Privacy Practices...

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 Notice of Privacy Practices has been created by The MILL (hereinafter referred to as the “Provider”) to inform you of how we may use your protected health information for treatment, payment and health care operations purposes and as otherwise permitted by law. Protected health information is information about you which can be used to identify you and which relates to your physical or mental condition, our provision of health care services to you, or the payment for health care services we provide to you. We are required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy practices with regard to accessing, amending and controlling the use of your protected health information. We will abide by the terms of the Notice of Privacy Practices currently in effect. However, we reserve the right to change the terms of this Notice of Privacy Practices at any time as it applies to all protected health information in our custody without providing any notice of such change. Upon the occurrence of any revision of the terms of the Notice of Privacy Practices currently in effect, you may obtain a revised copy of this Notice of Privacy Practices from our case records personnel at our office located at 3445 Elmwood Road, Rockford, IL at your request. You can also obtain a copy of the Notice of Privacy Practices by visiting our web site at www.themillrockford.com. The Privacy Contact for the Provider is: Debbie Brasch. Please direct all questions and requests to the Privacy Contact in writing at the address listed in the preceding paragraph. I. Treatment, Payment and Health Care Operations Your protected health information may be used and disclosed by us and other health care providers outside of our office that are involved in your care and treatment for the purpose of providing health care services to you. We may use and disclose your protected health information in order for us to obtain payment for the health care services and goods that we provide to you. We may also use and disclose your protected health information in order to conduct the business of the Provider. Following are examples of the types of uses and disclosures of your protected health care information that we are permitted to make. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures we may make. Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with another health care provider. For example, we would disclose your protected health information, as necessary, to a hospital that provides care to you. We will also disclose protected health information to other physicians and therapists who may be treating you. For example, your protected health information may be provided to a physician or therapist to whom you have been referred so that the physician or therapist has the necessary information to diagnose or treat you. In addition, we may disclose your protected health information from time-to-time to another physician or health care provider (e.g., a specialist or laboratory) who becomes involved in your care by providing assistance with your health care diagnosis or treatment. Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you such as; making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. We will disclose to your health insurance company information about the goods and services rendered to you in order to obtain payment from your insurance company. We may also disclose your protected health information to another entity so that it may seek payment. Healthcare Operations: We may use or disclose, as needed, your protected health information in order to support our business activities. These activities include, but are not limited to, quality assessment activities, employee review activities, face-to-face marketing activities, and conducting or arranging for other business activities. For example, we may share your protected health information with other consulting staff and therapists for quality assurance or peer review purposes. We will share your protected health information with third party “business associates” that perform various activities (e.g., billing services) for the Provider. Whenever an arrangement between our office and a business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information. We may disclose your protected health information to another entity for: health care fraud and abuse detection or compliance, conducting quality assessment and improvement activities, population-based activities relating to improving health or reducing health care costs, protocol development, case management and care coordination, and related functions that do not include treatment, reviewing the competence of health care professionals, conducting training programs, accreditation, certification, licensing, credentialing or other similar activities. Disclosures described in the preceding sentence will only be made if the other entity has or had a relationship with you. We may disclose your protected health information to an organized health care arrangement in which we participate for any health care operation activities of said organized health care arrangement. An example of an organized health care arrangement is a hospital and its medical staff. II. Uses and Disclosures of Protected Health Information Based Upon Your Written Authorization Other uses and disclosures of your protected health information for purposes other than treatment, payment and health care operations will be made only with your written authorization, unless otherwise permitted or required by law as described below. For example, if you wish to have the Illinois Department of Human Services, Office of Rehab Services, Disability Determination have access to your protected health information which is in our files, you will need to sign a written authorization permitting us to disclose such information. You may revoke an authorization at any time in writing, except to the extent that we have taken an action in reliance on the use or disclosure indicated in the authorization. III. Uses and Disclosures for Which You Have the Opportunity to Agree or Object We may use or disclose your protected health information in the circumstances described in this section III, without seeking an authorization, provided we first give you an opportunity to object to such use or disclosure. If