ONCOLOGY SPECIALISTS, S.C.
NOTICE OF PRIVACY PRACTICES

4/13/03

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.

If you have any questions about this notice, please contact Mary Beth Mardjetko, Administrative Director of our offices at 866-611-1991, 1700 Luther Lane, Park Ridge, Illinois 60068 and 7900 Milwaukee Avenue, Niles, Illinois 60714, or call the Oncology Specialists’ Privacy Hotline at 847-268-8597.

WHO WILL FOLLOW THIS NOTICE

This notice describes information about privacy practices followed by our employees, staff and other office personnel. The practices described in this notice will also be followed by healthcare providers you consult with by telephone (when your regular healthcare provider from our office is not available) who provide “call coverage” for your health care provider.

YOUR HEALTH INFORMATION

This notice applies to the information and records we have about your health, health status, and the health care and services you receive at this office. This is referred to as your medical record and contains your name, symptoms, health history and exam, test results, diagnoses, treatment given, and a plan for future care or treatment. This medical record is used to plan your care and treatment.

We are required by law to give you this notice. It will tell you about the ways in which we may use and disclose health information about you and describes your rights and our obligations regarding the use and disclosure of that information.

YOUR HEALTH INFORMATION RIGHTS

Your medical record is the physical property of Oncology Specialists, S.C., however the information within your medical record belongs to you. Federal and Illinois laws provide you with the following rights regarding your health information that is contained in the medical record that Oncology Specialists, S.C. keeps about you.

Right to obtain a copy of this notice of Privacy Practices. You may ask us to give you a copy of this notice at any time. To obtain such a copy, contact Mary Beth Mardjetko.
Right to request certain restrictions on the uses and disclosures of your health information. You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment, or healthcare operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for it, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed for emergency treatment. To request restrictions, you may complete and submit a Request for Restriction on Use/Disclosure of Medical Information to Mary Beth Mardjetko.
Right to inspect or receive a copy of your medical record. You have the right to inspect and copy the health information, such as medical and billing records, that we use to make decisions about your care. You must submit a written request to Mary Beth Mardjetko in order to inspect your records and an appointment to do so will be made for you. To request a copy of your medical record, you must complete and submit an Authorization for the Release of Medical Information to our medical record department. If you request a copy of the information, you will be charged a fee for the cost of copying, mailing, or other associated supplies. We may deny your request to inspect and/or copy in certain limited circumstances. If you are denied access to your health information, you may ask that the denial be reviewed.
Right to request an amendment to your medical record if you believe it contains an error. If you believe the health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment as long as this office keeps the information. To request an amendment, you must complete and submit a Request for Correction, Amendment, or Change of Personal Health Information to Mary Beth Mardjetko. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that we did not create, is not part of the health information that we keep, or is accurate and complete.
Right to obtain a list of all the people and companies to which Oncology Specialists, S.C., has released your health information (an accounting of disclosures). This is a list of the disclosures we made of medical information about you for purposes other than treatment, payment, and healthcare operations. To obtain this list, you must submit a Request for Accounting Disclosure form to Mary Beth Mardjetko. It must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. We may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Right to request that we communicate with you about your health care at a confidential phone number or address. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. We routinely call patients at their homes to leave reminders about appointments or to change appointments. Messages may be left on an answering machine. If you do not want messages left on an answering machine, you may request this not be done. When you call our office, staff will ask for phone numbers that can be used by the physician or nurse to return the call. To request confidential communications, you may complete and submit the Request for Confidential Communication to Mary Beth Mardjetko. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to revoke your written consent/authorization to use or disclose your health information except when the use or disclosure has already happened. You may revoke your consent at any time by giving us written notice. If you do revoke your consent, we will not be permitted to use or disclose information for purposes of treatment, payment, or healthcare operations, and we may therefore choose to discontinue providing you with healthcare treatment and services.

