Thorek Memorial Hospital Andersonville understands that medical information about our patients is sensitive and is committed to protecting its privacy. As a visitor of the hospital, please adhere to the following patient privacy guidelines to ensure that your loved one’s care and treatment remains confidential:
- If you have concerns regarding a patient’s condition, please remember that all conversations should be conducted at the patient’s bedside or in the confines of a designated conference room. Please refrain from discussing the family member’s medical information in the public waiting area.
- Videotaping, recording and cameras in patient areas are prohibited.
- Please refrain from cell phone use in all patient care areas. If you must make a phone call, please step into the family waiting area or outside of the hospital.
Thorek Memorial Hospital Andersonville Privacy Notice
Effective April 14, 2003,
Updated May 6, 2014,
Updated June 18, 2020
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 page describes the type of information we gather about you, with whom that information may be shared, and the safeguards we have in place to protect it. You have the right to the confidentiality of your medical information and the right to approve or refuse the release of specific information except when the release is required by law. If the practices described in this brochure meet your expectations, there is nothing you need to do. If you prefer that we not share information, we may honor your written request in certain circumstances described below. If you have any questions about this notice, please contact our Privacy Officer at the address below.
Who Will Follow This Notice
This notice of Privacy Practices (the “Notice”) describes Thorek Memorial Hospital Andersonville practices regarding the use of your medical information and that of:
- Any health care professional authorized to enter information into your hospital chart or medical record.
- All departments and units of the hospitals, clinics or doctor’s offices you may visit.
- Any member of a volunteer group we allow to help you while you are in the hospital.
- All employees, staff and other personnel who may need access to your information.
- All entities, sites and programs of Thorek Memorial Hospital Andersonville follow the terms of this notice. In addition, these entities, sites and locations may share medical information with each other – via physical or electronic transmission – for treatment, payment or health care purposes described in this notice.
Our Pledge Regarding Medical Information
We understand that medical information about you and your health is personal. Protecting medical information about you is important. We create a record of the care and services you receive. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by Thorek Memorial Hospital Andersonville whether made by healthcare professionals or other personnel.
This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.
We are required by law to:
- Keep medical information that identifies you private;
- Give you this notice of our legal duties and privacy practices with respect to medical information about you; and
- Follow the terms of the notice that is currently in effect.
How We May Use and Disclose Medical Information About You
The following categories describe different ways that we may use and disclose medical information. For each category of uses or disclosures we will provide examples. The examples provided are illustrative and are not intended to cover every circumstance under which we will make use of your medical information.
For Treatment. We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, training healthcare professionals, or other healthcare professionals who are involved in taking care of you. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In addition, the doctor may need to tell the dietitian if you have diabetes, so that he/she can arrange for appropriate meals. Different healthcare professionals also may share medical information about you in order to coordinate the different things you need, such as prescriptions, lab work and x-rays. We also may disclose medical information about you to people outside the hospital who may be involved in your medical care after you leave the hospital or who provide services that are part of your care.
Notwithstanding the above, we will comply with Illinois law in the event that it is more stringent than the federal Health Insurance Portability and Privacy Act (HIPPA). For example, we will not use or disclose any information regarding HIV or AIDS status, mental health or developmental disabilities, or genetic testing results without your express written authorization, except to the extent such disclosures are permitted by the relevant Illinois law governing such disclosures.
For Payment. We may use and disclose medical information about you so that the treatment and services you received may be billed to, and payment may be collected from, you, an insurance company, or a third party. For example, your insurance may need to know about surgery you received so that it will pay us or reimburse you for the cost of the surgery. We may also use and disclose medical information about you to obtain prior approval or to determine whether your insurance will cover the treatment.
For Healthcare Operations. We may use and disclose medical information about you for healthcare operations. This is necessary to make sure that all of our patients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also disclose information to doctors, nurses, technicians, training healthcare professionals, medical students, and other hospital personnel for review and learning purposes. We may remove information that identifies you from this set of medical information so others may use it to study healthcare and healthcare delivery without learning who the specific patients are.
Appointment Reminders. We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care. Such appointment reminders will be left with household members or on telephone answering machines unless you restrict this practice by contacting our Privacy Officer in writing.
Treatment Alternatives. We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
Health-Related Benefits and Services. We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
Hospital Directory. We may include certain limited information about you in the hospital directory while you are a patient at the hospital. This information may include your name, location in the hospital, your general condition (e.g., fair, stable, etc.) and your religious affiliation. The directory information, except for your religious affiliation, may also be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy, such as a priest or rabbi, even if she/he does not ask for you by name. This is so your family, friends and clergy can visit you in the hospital and generally know how you are doing.
Individuals Involved In Your Care or Payment for Your Care. We may release medical information about you to a family member or to an individual who is involved in your medical care. We may also give information to someone who helps pay for your care. We may also tell your family or an individual who is involved in your care your condition and that you are in the hospital. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.
Business Associates. We will disclose your medical information to our business associates – those vendors with whom we contract to provide a service to Thorek Memorial Hospital Andersonville. Examples of such business associates include our attorneys, auditors, certain healthcare providers, and other agencies. When services are contracted, we may disclose your medical information to our business associates so that they can perform the job that we ask them to do. To protect your medical information, however, we require our business associates to appropriately safeguard your medical information by requiring that they enter into an appropriate agreement with Thorek Memorial Hospital Andersonville.
