ONCOLOGY SPECIALISTS, S.C.
SUMMARY OF THE NOTICE OF PRIVACY PRACTICES

4/13/03

THIS IS A SUMMARY OF THE PRIVACY NOTICE DESCRIBING HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

IF YOU HAVE NOT RECEIVED A COPY, PLEASE REQUEST ONE.

If you have any questions about this notice, please contact Mary Beth Mardjetko, Administrative Director of our office at 866-611-1991, 1700 Luther Lane, Park Ridge, Illinois 60068, or call the Oncology Specialists Privacy Hotline at 847-268-8519.

WHO WILL FOLLOW THIS NOTICE

Our employees, staff and other office personnel.

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.

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.

Back to top

YOUR HEALTH INFORMATION RIGHTS

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.
• Right to request certain restrictions on the uses and disclosures of your health information.
• Right to inspect or receive a copy of your medical record.
• Right to request an amendment to your medical record if you believe it contains an error.
• 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).
• Right to request that we communicate with you about your health care at a confidential phone number or address.
• Right to revoke your written consent/authorization to use or disclose your health information except when the use or disclosure has already happened.

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.

Back to top

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU

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.

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.

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.

Back to top

OTHER USES OR DISCLOSURES OF YOUR HEALTH INFORMATION

Oncology Specialists, S.C. may, without your written authorization, release your health information with limitations and restrictions to:

• Business Associates
• Health Oversight Activities and Specialized Government Functions
• Law Enforcement Officials, Medical Examiners and Coroners and Court or Administrative Orders
• Notification and Other Communications with Your Relatives, Close Friends or Caregivers
• Funeral Directors and Organ, Eye, and Tissue Organizations
• Research
• Workers' Compensation
• Public Health Activities

Back to top

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.

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 847-268-8519.

Complaints to the Department of Health and Human Services may 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

You will not be penalized for filing a complaint.

Back to top

{ Close Window }