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
Midwest
Physician Centers uses health information about you for treatment, to obtain
payment for treatment, for administrative purposes, and to evaluate the quality
of care that you receive. Your health
information is contained in a medical record that is the physical property of
Midwest Physician Centers.
How Midwest Physician
Centers May Use or Disclose Your Health Information
For Treatment. Midwest Physician Centers may use your
health information to provide you with medical treatment or services. For example, information obtained by a health
care provider, such as a physician, nurse, or other person providing health
services to you, will record information in your record that is related to your
treatment. This information is
necessary for health care providers to determine what treatment you should
receive. Health care providers will
also record actions taken by them in the course of your treatment and note how
you respond to the actions.
For Payment. Midwest
Physician Centers may use and disclose your health information to others for purposes
of receiving payment for treatment and services that you receive. For example, a bill may be sent to you or a
third-party payor, such as an insurance company or health plan. The information on the bill may contain
information that identifies you, your diagnosis, and treatment or supplies used
in the course of treatment.
For Health Care Operations. Midwest Physician Centers may use and
disclose health information about you for operational purposes. For example, your health information may be
disclosed to members of the medical staff, risk or quality improvement
personnel, and others to:
·
evaluate the performance
of our staff;
·
assess the quality of
care and outcomes in your cases and similar cases;
·
learn how to improve our
facilities and services; and
·
determine how to
continually improve the quality and effectiveness of the health care we
provide.
Appointments. Midwest
Physician Centers may use your information to provide appointment reminders or
information about treatment alternatives or other health-related benefits and
services that may be of interest to you.
Group Health Plans. A group health plan, health insurance issuer, or HMO
with respect to a group health plan may disclose health information to the
sponsor of the plan.
Required by law. Midwest
Physician Centers may use and disclose information about you as required by
law. For example, Midwest Physician Centers may disclose information for the
following purposes:
·
for judicial and
administrative proceedings pursuant to legal authority;
·
to report information
related to victims of abuse, neglect or domestic violence; and
·
to assist law
enforcement officials in their law enforcement duties;
Public Health. Your health information may be used or
disclosed for public health activities such as assisting public health
authorities or other legal authorities to prevent or control disease, injury,
or disability, or for other health oversight activities.
Decedents. Health
Information may be disclosed to funeral directors or coroners to enable them to
carry out their lawful duties.
Organ/Tissue Donation. Your health information may be used or
disclosed for cadaveric organ, eye or tissue donation purposes.
Research. Midwest Physician Centers may use your
health information for research purposes when an institutional review board or
privacy board that has reviewed the research proposal and established protocols
to ensure the privacy of your health information has approved the research.
Health and Safety. Your health information may be disclosed to
avert a serious threat to the health or safety of you or any other person
pursuant to applicable law.
Government Functions. Specialized government functions such as
protection of public officials or reporting to various branches of the armed
services that may require use or disclosure of your health information.
Workers Compensation. Your health information may be used or
disclosed in order to comply with laws and regulations related to Workers
Compensation.
Other uses. Other uses and disclosures will be made only with
your written authorization and you may revoke the authorization except to the
extent Midwest Physician Centers has taken action in reliance on such.
You have the right to:
·
request a restriction on
certain uses and disclosures or your information as provided by 45 C.F.R.
§164.522; however, Midwest Physician Centers is not required to agree to a
requested restriction;
·
obtain a paper copy of
the notice of information practices upon request;
·
inspect and obtain a
copy of your health record as provided for in 45 C.F.R. §164.524;
·
request that your health
record be amended as provided in 45 C.F.R. §164.526;
·
request communications
of your health information by alternative means or at alternative locations;
and
·
receive an accounting of
disclosures made of your health information as provided by 45 C.F.R. §164.528.
If you wish to file a compliant it should be addressed to our
Compliance Officer if you believe your privacy rights have been violated. You will not be retaliated against for
filing a complaint. You may also
contact the Secretary, Health and Human Services (HHS).
Midwest Physician Centers is
required to:
·
maintain the privacy of
protected health information;
·
provide you with this
notice of its legal duties and privacy practices with respect to your health
information;
·
abide by the terms of
this notice;
·
notify you if we are
unable to agree to a requested restriction on how your information is used or
disclosed;
·
accommodate reasonable
requests you may make to communicate health information by alternative means or
at alternative locations; and
Midwest Physician Centers
reserves the right to change its information practices and to make the new
provisions effective for all protected health information it maintains. Revised notices will be made available to
you by posting in the center and on its web site, www.mpcdoc.com.
If you have any questions or
complaints, please contact: Midwest Physician Group, Privacy Officer, 20110
Governors Hwy., Olympia Fields, IL 60461
(708) 503-3998