Transitions of Western Illinois Notice of 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.
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
- Get a copy of your Record. You can ask to see or get an electronic or paper copy of your medical records or other health information that we have about you. This request should be made by completing our Request to Copy and Inspect Records form and submitting it to Medical Records. Sometimes we may deny your request. If we do, we will tell you in writing what our reasons are for the denial and how you can appeal the denial. We will provide you a copy or a summary of your information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
- Get a copy of your electronic Record: If your health information is maintained in an electronic format, you have the right to request that an electronic copy of your record be given or transmitted to another individual or entity. We will make every effort to provide access to your information in the form or format you request, if it is readily producible in such form or format. If your information is not readily producible in the form or format your record will be provided in either our standard electronic format or if you do not want this form or format, a readable hard copy form. We may charge you a reasonable fee for the labor associated with fulfilling your request.
- Ask us to correct your Record. You can ask us to correct your health records if you think they are incorrect or incomplete. You must make the request in writing to the Transitions Compliance Specialist. We may say “no” to your request, but we will tell you why within 60 days.
- Contacting you. You can ask us to contact you in a specific way. For example, you can ask that we contact you only by phone or email. Put your directions in writing and give it to a staff person at the program where you receive services. We can turn down the request, but we will always agree to it if it is reasonable. Please realize that we may reserve the right to contact you by other means and at other locations if you fail to respond to any communication from us that requires a response. We will notify you in accordance with your original request prior to attempting to contact you by another means or at another location.
- Ask us to limit what we use or share. You can ask us not to use or share certain health information. You can request a restriction by submitting your request in writing to our Compliance Specialist. We are not required to agree and we can say “no” if it would affect your healthcare.
- Ask us to limit information we share when paying out of pocket: If you pay for services wholly out-of-pocket, you can request that we not disclose information about that particular treatment to your health plan. We are required to honor that request. This request can be made by in writing to our Compliance Specialist.
- Get a list of those with whom we’ve shared information. You can ask for a list of the times we’ve shared your information for six years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except those about treatment, payment or healthcare operations and certain other disclosures (such as any you ask us to make). Please send your request in writing to the Transitions Compliance Specialist. We will respond to your written request within 60 days of receiving it. We’ll provide one accounting a year for free, but will charge a reasonable cost-based fee if you ask for another one within 12 months.
- Choose someone to act for you. If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.
- Get a copy of this Privacy Notice. You can ask for a paper copy of this Notice at any time, even if you have agreed to receive the Notice electronically. We will provide you a paper copy promptly.
- File a Complaint. You can complain if you feel we have violated your rights by writing to the Transitions Compliance Specialist at P.O. Box 3646, Quincy, IL 62305. You may also file a complaint with the United States Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
- Authorization to Release your Record. For certain health information, you can tell us your choices about what we share, for example, sharing information with your family, close friends, or others involved in your care. These disclosures of your health information will be made only with your written authorization, unless otherwise permitted or required by law. You may withdraw or cancel that permission, in writing, at any time. You understand that we are unable to take back any disclosures we have already made before you withdrew your permission.
- Marketing Purposes. We will never share your information for marketing purposes unless you give us written permission. However, representatives of Transitions may wear name tags, display door magnets, banners or other identification on their vehicles. If you choose to ride in our vehicles or accompany a staff person in public, you may be identified as associated with Transitions.
- Psychotherapy Notes. Should we have such notes, we will not share them without your written permission.
- Fundraising. Because we are a not-for-profit agency, we need help in raising money. We may contact you for fundraising efforts, but you can tell us not to contact you again.
Other Uses and Disclosures
How do we typically use or share your health information? We typically use or share your health information in the following ways.
- Help manage the treatment you receive. We can share information about you to provide, coordinate, or manage your services and care. For example, we may disclose health information to doctors, nurses, technicians, or other personnel, including people outside our office, who are involved in your medical are and need the information to provide you with medical care.
- Bill for your services. We can share information in order to get paid for the treatment and services you received from Transitions. For example, we may give your health plan or other payers information about you so that they can pay for treatment. We may also include protected information about you in a bill we sent to you or the person responsible for your payment.
