PROTECTED HEALTH INFORMATION
The heart of the privacy
regulations addresses the protection of individually identified health
information. This is defined as "Protected Health Information" or “PHI”. PHI
includes information that is a subset of health information, including
demographic information collected from an individual, and:
is created or received by a health care provider and
relates to the past, present, or
future physical or mental health or condition of an individual; the
provision of health care to an individual; or the past, present, or future
payment for the provision of health care to an individual; and
identifies the individual .
All the information that health
care providers currently collect that is individually identifiable related
to a consumer/client is considered PHI including payment information.
Use and Disclosure of Protected Health Information
In order to effectively provide you care,
there are times when we may need to share your confidential information with
others both within and outside our agency. This includes releasing
information for the purposes of:
Treatment: We may use
your protected health information that we create or receive about you to
provide you with care and services. We may disclose information about you
to our staff who provide your care. We may share information about you
with different programs within our facility in order to facilitate care.
In certain instances we may share information about you with another
facility. We may disclose your confidential information without your
consent to the Illinois Department of Human Services for the purpose
of admission, treatment, planning and discharge to and from State operated
facilities. In order to release your information to any other person or
agency for the purpose of admission, treatment, planning and discharge we
must obtain your written permission
coordination of health care benefits. Information will be sent to the
appropriate companies or organizations in order to obtain payment for
treatment and services provided. Such information will only be sent with
your written consent.
Health Care Operations
includes scheduling office visits, surgeries, or preadmission activities.
We may use information about you, without your written consent, in
order to coordinate our business activities. This may include setting up
your appointments, reviewing your care, verifying your payment
information, training staff, quality assurance activities, peer review,
licensure and accreditation. Note under Illinois law, a consumer’s
written consent to share information with a third party payor or other
health care providers is required.
Information Disclosed Without Your Consent
Under Illinois and Federal law, information
about you may be disclosed without your consent in the following
Sufficient information may be shared to address the immediate emergency
you are facing.
- Follow Up Appointments / Care: We may contact you to remind you
of future appointments or to provide information about treatment
alternatives or other health related benefits and services that may be of
interest to you. We may 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 by law to provide public health
information such as concerning communicable diseases or suspected abuse
and neglect such as child abuse, elder abuse, or institutional abuse. The
information released must be relevant to the investigation.
We are required to disclose information about the circumstances of a
client’s death to a coroner who is investigating.
- Governmental Requirements:
We may disclose information to a health oversight agency for activities
authorized by law such as audits, investigations, inspections, and
licensure. 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 with Illinois
state agencies that fund our services.
- Criminal Activity or Danger to Others:
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 to someone might exist.
- Release to the individual.
- Incident to a use or disclosure as permitted under
the HIPAA regulations.
- To a Business Associate to carry out specific
- For health oversight activities required by
law, including audits, civil, administrative, or criminal investigation,
inspections, licensure or disciplinary actions, civil, administrative, or
criminal proceedings or actions.
Except for these instances when we can release
information without your consent, we will not release confidential
information about you without your written permission.
Authorization is Required for:
Targeted marketing, that is not related to
specific medical needs of the consumer.
Fundraising. The materials must include a
notice describing how the consumer can opt out of future solicitations.
To assess eligibility for certain public
benefits or commercial products.
Patient’s next of kin or friend. Under
Illinois law, except when the Surrogate Act applies, consent should be
obtained from the consumer before speaking with others about the medical
care of the consumer.
To a non-health related division of a Covered
Entity. (e.g. if a hospital operates a health club, you would need
consumer consent before the health club could contact the consumer).
To the Patient’s employer or others who the
consumer wishes to have the information, including his/her attorney.
When using or disclosing PHI or
requesting PHI from another covered entity, Elm City Center will make reasonable
efforts to limit the PHI to the minimum necessary to accomplish the intended
purpose of the disclosure or request. The minimum necessary standard does
not apply to:
Disclosures to or requests by a
health care provider for treatment.
Disclosures to the individual or
those made with a written authorization from the consumer.
Disclosures to the Secretary of
Health and Human Services.
Disclosures required by law.
When a request is made on a
routine and recurring basis, Elm City Center will implement policies and
procedures (which may be standard protocols) that limit the PHI requested to
the amount reasonably necessary to accomplish the purpose for which the
request is made. For all other requests Elm City Center will develop
criteria designed to limit the request for PHI to the information reasonably
necessary to accomplish the purpose of the request and review requests for
disclosure on an individual basis in accordance with such criteria. Elm City
Center cannot use, disclose, or request an entire medical record,
except when the entire medical record is specifically justified as the
amount that is reasonably necessary to accomplish the purpose of the use,
disclosure, or request.
The “minimum necessary”
standard will be consistent with, and not override, professional judgment.
Illinois law applies since it is
more restrictive than HIPAA. It requires that a parent or guardian consent
to release of records of the unemancipated minor. For mental health,
substance abuse treatment, access to contraceptive information, and VD
counseling, a minor 12 or older has a right to obtain information without
parental consent or knowledge.
- Guardians - All legal guardian relationships will be honored.
Individuals claiming to be a person's guardian my be asked to provide
legal documents defining the relationship if these documents are not known
by Elm City Center.
Elm City may disclose PHI about
an individual whom Elm City reasonably believes to be a victim of
abuse, neglect, or domestic violence to a government authority. Under
Illinois law, health care providers are mandated reporters in case of
suspected child abuse and neglect, elder abuse, and abuse of institutional
residents. Elm City may elect not to provide
information to a personal representative of an individual if Elm City
believes that the individual has been or may be subjected to domestic
violence, abuse, or neglect by the personal representative, or treating
such person as the personal representative could endanger the individual.
Elm City may disclose to a law
enforcement official PHI that Elm City believes in good faith
constitutes evidence of criminal conduct that occurred on the premises of
the Elm City. The information to be provided must be limited to name,
address, date of birth, social security number, type of injury, blood
type, date and time of treatment and a description of any physical
characteristics to identify the person.
Although psychotherapy notes
are defined, and there are various restrictions on their release under
HIPAA, these are not as restrictive as under the Illinois Mental Health
and Developmental Disabilities Confidentiality Act, and therefore,
Illinois law will apply.
Duty to Warn.
HIPAA permits Elm City Center to
or disclose PHI, if the Provider in good faith believes the use or
to prevent or lessen a serious and imminent threat of harm to the health
or safety of a person or the public; and
Is to a
person or persons reasonably able to prevent or lessen the threat,
including the target of the threat; or
for law enforcement authorities to identify or apprehend an individual
because of a
statement by an individual admitting participation in a violent crime
that the covered entity reasonably believes may have caused serious
physical harm to the victim; or
appears from all the circumstances that the individual has escaped from
a correction institution or from lawful custody. Such a disclosure
cannot be made, if the information was learned during counseling or
therapy or when the consumer is seeking a referral for counseling or
therapy. Although Illinois has a duty to warn provision in the Mental
Health and Developmental Disabilities Confidentiality Act-this is
broader, in that it can be viewed as applying to any health care