you are present, we may either obtain your agreement to use or disclose your protected health information as described below, or we may provide you with an opportunity to object and accept our failure to object as your agreement, or we may reasonably infer from the circumstances that you do not object. If you are not present or are unable to agree or object to such use or disclosure of your protected health information, we may use our professional judgment to determine whether the use or disclose of your protected health information is in your best interest. All communication described in this Section III may be done orally. a. Individuals Involved in your Care. Unless you object, we may disclose your protected health information to your family member, other relative or close personal friend or any other individual identified by you as being a person who is directly involved with your care or payment relating your care or treatment. b. Disaster Relief. Unless you object, we may use or disclose your protected health information to a public or private entity authorized to assist in disaster relief efforts for the purpose of coordinating with such entities the notification of your family or other persons involved in your care. c. Notification of Family. Unless you object, we may use or disclose protected health information to notify or assist in the notification of a family member, a personal representative, or other person responsible for your care of your location and general condition. IV. Uses and Disclosures of Protected Health Information That Do Not Require Your Authorization or Opportunity to Object We are permitted to make the following uses and disclosures of your protected health information without having to obtain your authorization, or give you an opportunity to object: a. Uses and Disclosures Required by Law. We may use or disclose your protected health information when the use or disclosure is required by law, as long as the use or disclosure meets all applicable requirements of such law. b. Uses and Disclosures for Public Health Activities. We may disclose your protected health information to a public health authority, including but not limited to: the reporting of disease, injury, vital events such as birth or death, and the conduct of public health surveillance, public health investigations, and public health interventions; or at the direction of a public health authority, to an official of a foreign government agency that is acting in collaboration with a public health authority; the reporting of child abuse or neglect; reporting to the Food an Drug Administration adverse events, product defects or problems, any biological deviations, to track products to enable product recalls, repairs or replacements, or to conduct post marketing surveillance, reporting a person who may have been exposed to a communicable disease or otherwise be at risk for contracting or spreading a disease or condition as authorized by law. c. Uses and Disclosures about Victims of Abuse, Neglect or Domestic Violence. We may disclose your protected health information, to a governmental authority if we reasonably believe that you are a victim of abuse, neglect or domestic violence. Such disclosure is only allowed if it is required by law or if it is expressly authorized by law and certain other requirements are met. d. Uses and Disclosures for Oversight Activities. We may disclose your protected health information to health oversight agencies (e.g., The U.S. Department of Health and Human Services) for oversight activities authorized by law, including the following: audits; civil, administrative, or criminal investigations; inspections; licensure or disciplinary actions; civil, administrative, or criminal proceedings or actions; or other appropriate oversight activities. e. Disclosures for Judicial Proceedings. We may disclose your protected health information in a judicial or administrative proceeding if the request for such protected health information is made through or pursuant to: (A) an order from a court or administrative tribunal or (B) in response to a subpoena or discovery request from a party to the proceeding if certain assurances have been provided to us. f. Disclosures for Law Enforcement Purposes. Under certain circumstances, we may disclose your protected health information to law enforcement officials. g. Uses and Disclosures Concerning Decedents. We may disclose protected health information to coroners and medical examiners for the purpose of identifying a deceased person, determining a cause of death, or other duties as authorized by law. We may also disclose protected health information to funeral directors to carry out their duties in accordance with applicable laws. h. Uses and Disclosures for Research Purposes. We may use or disclose your protected health information for research purposes, provided the research has been approved by appropriate oversight entities and sufficient privacy protections have been implemented. i. Uses and Disclosures to Avert a Serious Threat to Health or Safety. We may disclose your protected health information if we believe the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public, and the disclosure is made to a person(s) able to prevent or lessen the threat including the target of the threat; or the disclosure is necessary for law enforcement authorities to identify or apprehend an individual. j. Military Activities. If you are a member of the Armed Forces we may use and disclose your protected health information for activities deemed necessary by appropriate military command authorities. k. National Security and Intelligence Activities. We may disclose your protected health information to authorized federal officials for the conduct of lawful intelligence, counterintelligence and other national security activities authorized by the National Security Act or for the provision of protective services to the President. l. Correctional Authorities. We may disclose protected health information of persons in the custody of correctional authorities under certain circumstances if requested by those authorities. m. Workers’ compensation. We may disclose your protected health information as authorized to comply with workers’ compensation laws. V. Emergencies We may use or disclose your protected health information without your authorization or acknowledgement