ONCOLOGY SPECIALISTS’ RESPONSIBILITIES ARE TO:

Maintain the privacy of your health information as required by law
Provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you
Do what is required by this notice or a notice that is in effect at the time we use or disclose your health information
Notify you if we are unable to agree to your requested restriction on disclosure of your health information
Agree to reasonable requests to communicate your health information by an alternative method or at an alternate location

We reserve the right to change our privacy practices and to use a new Notice of Privacy Practices for all health information we maintain about you and other patients. If Oncology Specialists, S.C. changes its practices, a new Notice of Privacy Practices will be available upon your request, by mail or in person at this site.

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU

Oncology Specialists, S.C. will use and disclose your health information contained in the medical record to give you treatment, obtain payment for your treatment, and operate our healthcare business.

EXAMPLES OF HOW YOUR HEALTH INFORMATION WILL BE USED OR DISCLOSED FOR TREATMENT, PAYMENT AND OPERATIONS

We will use your health information for treatment.

We will use health information about you to provide you with medical treatment or services. We may disclose health information to doctors, nurses, technicians, office staff, or other personnel who are involved in taking care of you and your health.

For example: Your physician, nurses, or other members of the healthcare team will collect and document information about you in your medical record. This health information will be used to choose the treatment they believe is best for you. Nurses and other members of the team will document in your record the actions they took and their observations made of you. Your physician will then know how you are responding to the chosen treatment. We may disclose information to another physician or care provider who will be assuming your care in the absence of your physician.

Staff in our office may share information about you and disclose information to people who do not work in our office in order to coordinate your care, such as phoning in prescriptions to your pharmacy, scheduling lab work and ordering x-rays or scans, and determining eligibility for research studies. Family members and other healthcare providers may be part of your medical care outside this office and may require information about you that we have.

We will use your health information for payment.

We may use and disclose health information about you so that the treatment and services you receive at this office may be billed to and payment may be collected from you, an insurance company, or a third party.

For example: We will send a bill that includes some of your health information to you, to the person responsible for the bill, and to your third party payer (such as your insurance company or Medicare). We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment. The type of health information we will send includes your name, other identifying information, diagnosis, treatment, procedures performed, and supplies provided during your treatment.

We will use your health information for our routine operations.

We may use and disclose health information about you in order to run the office and make sure that you and our other patients receive quality care. These uses and disclosures are necessary to run the practice, to comply with accreditation and other standards and to make sure that all our patients receive quality care.

For example: We may use your medical information to review treatment and services and to evaluate the performance of our staff in caring for you. We may also combine medical information about many of our patients to decide what additional services we should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, technicians, medical students, residents, professional students, trainees or practitioners in health care, non-health care professionals, and other personnel or members of our workforce for review, education, teaching and learning purposes.

We may contact you as a reminder that you have an appointment for treatment or medical care at our office.

We may tell you about or recommend possible treatment options or alternatives that may be of interest to you.

OTHER USES OR DISCLOSURES OF YOUR HEALTH INFORMATION

Upon receipt of your written authorization to use and/or disclose your health information

We will use and/or disclose your health information to those persons or companies for which you give us your written authorization or permission to do so. If you authorize us to use or disclose your information, you must complete an Authorization for Disclosure of Protected Health Information form. If you consent to participate in a research study, the authorization for the use and disclosure of our health information will, in most cases, be in the study consent. You may revoke your authorization in writing at any time except to the extent that we have already used or disclosed your health information as you previously authorized. If your health information includes highly confidential Information, such as HIV status or substance abuse information, we may only use and disclose such information for treatment, payment, and operations as described above. Otherwise, unless a disclosure is allowed or required by federal or Illinois law, you must give us your written authorization to disclose your highly confidential Information.

Oncology Specialists, S.C. may, without your written authorization, release your health information for the purposes described below.

Business Associates: We provide some services through other persons or companies that need access to your health information to carry out these services. The law refers to these persons or companies as Business Associates. Examples of these Business Associates include answering service companies, technology support companies, and organizations that collect information about patients who have been treated with similar problems such as cancer. These organizations list the information in registry directories that help physicians throughout Illinois to improve the quality of care for other patients with the same problems. We may disclose your health information to our Business Associates so that they can do the job we have contracted with them to do. We require that they use appropriate safeguards to ensure the privacy of your health information.

