Privacy Practices

This notice describes how confidential information about you may be used and disclosed and how you can get access to this information. Please read it carefully. Effective Date: April 14, 2003.

We respect client confidentiality and only release confidential information about you in accordance with the Illinois and federal law. This notice describes our policies related to the use of the records of your care generated by this practice.

Privacy Contact - If you have any questions about this policy or your rights contact: Quality Improvement Coordinator.

Treatment - We may use or disclose treatment information about you to provide, coordinate, or manage your care or any related services, including sharing information with others outside Cunningham Children's Home that we are consulting with or referring you to.

Payment - With your written consent, information will be used to obtain payment for the treatment and services provided. This will include contacting your health insurance company for prior approval of planned treatment or for billing purposes.

Healthcare Operations - We may use information about you to coordinate our business activities. This may include setting up your appointments, reviewing your care, training staff.

Emergencies - Sufficient information may be shared to address the immediate emergency you are facing.

Follow-up Appointments/Care - We will be contacting you to remind you of future appointments or information about treatment alternatives or other health-related benefits and services that may be of interest to you. We will leave appointment information on your answering machine unless you tell us not to.

As Required by Law - This would include situations where we have a subpoena, court order or are mandated to provide public health information, such as communicable diseases or suspected abuse and neglect such as child abuse, elder abuse, or institutional abuse.

Coroners - In the event of your death, we are required to disclose information about the circumstances of your death to a coroner who is investigating it.

Governmental Requirements - We may disclose information to a health oversight agency for activities authorized by law, such a audits, investigations, inspections and licensure. There also might be a need to share information with the Food and Drug Administration related to adverse events or product defects. We are also required to share information, if requested, with the U.S. Department of Health and Human Services to determine our compliance with federal laws related to health care and to Illinois state agencies that fund our services.

Criminal Activity - If a crime is committed on our premises or against our personnel we may share information with law enforcement to apprehend the criminal. We also have the right to involve law enforcement when we believe an immediate danger may occur to someone.

Fundraising - As a not for profit provider of health care services, we need assistance in raising money to carry out our mission. We may contact you to seek a donation.

Copy of Record -You are entitled to inspect the client record Cunningham has generated about you. We may charge you a reasonable fee for copying and mailing your record. Note: Under Illinois law, when releasing records there can be a $20 handling charge for processing records and a charge of $.75 per page for pages 1-25, $.50 per page for pages 26-50, and $.25 per page for records in excess of 50 pages.

Release of Records - You may consent in writing to release of your records to others, for any purpose you choose. This could include your attorney, employer, or others who you wish to have knowledge of your care. You may revoke this consent at any time, but only to the extent no action has been taken in reliance on your prior authorization.

Restriction of Record - You may ask us not to disclose part of the clinical information. This request must be in writing. Cunningham Children's Home is not required to agree to your request if we believe it is in your best interest to permit use and disclosure of the information. The request should be given to the Privacy Contact.

Contacting You - You may request that we send information to another address or by alternative means. We will honor such request as long as it is reasonable and we are assured it is correct. We have a right to verify that the payment information you are providing is correct.

Amending Record - If you believe that something in your record is incorrect or incomplete, you may request we amend it. To do this contact the Privacy Contact and ask for the Request to Amend Health Information form. In certain cases, we may deny your request. If we deny your request for an amendment you have a right to file a statement you disagree with us. We will then file our response and your statement in your record.

Accounting for Disclosures - You may request an accounting of any disclosures we have made related to your confidential information, except for information we used for treatment, payment or health care operations purposes or that we shared with you or your family, or information that you gave us specific consent to release. It also excludes information we were required to release. To receive information regarding disclosure made for a specific time period (no longer than six years and after April 14, 2003), please submit your request in writing to our Privacy Contact. We will notify you of the cost involved in preparing this list.

Questions and Complaints - If you have questions, or wish a copy of this Policy or have any complaints you may contact our Privacy Contact in writing at our office for further information. You also may complain to the Secretary of the U.S. Department of Health and Human Services if you believe Cunningham Children's Home has violated your privacy rights. We will not retaliate against you for filing a complaint.

Changes in Policy - Cunningham Children's Home reserves the right to change its Privacy Policy based on the needs of the Agency and changes in state and federal law.