THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Near North Health Service Corporation (NNHSC) is committed to treating and using your protected health information responsibly. This Notice of Health Information Practices describes the personal health information that we collect and how/when we use or disclose this information. It also describes your rights as they relate to your protected health information. This notice is effective April 14, 2003 and applies to all protected health information as defined by federal regulations.
Each time you visit one of NNHSC's health centers a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment and a plan for future care or management. This information often referred to as your health or medical record is a:
Understanding what is in your record and how your health information is used helps you to ensure its accuracy; better understand who, what, when, where and why others may access your health information; and, make more informed decisions when authorizing disclosure to others.
Although your health record is the physical property of NNHSC, the information contained in the record belongs to you. You have the right to:
Near North Health Service is required to:
NNHSC reserves the right to change its practices and to make the new provisions effective for all protected health information that it maintains. Should NNHSC's information practices change, a revised notice will be mailed to the address you supplied or, if you agree, it will be sent via email.
We will not use or disclose your health information without your authorization, except as described in this notice. We will also discontinue the use or disclosure of your health information after we have received a written revocation of the authorization according to the procedures included in the authorization.
If you have questions and would like additional information about this notice or its contents, you may contact NNHSC's Privacy Officer by calling (312) 337-1073, or by writing to: Privacy Officer, Near North Health Service Corporation, 1276 North Clybourn Avenue, Chicago, Illinois 60610, or by emailing the Privacy Officer at firstname.lastname@example.org.
If you believe your privacy rights have been violated you may file a complaint with NNHSC's Privacy Officer (at the address listed above) or you may contact the U.S. Department of Health and Human Services Office of Civil Rights. There will be no penalty for filing a complaint by either the NNHSC's Privacy Officer or the Office of Civil Rights. The Office of Civil Rights' address is:
Office of Civil Rights
U.S. Department of Health & Human Services
200 Independence Avenue, S.W.
Room 509F, HHH Building
Washington, D.C. 20201
[Note: This document is a summary of the Near North Health Service Corporation's Health Information Policy. Anyone who wishes to see the Policy in its entirety may do so by contacting the NNHSC Privacy Officer at 1276 N. Clybourn Avenue, Chicago, IL 60610, or by calling to schedule an appointment on 312.337.1073.]