Northwest

Wellness

Center

 

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION AS REQUIRED BY THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPPA).”
PLEASE REVIEW IT CAREFULLY.
Statement of Uses and Disclosures: The Notice includes the following:
• The types of uses and disclosures that the practice is permitted to make under the Privacy Rule for treatment, payment, and health care operations;
• The other purposes for which the Privacy Rule permits or requires the practice to use or disclose PHI without the individual's written authorization;
• A description of any material limitations or prohibitions imposed by State or other applicable law on permitted uses and disclosures beyond that outlined in the first two dot points;
• Sufficient detail in each description to place the individual on notice of the uses and disclosures that are permitted or required by the Privacy Rule and other applicable law; and
• A statement that other uses and disclosures will be made only with written authorization and that the individual may revoke such authorization.
In addition, the practice includes a statement that the practice will/will not contact the individual with appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to the individual.
Individual Rights: The Notice contains a description of the individual rights granted under the Privacy Rule:
• The right to receive confidential PHI communications of PHI;
• The right to inspect, copy and request amendment of PHI; and
• The right to receive an accounting of PHI disclosures.
The practice allows individuals to request restrictions on the use and disclosure of PHI, and evaluates the request on an individual basis.
The Notice states that the practice may not limit its obligation to make a use or disclosure that either the law requires or the Privacy Rule permits to prevent or lessen a serious and imminent threat to a person’s or public health or safety.
Duties of the Practice: The Notice outlines the practice’s duties, including that the law requires the practice to:
• Maintain the privacy of PHI and provide individuals with notice of the practice’s legal duties and privacy practices with respect to PHI;
• Abide by the terms of the Notice currently in effect; and
• Include a statement that the practice reserves the right to change the terms of its notice and to make the new notice provisions effective for all PHI that it maintains. When this occurs, the practice provides individuals with a revised notice at the patient’s next visit or informs them of how to obtain a revised notice.
Complaints: The Notice explains that individuals may complain to the practice’s privacy officer and to the HHS Secretary, if they believe their privacy rights have been violated. In addition, the Notice indicates how the individual may file a complaint and that the practice will not retaliate against any individual that files a complaint.
Contact: The Notice will contain the title, and telephone number of a person or office to contact for further information. That person is the practice’s privacy officer.

Barbara M. Sokolowski
Practice Manager
909 East Palatine Road
Palatine, Illinois 60074
(847) 776-1400

Effective Date: The Notice contains an effective date, which is not earlier than the date on which the notice is published. The practice’s initial notice was effective April 14, 2003.
Revisions to the Notice: The practice will promptly revise and provide its Notice whenever there is a material change to the uses or disclosures, the individual's rights, the covered entity's legal duties, or other privacy practices stated in the Notice. Except when required by law, a material change to any term of the Notice will not be implemented prior to the effective date of the notice in which such material change is reflected.
Documentation:

The practice documents compliance with the Notice requirements by retaining copies of each of its Notices of Privacy Practices. Copies of the “Receipt of Notice of Privacy Practices” forms are maintained in each patient’s medical record. Copies of materials will be retained as required for a period of six years from the date of creation.


 

   

HIPPA Information

   

Design & Marketing