- Run our organization. We can use some information about you to support our business. For example, evaluating the program you attend, training our staff, accreditation, licensure, or when we are undergoing an audit.
- Business Associates: There are some activities conducted in our organization through other companies termed as “business associates.” Federal law requires us to enter into business associate agreements with these other companies to safeguard your information. Examples include physician services, legal services, therapy services, consulting and information technology vendors.
- Organized Health Care Arrangement: Transitions participates with other behavioral health services agencies (each, a “Participating Covered Entity”) in the IPA Network established by Illinois Health Practice Alliance, LLC (“Company”). Through Company, the Participating Covered Entities have formed one or more organized systems of health care in which the Participating Covered Entities participate in joint quality assurance activities, and/or share financial risk for the delivery of health care with other Participating Covered Entities, and as such qualify to participate in an Organized Health Care Arrangement (“OHCA”), as defined by the Privacy Rule. As OHCA participants, all Participating Covered Entities may share the PHI of their patients for the Treatment, Payment and Health Care Operations purposes of all of the OHCA participants.
- Interdisciplinary Team: The SIU Center for Family Medicine is a Federally Qualified Health Center and provides psychiatry and primary care services at designated Transitions sites. Transitions and SIU staff work together as an interdisciplinary team to provide a more holistic approach to physical and mental wellness. As an interdisciplinary team, staff from Transitions, SIU Center for Family Medicine, and psychiatrists contracted through Blessing Health System may share information about your care for the purpose of admission, treatment, planning, coordinating care, discharge, or governmentally mandated public health reporting.
- Representative Payee Services: If you receive Representative payee services you may be identified as a consumer of Transitions of Western Illinois.
- Paid Training: If you participate in any of our paid training opportunities, your earnings will be reported for tax purposes as required by state and federal law.
Other Ways We Are Allowed To Share Your Information - usually in ways that contribute to the public good.
- Emergencies. We can share information as needed to deal with an immediate emergency you are facing. For example, we may tell an ambulance crew what medications you’re taking.
- Follow up Appointments/Care. We may contact you with reminders of future appointments (we will leave appointment information on your answering machine unless you tell us not to). We might also tell you about benefits available to you or give you health-related information you might want to know about.
- Court Order. We can share information about you in response to a court or administrative order, or in response to a subpoena.
- Abuse or Neglect. We are required to notify government authorities if we suspect abuse, neglect or domestic violence.
- Public Health and National Security. We may be required to disclose to government officials or military authorities health information necessary to complete an investigation related to public health or to national security. Health information could be important when the government believes that the public safety could benefit when the information could lead to the control or prevention of contagious diseases.
- Coroners, Medical Examiners or Funeral Directors. We must give health information to coroners, medical examiners, or funeral directors so that they can do their jobs.
- Organ and Tissue Donation. We can share your health information to organizations that are involved in organ or tissue donation.
- Research. We may share information with our research staff, but only if Transitions has formally approved the research. Transitions will approve research only if it has proven that when data is disclosed your health information will be kept private.
- Workers’ Compensation. We may share your health information as necessary to comply with laws related to workers’ compensation or other similar programs.
- Comply with the Law or When Required by Law. We may share your health information when required by law. For example, if a crime is committed on our property or against our personnel, we may share information with law enforcement so they can catch the criminal. We may also call the police or sheriff when we think someone is in immediate danger.
We are required by law to maintain the privacy of your health information in accordance with federal and state law.
- Protecting Your Confidential Information. Please be aware that state and other federal laws may have additional requirements that we must follow or may be more restrictive than HIPAA on how we use and disclose your health information (such as those laws applicable to alcohol and drug abuse patient records (42 CFR Part 2) and mental health records (740 ILCS 110 et seq.)).
- When we release information, we will not release more information than necessary. We will not share or use information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time.
- Notifying you of a Breach. You have the right to be notified in the event that we discover there was a breach of your unsecured health information.
We reserve the right to change this Notice and our privacy practices based on the needs of Transitions and changes in Illinois and Federal law. The new notice will be available upon request, at all our office locations and on our web site. If you have any questions about this Notice, please contact the Compliance Specialist at 217-223-0413. Effective date: May 9, 2019