THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOUR CHILD AND FAMILY MAY BE USED AND DISCLOSED AND HOW YOU CAN GAIN ACCESS TO THIS INFORMATION.
PLEASE REVIEW THIS CAREFULLY. If you have any questions about this notice, please contact Elena Kaiser.
Address: 2530 Crawford ave, suite 305
Evanston, Illinois 60201
INTRODUCTION This Notice of Privacy Practices is provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA).
Elena Kaiser PC is committed to treating and using your protected health information responsibly. This Notice of Health Information Privacy Practices describes the personal health information Elena Kaiser PC collects, and how and when its representatives may use or disclose that information. This notice also describes your rights as they relate to your Protected Health Information. This Notice is effective September 1, 2017 and applies to all protected health information as defined by federal regulations.
ACKNOWLEDGEMENT OF RECEIPT OF THIS NOTICE You will be asked to sign an acknowledgement of receipt of this Notice. Elena Kaiser PC’s intent is to make you aware of the possible uses and disclosures of your protected health information and your privacy rights. The delivery of your speech and language therapy services will in no way be conditioned upon your signed acknowledgement. If you decline to sign the acknowledgement, Elena Kaiser PC will continue to provide treatment, and will use and disclose your protected health information for treatment, payment, and health care operations when necessary.
UNDERSTANDING YOUR HEALTH RECORD/INFORMATION A record of each speech therapy session is made. This record may contain your symptoms, examinations and results, diagnoses, treatment, and a plan for future care or treatment. This information, often called your health or medical record, serves as 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.
YOUR HEALTH INFORMATION RIGHTS Although your health record is the physical property of Elena Kaiser PC the information belongs to you. You have the right to:
Elena Kaiser PC’S RESPONSIBILITIES: Elena Kaiser PC is required to:
Elena Kaiser PC reserves the right to change Privacy Information practices and to make the new provisions effective for all protected health information its representatives maintain. Revised notices will be available as requested. Elena Kaiser PC will not use or disclose your health information without your authorization, except as described in this notice. Elena Kaiser PC will also discontinue to use of your health information after it has received written revocation of the authorization according to the procedures included in the authorization.
EXAMPLES OF HOW Elena Kaiser PC MAY USE OR DISCLOSE YOUR HEALTH INFORMATION
For Treatment: Elena Kaiser PC may use your health information to provide you with services. This may include recording information regarding your treatment, the course of action that Elena Kaiser PC will take to treat your issues, and how you respond to these activities.
For Payment: Elena Kaiser PC may use and disclose your health information to others for purpose of receiving payment for treatment and services that you receive. For example, a bill may be sent to you or a third-party payor, such as your insurance company or health plan. The information on the bill may contain information that identifies you, your diagnosis, and the treatment used in the course of treatment.
For Quality Control: Elena Kaiser PC may use your information to assess the treatment provided and outcomes in your and similar cases. This information would then be used to continually improve the quality and effectiveness of the therapeutic services Elena Kaiser PC provides.
Appointments: Elena Kaiser PC may use your information to provide appointment reminders or information about treatment alternatives or other health-related benefits and services and services that may be of interest to you.
Directory: Unless you notify Elena Kaiser PC that you object, Elena Kaiser PC may use your name if you have been transported to a hospital or other facility to check on your status.
Notification or Communication with Family Members: Elena Kaiser PC therapists, using their best judgment, may use or disclose information to notify or assist in notifying family relatives, personal representatives, close personal friends, or other people you identify; information relevant to that person's involvement in your care or payment information related to your care.
Research: Elena Kaiser PC may disclose information to researchers when their research has been approved by an institutional review board (IRB) that has reviewed the research proposal and established protocols to ensure the privacy of your health information.
Public Health: Your health information may be used or disclosed for public health activities such as assisting public health authorities or other legal authorities to prevent or control disease, injury, disability, or for other health oversight activities.
Required by Law: Elena Kaiser PC may use and disclose information about you as required by law. For example, Elena Kaiser PC may disclose information about you for the following purposes:
Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority, or attorney, provided that a workforce member or business associate believes in good faith that Elena Kaiser PC has engaged in unlawful conduct or has otherwise violated professional or clinical standards, and is potentially endangering one or more clients, workers, or the public.
Health and Safety: Your health information may be disclosed to avert a serious threat to the health or safety of you or any other person pursuant to applicable law.
Government Functions: Specialized government functions such as protection of public officials or reporting to various branches of the armed services that may require use or disclosure of your health information.
OBTAINING AND STORAGE OF INFORMATION Your information will be obtained from medical facilities, agencies, and other persons involved with the health care of your child and family only with your written consent. Your signature is required in order for healthcare information to be obtained from outside sources.
Medical information may be delivered through U.S. mail or through facsimile services. All documentation delivered via U. S. mail will only be opened by Elena Kaiser PC. Facsimiles arrive in a private location and are also only obtained by Elena Kaiser PC. Once these documents arrive they are placed into your child’s secured file. Other professionals may also request contact via telephone. Minimal information will be given via cellular communication in public locations. Should another professional wish to complete such a call, a request will be made to reschedule for another time or Elena Kaiser PC will move to a location where your privacy can be assured.
ELECTRONIC DATA (via TheraNest practice management)
SECURITY TECHNOLOGY AND PRACTICES Your sensitive data is hosted in a Tier 1 secure hosting provider specializing in helping healthcare organizations achieve and maintain HIPAA and HITRUST security requirements:
Once medical information has been obtained, it will be placed in a confidential folder and / stored on Elena Kaiser PC’s secure software system. No one other than Elena Kaiser PC will have access to these files without your written and signed consent.
After six years of inactive status, your hard copy stored medical information will be destroyed via shredding. The shredded information will then be discarded.
For more information, to discuss a problem, or if you have questions and would like additional information, you can contact Elena Kaiser PC:
Elena Kaiser PC
Evanston, Illinois 60201
Phone: : 847-337-2377
If you believe that your privacy rights have been violated, you can discuss the situation with Elena Kaiser PC, or you can file a complaint with the Office for Civil Rights, U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint with either Elena Kaiser PC or the Office for Civil Rights. The address for the OCR is listed below:
Office for Civil Rights-U.S. Department of Health and Human Services
200 Independence Ave.,
Washington, D.C. 20201
866-OCR-PRIV (866-627-7748) or 886-788-4989 TTY
ACKNOWLEDGEMENT OF RECEIPT OF THIS NOTICE Elena Kaiser PC is concerned about the privacy of your health care information. Elena Kaiser PC intent is to make you aware of the possible use and disclosures of your protected health information and privacy rights. The delivery of your therapy services is in no way conditioned upon your signed acknowledgment. If you decline to provide a signed acknowledgment, Elena Kaiser PC will continue to provide treatment, and use and disclose your protected health information for treatment, payment, and health care operations as necessary.
Address: 2530 Crawford Ave, Suite 305Evanston, Illinois 60201