of receipt of this notice in order to treat you or assist with coordinating your treatment in an emergency situation. As soon as reasonably practicable after treatment has been provided to you, we will seek your acknowledgement of receipt of this notice of privacy practices. VI. Your Rights With regard to your protected health information, you have the following rights: a. The Right to Request Restriction of Uses and Disclosures. You have the right to request that we restrict the uses or disclosures of your protected health information to carry out treatment, payment or health care operations and to family members, other relatives or persons directly involved in your care or payment. We are not required to agree to any such restrictions, but if we do, we must comply with such restrictions, other than in an emergency or certain other circumstances permitted or required by law. b. The Right to Confidential Communications. You have the right to request that we provide you with an alternative means of communication in the event you tell us that our customary methods of communication may not preserve the confidentiality of your information. You may request that we send such communications to you to alternative locations. This request must be made by you, in writing to our Privacy Contact. The request must specify how or where you wish to be contacted. We will attempt to accommodate all reasonable requests. c. The Right to Access Protected Health Information. You have a right to access to inspect and copy your protected health information. Under certain circumstances, we may deny your request for access to inspect and copy your protected health information. Depending on the circumstances, our denial of your request for access may be reviewed by a licensed health care professional that was not involved in the original decision to deny your request to review your information. To request access to your protected health information in our custody, you must submit your request in writing to our Privacy Contact. If you request a copy of your information, we may charge a fee for the cost of copying, postage or other items or services involved with your request. You may not remove our records from the premises. d. The Right to Amend Protected Health Information. You have the right to request that we amend your protected health information in our custody. We may deny your request to amend your protected health information if 1) we did not create the information unless the individual or entity that created the information is no longer available to make the requested amendment, 2) the information is not maintained by or in our custody, 3) you do not have the right to access such information, or 4) we have determined that such information is accurate and complete. You must submit your request for an amendment to your protected health information in writing to our Privacy Contact and explain the basis for your request. e. The Right to an Accounting of the Disclosures of Protected Health Information. You have the right to an accounting of how we have disclosed your protected health information that we have made in the six-year period prior to the date of your request for the accounting. We are not required to account for uses and disclosures of your protected health information by us: i. To carry out treatment, payment or health care operations performed by us or our business associates; ii. To other health care providers to provide treatment to you; iii. To other covered entities or health care providers for payment activities of said persons; iv. To other covered entities which have had a treatment relationship with you for certain health care operation purposes of said entities; v. To you pursuant to your rights to access your protected health information; vi. Made pursuant to an authorization signed by you; vii. To friends and family involved in your care and treatment or payment for your care and treatment, or for certain notification purposes; viii. For national security or intelligence purposes; ix. To correctional authorities with respect to persons in custody; x. That occurred prior to April 14, 2003; xi. For facility director purposes, if applicable; or xii. Incident to a use or disclosure otherwise permitted or required by law. Your request for an accounting must be made in writing to our Privacy Contact at the aforementioned address. Your first request in any twelve (12) month period will be provided to you at no charge; however, additional requests will be charged to you based on our cost to conduct the accounting. We will inform you of the fee for the additional accounting prior to our conducting the accounting so that you may consider whether to modify or withdraw your request before you incur any fees. f. Right to Receive Paper Notice. If you have agreed to receive this notice electronically, you have the right to receive a paper copy of this notice. VI. Complaints If you believe your privacy rights have been violated or that we have not complied with this Notice of Privacy Practices, you may file a written complaint with our Privacy Contact at the aforementioned address or with the Secretary of the U.S. Department of Health and Human Services. Our Privacy Contact can also be reached by calling 815.877.3440. We will not penalize or charge you for filing a complaint with our Privacy Contact. VII. Additional Rights: Effective Date This Notice of Privacy Practices has been prepared to reflect your rights under the Health Insurance Portability and Accountability Act. If state law provides you with greater access to information, or provides greater protection to that information, than as described in this policy, then Provider shall follow the provisions of state law. Examples of such state laws are the Mental Health and Developmental Disabilities Confidentiality Act, the AIDS Confidentiality Act and the Genetic Information Privacy Act. In addition, if a Federal law creates greater protection for the information described in this Policy, the Provider shall follow the provisions of such federal law. An example of such a Federal law is the Federal Drug Abuse, Prevention, Treatment and Comprehensive Alcohol Abuse and Alcoholism Prevention Treatment, and Rehabilitation Act of 1970. This Notice of Privacy Practices is effective as of April 14, 2003.



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