Notice of Privacy Practices

Southern Illinois University School of Medicine and SIU HealthCare (also known as SIU Medicine) 217-545-8000

Normal Business Hours: 8 a.m.-4:30 p.m.

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS YOUR INFORMATION. PLEASE REVIEW IT CAREFULLY.

The terms of this Notice of Privacy Practices (“Notice”) apply to SIU School of Medicine and SIU HealthCare. The information contained within this Notice will be adhered to by:

  • Any health care professional who treats you at any of our locations.
  • All departments of SIU School of Medicine and SIU Medicine, including the Federally Qualified Health Centers (FQHCs), employees, associates, staff, students, residents, or volunteers of our organization.

Our duties regarding your health information

We are required to provide you with this notice. We must protect your Protected Health Information (PHI). This protection includes any protected health information that is oral, written, or electronic, such as health information sent by fax, computer, or other electronic device.

This notice explains how we may use and share your health information. This notice also explains your rights and our obligations regarding the use and sharing of your PHI. Under federal and Illinois state law, we are required to follow the terms of the notice.

Changes to this notice

We have the right to change the terms of this notice as necessary and make the new notice effective for all protected health information maintained by us.

You may obtain a copy of any revised notices online or at any of our clinic locations, or a copy may be obtained by mailing a request to:

     SIU Medicine
     ATTN: Privacy Office
     P.O. Box 19639 
     Springfield, IL 62794-9639 

How we may use your protected health information

We may use your health information for the following purposes:

  1. Treatment: We may make use and share your protected health information as necessary for your treatment. For example, doctors, nurses and other professionals involved in your care will use information in your medical record to plan your care. That may include procedures, medications, and tests. We may also disclose or share your protected health information with other health care facilities or professionals who are or will be providing treatment to you.
  2. Payment of health services: We may use and/or share your information to bill and receive payment for the services that you receive from us. For example, we may use your health information in our billing or claims department to prepare a bill or statement. These bills may be sent to you, your insurance company, including Medicare or Medicaid, or another group or individual who may pay for your health services.
  3. Health care operations: We may also use and share your protected health information as necessary and as allowed by law, for our activities related to your health care.

These activities include, but are not limited to:

  • clinical improvement and teaching
  • professional peer review
  • business management
  • accreditation, licensing
  • consultants, appointment reminders, surveys, and other health related services.

You may be contacted by mail, phone or text at any of the telephone numbers associated/connected with you, including wireless numbers. Telephone calls may include the use of pre-recorded or artificial voice messages and/or automatic dialing device.

Messages may be left on answering machines, voicemail, emails, or texts, including such message information required by law for SIU Medicine to conduct business.

How We May Use And Disclose Your PHI In Other Special Circumstances

How we may use and share your protected health information (PHI) in other special circumstances.

We are permitted under federal and state law to use or share your information without your permission under certain conditions that may arise as described below:

  1. Business Associates: There are some activities conducted in our organization by other companies called “Business Associates.” Federal law requires us to enter into business associate agreements with some companies to protect your protected health information. Examples include legal services, therapy services, billing services, consulting and electronic technology vendors.
  2. Research: We may use and share your protected health information in limited instances. For example, a research organization may wish to compare results of all patients who received a certain medication. They may need to review medical records. In all cases where your specific consent has not been given, your privacy will be protected by strict confidential conditions by an Institutional Review Board (IRB) or privacy board, which oversees the research.
  3. Individuals involved in your care or payment for your care:
    1. We may share your health information with a family member, other relative, friend or any other person you identify who is involved in your care or involved with the payment for your care unless you tell us otherwise.
    2. You have a right to choose someone to act for you. If you have given someone medical power of attorney or someone is your legal guardian, that person (an authorized representative) can exercise your rights and make choices about your health information. We will make sure the authorized representative has this authority and can act for you before we take any action.
  4. We may share limited protected health information to a public or private organization that is allowed to help in disaster relief efforts to locate a family member or other person involved in caring for you.
  5. We may contact you about fundraising efforts. You have the right to deny participation or receipt of information about fundraising. If you do not want to participate, please send your name, address and a statement that you do not wish to receive fundraising materials or information from SIU Medicine to our Privacy Officer at SIU Medicine, P.O. Box 19639, Springfield, IL 62794-9639.

