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

We respect participant confidentiality and only release personal health information about you in accordance with Illinois and federal law. This notice describes our policies related to the use of your records of care generated by Heartland Alliance, Inc.

Privacy Contact. If you have any questions about this policy or your rights contact the Director of Quality Management at 773-751-4108 for services received at Heartland Health Outreach. For Heartland Human Care Services call 773-728-5960 ext 6251. If you are receiving services at Heartland Housing, you can access either number.  

USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION

To effectively provide you care, there are times when we will need to share your personal health information with others beyond Heartland Alliance, Inc. These times include:

Treatment. With your permission we may use or disclose personal health information about you to provide, coordinate, or manage your care or any related services, including sharing information with others outside Heartland Alliance, Inc. that we are consulting with or referring you to.

Payment. Information will be used to obtain payment for the treatment and services provided. This will include contacting your health insurance company for prior approval of planned treatment or for billing purposes.

Health Care Operations. We may use information about you to coordinate our business activities. This may include setting up your appointments, reviewing your care, or training staff.

Information Disclosed Without Your Consent. Under Illinois and federal law, information about you may be disclosed without your consent in the following circumstances:

Emergencies. Sufficient information may be shared to address the immediate emergency you are facing.

Follow Up Appointments/Care. We will be contacting you to remind you of future appointments or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

As Required by Law. This would include situations where we have a subpoena, court order, or are mandated to provide public health information, such as communicable diseases or suspected abuse and neglect such as child abuse, elder abuse, or institutional abuse.

Coroners, Funeral Directors. We may disclose personal health information to a coroner or personal health examiner and funeral directors for the purposes of carrying out their duties.

Governmental Requirements. We may disclose information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, and licensure. We may need to share information with the Food and Drug Administration related to adverse events or product defects. We are also required to share information, if requested with the Department of Health and Human Services to determine our compliance with federal laws related to health care.

Criminal Activity or Danger to Others. If a crime is committed on our premises or against our personnel we may share information with law enforcement to apprehend the criminal. We also have the right to involve law enforcement and to warn any potential victims when we believe an immediate danger may occur to someone.

Fundraising. As a not for profit provider of health care services we need assistance in raising money to carry out our mission. We may contact you to seek a donation.

Research : We may disclose your health information to researchers if you have agreed to participate in a research study and have consented to that study.

PARTICIPANT RIGHTS

You have the following rights under Illinois and federal law:

Copy of Record. You are entitled to inspect the personal health record Heartland Alliance, Inc. has generated about you. We may charge you a reasonable fee for copying and mailing your record.

Release of Records. You may consent in writing to the release of your records to others for any purpose you choose; This could include your attorney, employer, or others who you wish to have knowledge of your care. You may revoke this consent at any time, but doing so will only prevent the future sharing of information; We are not responsible for the retrieval of information that has already been shared based on a prior authorization.

Restriction on Record. You may ask us not to use or disclose part of the personal health information. This request must be in writing. Heartland Alliance, Inc. is not required to agree to your request if we believe it is in your best interest to permit use and disclosure of the information. The request should be given to the Director of Quality Management. 

Contacting You. You may request that we send information to another address or by alternative means. We will honor such request as long as it is reasonable and we are assured it is correct. We have a right to verify that the payment information you are providing is correct. We also will be glad to provide you information by email if you request it.

Amending Record. If you believe that something in your record is incorrect or incomplete, you may request we amend it. To do this contact the Director of Quality Management and ask for the Request to Amend Health Information form. In certain cases, we may deny your request. If we deny your request for an amendment you have a right to file a statement you disagree with us. We will then file our response and your statement and our response will be added to your record.

Accounting for Disclosures. You may request an accounting of any disclosures we have made related to your personal health information, except for information we used for treatment, payment, or health care operations purposes or that we shared with you or your family, or information that you gave us specific consent to release. It also excludes information we were required to release. To receive information regarding disclosure made for a specific time period no longer than six years and after April 14, 2003, please submit your request in writing to our Director of Quality Management. We will notify you of the cost involved in preparing this list.

Questions and Complaints. If you have any questions, or would like a copy of this Policy or have any complaints, you may contact our Director of Quality Management in writing at our office for further Information. You also may file a complaint to the Secretary of Health and Human Services if you believe Heartland Alliance, Inc. has violated your privacy rights. We are legally prohibited from retaliating against persons who file a complaint against us.

Changes in Policy. Heartland Alliance, Inc. reserves the right to change its Privacy Policy based on the needs of Heartland Alliance, Inc. and changes in state and federal law.