As Required By Law. We will disclose medical information about you when required to do so by federal, state or local law. For example, we may disclose your health information to the Food and Drug Administration (FDA) to report adverse events with food or drugs. We may also disclose information for law enforcement purposes as required by law or in response to a valid subpoena.
To Avert a Serious Threat to Health and Safety. We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
Fundraising Activities. We may use medical information about you in an effort to raise money for Thorek Memorial Hospital Andersonville and its operations. We may disclose medical information to a foundation related to the hospital so that the foundation may raise money for the hospital. We only would release information, such as your name, address and phone number. If you do not want Thorek Memorial Hospital Andersonville to contact you for fundraising efforts, you must notify our Privacy Officer in writing at the address below.
Organ and Tissue Donation. If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation, or to an organ donation bank, as necessary, to facilitate organ or tissue donation and transplantation.
Military and Veterans. If you are a member of the armed forces, we may release medical information about you as required by military command authorities.
Worker’s Compensation. We may release medical information about you for worker’s compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.
Public Health Risk. We may disclose medical information about you for public health activities. These activities generally include the following:
- To prevent or control disease, injury or disability;
- To report births and deaths;
- To report child or elder abuse and/or neglect;
- To report reactions to medications or problems with products;
- To notify people of recalls of products they may be using;
- To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and
- To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence.
Health Oversight Activities. We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the healthcare system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes. We may disclose medical information about you in response to a subpoena, discovery request, or other lawful order from a court. Illinois law may require your written permission to disclose information in certain proceedings involving information obtained by providers, such as physicians, rape counselors and crisis counselors.
Law Enforcement. We may release medical information if asked to do so by a law enforcement official as part of law enforcement activities; in investigations of criminal conduct or of victims of crime; in response to court orders; in emergency circumstances; or when required to do so by law.
Coroners, Medical Examiners and Funeral Directors. We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients of the hospital to funeral directors as necessary to carry out their duties.
Protective Services for the President, National Security and Intelligence Activities. We may release medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state; or conduct special investigations; or for intelligence, counterintelligence and other national security activities authorized by law.
Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with healthcare; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
Your Rights Regarding Medical Information About You
You have the following rights regarding medical information we maintain about you:
Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your care. This would usually includes medical and billing records, but does not include psychotherapy notes.
To inspect and copy medical information which may be used to make decisions about you, you must submit your request in writing to our Privacy Officer at the address below. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.
We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to your medical information, in many circumstances you may request that the denial be reviewed. If a review is applicable, another licensed healthcare professional chosen by Thorek Memorial Hospital Andersonville will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review. Please note, however, that under certain limited circumstances, there is no opportunity for a review of denial of access to your medical information.
Right to Amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept. Any amendment to your medical records will be disseminated to anyone who received the original information.
To request an amendment, your request must be made in writing and submitted to our Privacy Officer. In addition, you must provide a reason that supports your request.
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, unless the person or entity that created the information is no longer available to make the amendment;
- Is not part of the medical information kept by Thorek Memorial Hospital Andersonville;
- Is not part of the information which you would be permitted to inspect and copy; or
- Is accurate and complete.
In the event that we are unable to agree to a request for amendment we will provide you with written notification.
Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures.” This is a list of the disclosures of your medical information that we have made to third parties. Such an accounting shall not include disclosures made for treatment, payment or health care operations; for national security interests; to comply with authorized requests of law enforcement or correctional institution officials; or to you to inform you of the content of your medical records. In addition, an accounting will not include disclosures that you expressly have authorized; disclosures made to persons involved in your care; or disclosures made to maintain the facility’s directory.
All requests for accountings shall be submitted in writing and directed to our Privacy Officer. Your request must state a time and period that may not be longer than six years and may not include dates before June18, 2010. Your request should indicate in what form you want the list (for example, on paper or electronically). The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Right to Request Restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or healthcare operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, such as a family member or friend.
We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment. In the event that we are unable to agree to your request for restrictions on the use or disclosure of your medical information, we will provide you with written notice.
All requests for restrictions shall be in writing and shall be directed to our Privacy Officer at the address below. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply. Please note that you will be required to bear any additional costs associated with your request (for example, additional postage, etc.).
Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
To request confidential communications, you must make your request in writing to our Privacy Officer. We will not ask you the reason for your request and we will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.
To obtain a paper copy of this notice, please request one in writing from our Privacy Officer at the address below. We will provide a copy of the current notice to any individual upon request.
Changes To This Notice
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post copies of the current notice in paper form in prominent locations throughout Thorek Memorial Hospital Andersonville facilities. We will also post a copy of our current notice on our website: https://thorekandersonville.org. The notice will contain the effective date in the header of the first page and on the last page.
If you believe your privacy rights have been violated, you may file a complaint with Thorek Memorial Hospital Andersonville or with the Secretary of the Department of Health and Human Services. To file a complaint with Thorek Memorial Hospital Andersonville contact our Privacy Officer at the address and phone number below. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
Authorized Uses of Medical Information
Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written authorization. If you authorize us to use or disclose medical information about you, you may revoke your authorization, in writing, at any time. If you revoke your authorization, thereafter, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have made in reliance upon your authorization, and that we are required to retain our records of the care that we provided you.
Privacy Officer: Edwin Punsalan
5025 N Paulina St,
Chicago, IL 606040