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During your treatment at Elmhurst Immediate Care our caregivers may gather information about your medical history and current health. This Notice of Privacy Practices explains how that information may be used and shared with others. It also explains your privacy rights regarding this information.

Elmhurst Immediate Care is required by law to abide by the terms of this Notice, to make sure that information that identifies you is kept private, and to give you this Notice of our legal duties and practices with respect to medical information about you.

Uses and Disclosures of your Health Information

1. Elmhurst Immediate Care may use health information to carry out treatment, payment and health care operations.

a. Treatment if the provision, coordination or management of health care. For example, we may use and disclose your information to consult with a third party or to refer you to other health care providers. We will get your written consent prior to making disclosures outside Elmhurst Immediate Care for treatment purposes, except in emergencies.

b. Payment includes the activities necessary to obtain reimbursement for the provision of health care. For example, we may need to give your health plan information about treatment you received at Elmhurst Immediate Care so your health plan will pay us or reimburse you for the treatment. We will get your written consent prior to making disclosures for payment purposes.

c. Health care operations include the activities necessary for Elmhurst Immediate Careto run its business operations. For example, we may use your information to review treatment and services and to evaluate the performance of our staff.

2. We may use or disclose your health information:

a. When required by federal, state, or local law.

b. To support public health activities by reporting as required or authorized by state or federal law. These reports may include the reporting of exposure to a communicable disease or risk of spreading a disease or condition.

c. To cooperate with law enforcement officials for certain law enforcement purposes as directed by a court order, warrant, criminal subpoena, or other lawful processes.

d. To report abuse or neglect.

e. To support health oversight activities that are authorized by law, such as administrative or criminal investigations, inspections, licensure or disciplinary actions and other similar activities necessary for appropriate oversight f government benefit programs or functions.

f. When required by a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death or other duties as required by law.

g. When necessary to prevent or lessen a serious and imminent threat to the health and safety of a person or the public and the disclosure is to a person reasonably able to prevent or lessen the threat, as consistent with applicable law and standards.

h. For judicial or administrative proceedings, in response to a valid court order, administrative order, a grand jury subpoena, or with your written consent.

i. For research purposes, with your written authorization or as permitted by state law.

j. To business associates to perform functions on Elmhurst Immediate Care behalf, if the business associate has signed an agreement to protect the confidentiality of the information.

3. We may disclose your health information to a family member, or relatives, or a close friend or any other person you identify if the information relates to that person’s involvement in your health care if you consent to such a disclosure. If you are unable to agree or object to the use or disclosure, we may disclose such information as necessary if we determine that it is in your best interest.

4. In other situations, your written authorization will be obtained before Elmhurst Immediate Care will use or disclose your health information to third parties outside Elmhurst Immediate Care.

5. State and federal laws may be more stringent and may prohibit certain uses and disclosures identified above. When another law is more stringent than HIPPA, we will follow the more stringent requirements. For example, some state laws require additional protection for records related to mental health treatment, drug and alcohol treatment, and HIV-related information.

Patient Rights

1. You may request Elmhurst Immediate Care to restrict use and disclosures of your health information. However, Elmhurst Immediate Care is not required to agree to the requested restriction. These requests should be made to Elmhurst Immediate Care, Privacy Officer. Requests must be made in writing. In your request, you must tell us (a) what information you want to limit; (b) whether you want to limit Elmhurst Immediate Care use, disclosure, or both, and (c) to whom you want the limits to apply, for example, you want to prohibit disclosures to your spouse.

2. You have the right to request confidential communications by alternative means or at alternative locations. For example, you may request that we communicate with you only by mail. We will accommodate all reasonable requests, but your request must specify how or where you wish to be contacted, and we may require you to provide information about how payment will be handled. You must request confidential communications in writing.

3. You have a right to inspect and obtain a copy of your health information that is used to make decisions about your care for as long as Elmhurst Immediate Care maintains the information. This right does not apply to certain health information, including information compiled in reasonable anticipation of or for litigation and other information not subject to the right to access information under state law and HIPPA. Requests for access to health information should be made in writing to Elmhurst Immediate Care, Privacy Officer. If access is denied, you will be provided with a written explanation that sets forth the basis of the denial, a description of how you may review those rights and a description of how you may complain.

4. You have the right to request that Elmhurst Immediate Care amend you health information if it is incorrect or incomplete. Requests for amendment of information should be made in writing to Elmhurst Immediate Care, Privacy Officer, and you must provide a reason that supports your request to have the information changed. Elmhurst Immediate Care may deny your request for an amendment if the request is not in writing and submitted to the Privacy Officer. In addition, we may deny your request if you ask us to amend information that: (a) was not created by Elmhurst Immediate Care (unless the person or entity that created the information is no longer available to make the amendment); (b) is not part of the medical information kept by Elmhurst Immediate Care; (c) is not part of the information you would be permitted to inspect and copy; (d) is accurate and complete.

5. At your request, Elmhurst Immediate Care will provide you with an accounting of disclosures by Elmhurst Immediate Care of your health information during the six years prior to the date of your request. However, such accounting will not include disclosures made: 1) to carry out treatment, payment or health care operations; 2) directly to you or your personal representatives; 3) prior to the effective date of this notice; or 4) based on your written authorization. If you request more than one accounting within a 12-month period, Elmhurst Immediate Care will change a reasonable, cost-based fee for each subsequent accounting. Requests for a request of an accounting of disclosures should be made in writing to Elmhurst Immediate Care, Privacy Officer.

6. To obtain a paper copy of this notice, contact Elmhurst Immediate Care, Privacy Officer.

7. You may exercise your rights through a personal representative as permitted or required by applicable law. Your personal representative may be required to produce evidence of authority to act on your behalf before that person will be given access to your information or allowed to take any action for you.

8. If you believe your privacy rights have been violated you may complain to the Elmhurst Immediate Care, Privacy Officer. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services. Elmhurst Immediate Care will not retaliate against you for filing a complaint.

Elmhurst Immediate Care Duties

This Notice is effective beginning August 10, 2010. However, Elmhurst Immediate Care reserves the right to change its privacy practices and this Notice, and to apply the changes to any health information received or maintained by Elmhurst Immediate Care prior to the date of changes. If the terms of this Notice are changed, a revised version will be available upon request and will be posted in a clear and prominent location.