Other Uses And Disclosures

We are permitted or required by law to make certain other uses and disclosures of your PHI without your consent or authorization, We may release your PHI:

  • For any purpose required by law.
  • For public health activities, such as required reporting of disease, injury, birth and death, and required public health investigations.
  • For suspicion of child abuse or neglect or if we believe you to be a victim of abuse, neglect, or domestic violence.
  • To the Food and Drug Administration if necessary to report adverse events, product defects or product recalls.
  • To government oversight agencies conducting audits, investigations, or civil or criminal proceedings if required by law.
  • If required by a Court or administratively ordered subpoena or discovery request.
  • To law enforcement officials as required by law to report wounds, injuries and crimes.
  • To coroners and/or funeral directors consistent with law.
  • To arrange an organ or tissue donation from you or a transplant for you.
  • As required by armed forces services, if you are a member of the military and if necessary for national security or intelligence activities.
  • For Workers' Compensation agencies if necessary for your Workers' Compensation Benefit Determination.

Legal requirements of sharing of health information without approval:

We are permitted or required by law to share your protected health information without your consent or approval under certain circumstances. We may share your protected health information:

  • For public health activities, such as required reporting of disease, injury, birth and death, product defects, adverse events, and required public health investigations.
  • For suspicion of child abuse or neglect or if we believe you may be a victim of abuse, neglect, or domestic violence.
  • With government agencies that audit, investigate, or lead civil and/or criminal actions, as required by law.
  • In response to a court orders, actions, subpoenas, and administrative requests, etc.
  • With law enforcement officials for law enforcement purposes such as identification of a person or suspect, criminal activity, crimes, and medical emergencies or to provide information about a crime victim.
  • To report a death
  • With coroners, medical examiners, and/or funeral directors required by law.
  • To prevent a serious threat to health or safety including reporting to the Illinois Dept. of Human Services any firearm violation(s). (IL. Firearm Owners Identification=FOID)
  • If you are an inmate of a correctional institution, or under the custody of a law enforcement official, we may release your health information to the correctional institution or law enforcement official as necessary.
  • To assist the U.S. Food and Drug Administration (FDA) with any recalls or alerts to medications and/or products
  • To arrange an organ or tissue donation from you or a transplant for you.
  • If you are a member of the military or a veteran we may be required to release information for national security and intelligence activities.
  • As required by law for worker’s compensation claims and benefits.

Uses and sharing of health information requiring your written approval:

  • We will not share psychotherapy notes without your written approval unless the use and sharing of information is permitted by law.
  • We will not use or share your protected health information for certain marketing purposes without your written approval.
  • We will ask for your written approval before we use or share your health information for any purpose other than those listed in this Notice.

You may cancel your approval in writing at any time to stop sharing of your health information. Once information has been shared that you already approved, we cannot get that shared information back. If we collected your information linked with a research study, we are permitted to use and share that information as needed to protect the information of the research study.

Your individual rights regarding your health information:

You or your authorized representative have the following rights regarding your protected health information:

  1. Obtain a paper copy of this notice upon request: You have the right to obtain a paper copy of this Notice at any time, even if you have agreed to receive the Notice electronically. We will offer you with a paper copy quickly upon request in any of our clinics. You may read this notice at www.siumed.org or you may write to our Privacy Officer at SIU Medicine, P.O. Box 19639, Springfield, IL 62794-9639.
  2. Inspect and obtain a copy of your protected health information: You may make a request in writing to look at and obtain a copy of your health information. Contact information for SIU Medical Records is found on the last page of this notice. We will reply to your request in writing within 30 days (with a possible 30-day delay). You also have the right to request an electronic copy of your protected health information. If your protected health information is not readily created in an electronic form or format, we will offer your protected health information in a readable electronic form and format as decided by you and SIU Medicine. A fee may be charged for the expense of completing your request. We may deny your request to inspect and copy, in some limited cases, such as we would have fairly decided that giving access to protected health information would risk your life or safety or cause large harm to you or another person. If you are denied access to your protected health information, you may ask that the denial be looked over again.
  3. Request an amendment of protected health information: You have the right to request that your protected health information be corrected. To request a change, send a written request to Director of Medical Records. See the address listed on the last page of this notice. We are not expected to make all requested changes. We will look at each request carefully. We will reply to your request in writing within 60 days (with a possible 30-day delay). In our answer, we will either: (i) agree to make the change(s), or (ii) tell you of our denial, explain our reason, and give you other actions available, if there are any for you to do.
    1. Receive disclosures of your protected health information: You have the right to receive a list showing to whom your protected health information has been disclosed/shared. The law prevents listing many of the usual approved sharing, such as those times of giving care to you, to pay for your health services, or where you gave us your written permission to allow your protected health information to be shared. To obtain a listing of how your protected health information is shared, make a written request to our Privacy Officer.
    2. Request confidential communications: You have the right to request that we talk with you about your health care in a certain way or at a certain location. These requests should be made in writing. For example, you may ask that we contact you by mail at home or at work. Requests for confidential communications at other locations and/or by other ways should be made in writing to the Privacy Officer. SIU Medicine will make every effort to follow your reasonable requests.