Health Oversight Activities and Specialized Government Functions. We may disclose your health information to an agency that oversees healthcare systems and ensures compliance with the rules of government health programs such as Medicare or Medicaid for audits, investigations, inspections, or licensing purposes. These disclosures may be necessary for certain state and federal agencies to monitor the healthcare system, government programs, and compliance with civil rights laws. Under certain circumstances disclosures may be made to the U. S. Military or the U. S. Department of State.

Law Enforcement Officials, Medical Examiners and Coroners and Court or Administrative Orders:

We may disclose your health information to the police, other law enforcement officials, medical examiners and coroners, and to the courts or administrative proceedings as allowed or required by law or required by a court order or other legal process such as a subpoena.

Notification and Other Communications with Your Relatives, Close Friends or Caregivers. We may disclose health information about you to your family members or friends if we obtain your verbal agreement to do so or if we give you an opportunity to object to such a disclosure and you do not raise an objection. We may also disclose heath information to your family or friends if we can infer from the circumstances, based on our professional judgment, that you would not object. For example, we may assume you agree to our disclosure of your personal health information to your spouse when you bring your spouse with you into the exam room during treatment or while treatment is discussed.

In situations where you are not capable of giving consent (because you are not present or due to your incapacity or medical emergency), we may, using our professional judgment, determine that a disclosure to your family member or friend is in your best interest. In that situation, we will disclose only health information relevant to the person’s involvement in your care. For example, we may inform the person who accompanied you to the emergency room about your condition and provide updates on your progress and prognosis. We may also use our professional judgment and experience to make reasonable inferences that it is in your best interest to allow another person to act on your behalf to pick up, for example, filled prescriptions, medical supplies, or X-rays.

Funeral Directors and Organ, Eye, and Tissue Organizations: We may disclose your health information to funeral directors as necessary to carry out their duties and as allowed by law or to organ, eye, and tissue organizations that facilitate organ, eye, or tissue procurement, banking, or transplantation.

Research: We may use and disclose your health information to identify you as a potential candidate for a research study. Oncology Specialists and its physicians are involved in many clinical trials. This may be of benefit to you as our physicians are aware of investigational treatments that may be available here and at other select institutions that are not widely available elsewhere. In order to provide you with useful information concerning research studies available to you, we may review your medical record from time to time to determine whether you may be eligible to participate in studies in which you would then access investigational treatments. We believe it is consistent with our treatment of you to consider these kinds of options in connection with your care. Advocate research associates and nurses will review your medical record during these reviews. Your written authorization will be required for participation in a research study if the researcher and/or research associates determine that you may be eligible for a study that would be beneficial to you. Under no circumstances would we allow anyone to use your name or identity publicly.

Workers’ Compensation: We may disclose your health information as allowed or required by Illinois law relating to workers’ compensation or to other similar programs.

Public Health Activities: We may disclose your health information for public health reasons in order to prevent or control disease, injury, or disability or report births, deaths, suspected abuse or neglect, non-accidental physical injuries, reactions to medications, or problems with products.

ADDITIONAL EXAMPLES OF HOW YOUR HEALTH INFORMATION WILL BE USED OR DISCLOSED

Marketing: Upon receiving your written authorization we may use your health information to provide you with marketing information about other programs or services.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services.

If you would like further information about our privacy practices, have questions or concerns or wish to file a complaint with our office, contact Mary Beth Mardjetko, Administrative Director at 866-611-1991 or call the Oncology Specialists’ Privacy Hotline at 847-268-8597.

Complaints to the Department of Health and Human Services (HSS) should be addressed to:

Office of Civil Rights, U.S. Department of Health and Human Services
233 N. Michigan Ave., Suite 240
Chicago, IL 60601

Phone: 312-886-2359 FAX 312-886-1807 TDD 312-353-5693

We support your right to the privacy of your health information. You will not be penalized for filing a complaint with us or the Department of HHS.

{ Close Window }

ONCOLOGY SPECIALISTS, S.C. NOTICE OF PRIVACY PRACTICES