plan or health insurer, as permitted by law, through health information exchanges (HIE). For example, information about your past medical care and current medical conditions and medications can be available to us, other care providers or a hospital, if they participate in the HIE as well. Exchange of health information can provide faster access, better coordination of care and assist providers and public health officials in making more informed decisions. Health records will be available to the HIE unless an individual elects to opt-out. An individual who wishes to opt-out of participation in the HIE should contact the Health Information Services Department to request this restriction. An individual’s decision to opt-out of HIE participation will not adversely affect his or her ability to receive care. However, it may affect the information available to the provider. It does not affect the sharing of health information for treatment through more traditional methods, such as having records faxed or mailed. After choosing to opt-out of HIE participation, an individual may later decide to opt back in by contacting the Health Information Services Department.

Other Legal Restrictions: HIPAA generally does not override other laws that give people greater privacy protections. As a result, if any applicable state or federal privacy law requires us to provide you with more privacy protections, then we must follow the law in addition to HIPAA. Certain types of information may have additional protection under federal or state law; such as mental health records and HIV AIDS tests results.

Christie Clinic complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

Notice About Nondiscrimination and Accessibility Requirements

Christie Clinic complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Christie Clinic does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Christie Clinic provides the following aids and services free of charge:

• Aids and services to people with disabilities to communicate effectively with us, such as qualified sign language interpreters and written information in other formats (large print, audio, accessible electronic formats, other formats);
• Language services to people whose primary language is not English, such as qualified interpreters and information written in other languages
• If you need these services, contact Christie Clinic’s Section 1557 Coordinator.

If you believe that Christie Clinic has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Section 1557 Coordinator, 101 W. University Ave., Champaign, IL 61820, 217-366-1200, 217-366-1294, compliance@christieclinic.com. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the Section 1557 Coordinator is available to help you.

ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1–217-366-1200 (TTY: 1–888-391-0412).

ATENCIÓN:si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística.Llame al 1–217-366-1200 (TTY: 1–888-391-0412).

UWAGA:Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej.Zadzwoń pod numer 1–217-366-1200 (TTY: 1–888-391-0412).

注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1–217-366-1200 (TTY: 1–888-391-0412).。

주의:한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다.1-217-366-1200 (TTY: 1–888-391-0412) 번으로 전화해 주십시오.

PAUNAWA:Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad.Tumawag sa 1-217-366-1200 (TTY: 1–888-391-0412)

ملحوظة:إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان.اتصل برقم 1-217-366-1200 (رقم هاتف الصم والبكم: 1-888-391-0412).

ВНИМАНИЕ:Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода.Звоните 1–217-366-1200 (телетайп: 1–888-391-0412).

સુચના: જો તમે ગુજરાતી બોલતા હો, તો નિ:શુલ્ક ભાષા સહાય સેવાઓ તમારા માટે ઉપલબ્ધ છે. ફોન કરો 1–217-366-1200 (TTY: 1–888-391-0412).

خبردار: اگر آپ اردو بولتے ہیں، تو آپ کو زبان کی مدد کی خدمات مفت میں دستیاب ہیں ۔ کال کریں 1-217-366-1200 (TTY: 1-888-391-0412).

CHÚ Ý:Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn.Gọi số 1–217-366-1200 (TTY: 1–888-391-0412).

ATTENZIONE:In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti.Chiamare il numero 1–217-366-1200 (TTY: 1–888-391-0412).

ध्यान दें:यदि आप हिंदी बोलते हैं तो आपके लिए मुफ्त में भाषा सहायता सेवाएं उपलब्ध हैं। 1–217-366-1200 (TTY: 1–888-391-0412) पर कॉल करें।

ATTENTION :Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement.Appelez le 1–217-366-1200 (ATS : 1–888-391-0412).

ΠΡΟΣΟΧΗ: Αν μιλάτε ελληνικά, στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης, οι οποίες παρέχονται δωρεάν. Καλέστε 1–217-366-1200 (TTY: 1–888-391-0412).

ACHTUNG:Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung.Rufnummer: 1–217-366-1200 (TTY: 1–888-391-0412).