Your right to request limits of certain uses and sharing of your information:

1. You may request, in writing, a limit on how we use or share your protected health information for your treatment, for payment of your health care services, or for activities connected to our health care practices. You may also request a limit on what health information we may share to someone who is involved in your care, such as a family member or friend. To make a request, see address information on the last page of this notice.

2. We are not required to agree to your request in all situations. Also, any limit we may approve will not affect any use or sharing of information that we are required or permitted to make under the law. We must agree to your request to restrict the sharing of your health information to your health plan if the information shared is not required by law and the health information you want limited is to a certain health care item or service that you (or someone other than your health plan, on your behalf) have paid us in full at the time of service.

Breach notification: You have the right to be told when a breach of your protected health information has occurred. We will notify you as soon as sufficient information about the breach is available, but not to delay past 60 days.

Language and Special Needs Services: SIU Medicine offers free aids and services to people with disabilities to communicate easier or whose main language is not English. These aids and services are such things as video/phone interpretation, certified interpreters, communication boards, and low-vision aids/tools. If you need these services, contact the Director of Risk Prevention & Patient Safety/Civil Rights Coordinator at the address below.

Organized Health Care Arrangement: SIU Medicine keeps some medical records in a shared electronic health record system. The shared electronic health record system joins protected health information of Southern Illinois University School of Medicine and SIU Medicine patients with other covered entities so each patient has a single health record for physician office services provided by the participating covered entities in the Springfield, Illinois area. Through the use of the electronic health record systems for joint quality assurance and/or utilization review activities, the participating covered entities, including Southern Illinois University School of Medicine, SIU Medicine, portions of Memorial Health Services, and Springfield Clinic, qualifies an Organized Health Care Arrangement (“OHCA”), as defined by the Health Information Portability and Accountability Act (HIPAA). As OHCA participants, all participating covered entities may use and disclose the protected health information contained within the electronic health record for the treatment, payment, and health care operations purposes of each of the OHCA participant. In addition, SIU Medicine is a participant in an OHCA in the Crossriver Quality Health Partners clinically integrated network, in which participants may jointly participate in activities involving utilization review, quality assessment and improvement activities, and/or payment activities involving shared financial risk for delivering health care.

Compliments and Concerns: We welcome a chance to talk to you about any of your compliments and concerns you may have about the privacy of your health information or any complaints related to your privacy rights. You may file a complaint with our Privacy Officer at SIU Medicine, P.O. Box 19639, Springfield, IL 62794-9639 or 800.342.5748

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independent Avenue, S.W., Washington, D.C. 20201, calling 877.696.6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. There will be no retaliation for filing a complaint.

You will be asked to sign a form confirming that you received this Notice of Privacy Practices. If you have questions or need more help regarding this Notice, you may contact SIU Privacy Office at the below address and phone.

SIU Medicine
Attn: Privacy Officer
P.O. Box 19639
Springfield, IL 62794-9639

You may request an Access Request Form and/or an Amendment of Information Request Form from SIU Medical Records or at a Family & Community Medicine office location, listed below.

The location directly below is for all SIU Medicine Medical Records except the family medicine locations in Springfield, Quincy and Carbondale and those addresses are listed separately below).

SIU Medicine
Director of Medical Records
201 E. Madison Street
Springfield, IL 62702

Addresses for SIU Medicine Medical Records for Center for Family Medicine:

SIU Center for Family Medicine-Springfield
Director of Medical Records
520 N. 4th St.
Springfield, IL 62794-9641

SIU Center for Family Medicine-Quincy
Director of Medical Records
612 N. 11th St.
Quincy, IL 62301

SIU Center for Family Medicine-Carbondale
Director of Medical Records
300 West Oak Street
Carbondale, IL 62901

(10/24/19)