This Notice of Privacy Practices is being provided to you on behalf of Chicago Lake Shore Medical
Associates with respect to the medical services provided at all Chicago Lake Shore locations. We
understand your medical information is private and confidential. Further, we are required by law to
maintain the privacy of protected health information. Protected health information that we obtain from
you or others that relates to your past, present or future physical or mental health, the health care you have received or payment for your health care.
Although your health record is the physical property of Chicago Lake Shore Medical
Associates, the information belongs to you. You have the right to:
- Request a restriction on certain uses and disclosures of your information as provided by
applicable law.
- Obtain a paper copy of the notice of information practices upon request.
- Inspect and copy your health record as provided by applicable law.
- Obtain an accounting of disclosures of your health information as provided by applicable law
- Request communications of your health information by alternative means or at alternative
locations (phone, fax, P.O. Box, for example).
- Revoke your authorization to use or disclose health information except to the extent that action
has already been taken
Chicago Lake Shore Medical Associates is required to:
- Maintain the privacy of your health information.
- Provide you with a notice as to our legal duties and privacy practices with respect to information we
collect and maintain about you.
- Abide by the terms of this notice.
- Notify you if we are unable to agree to a requested restriction.
- Accommodate reasonable requests you any have to communicate health information by alternative
means or at alternative locations.
- We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will mail a revised notice to
the address you've supplied us.
- We will not use or disclose your health information without your authorization, except as described in this notice
We will use your health information for treatment. For example: Information obtained by a physician
or other member of our office will be recorded in your record and used to determine a course of treatment.
We will provide other physicians or health care providers assigned to your care with copies of various
reports that should assist them in treating you.
We will use your health information for payment. For example: A bill may be sent to you or a third
party payer. The information on or accompanying the bill may include information that identifies you, as
well as your diagnosis, procedures and suppliers used.
We will use your health information for regular health operations. For example: Members of our
staff may use information in your health record to assess the care and outcomes in your case. This
information will then be used in an effort to continually improve the quality and effectiveness of the
healthcare services provided
Business Associates: There are some services provided at Chicago Lake Shore Medical Associates through contacts with business associates. Examples: laboratories, billing services, medical transcription providers. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we have asked them to do, and bill you or your third party payer for the services rendered. So that your health information is protected, we require the business associate to appropriately safeguard your information.
Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and general condition.
Communication with Spouse/Family: Health professionals, using their best judgment, may disclose to your spouse, family member, or another person you identify, health information relevant to that person's involvement in your care or payment related to your care. You have the right to object to these disclosures, and we will not make these disclosures if you object.
Marketing: We may contact you to tell you about or recommend possible treatment alternatives or medical technology and services that may be of interest to you.
Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, or product and product defects to enable product
recalls, repairs or replacement.
Public Health: As required by law, we may disclose your health information to public health or legal authorities charges with preventing or controlling disease, injury or disability.
Law Enforcement: We may disclose health information for law enforcement purposes as required by law, or in response to a valid subpoena
If you have any questions or would like further information about this notice, or if you believe your rights to privacy have been violated, you should contact:
Privacy Officer (312)926-6000
This notice is effective as of April 14, 2003 |
