Your rights regarding patient information

Right to Inspect and Copy

You have the right to inspect and obtain a copy of patient information within your medical and billing records and other records used to make treatment or payment decisions about you. Under limited circumstances, we may deny you access to a portion of your records.

To inspect or obtain a copy of your medical records or other records used to make treatment decisions about you, you must submit your request to the Children’s Memorial Hospital Health Information Management Department. To inspect or obtain a copy of your Children’s Memorial Hospital billing records, you must submit your request to the Children’s Memorial Hospital Patient Financial Services Department. To inspect or obtain a copy of another provider's billing records about you, you must submit your request to that provider’s Patient Financial Services Department. If you request a copy of your records, we may charge a reasonable fee in accordance with Illinois law for the costs of copying and mailing them.

Right to Amend

If you feel that any of the patient information that we maintain in your medical and billing records and other records used to make decisions about you is incorrect or incomplete, you may request that we amend the information.

To request an amendment to patient information in your medical records or other records used to make treatment decisions about you, you must make your request in writing, include a reason in support of your request and submit the request to the Children’s Memorial Hospital Health Information Management Department. To request an amendment to patient information in your Children’s Memorial Hospital billing records, you must make your request in writing, include a reason in support of your request and submit the request to the Children’s Memorial Hospital Patient Financial Services Department. To request an amendment to patient information in another provider's billing records, you must make your request in writing, include a reason in support of your request and submit the request to the other provider’s Patient Financial Services Department. We will comply with an amendment request unless we believe that the information that would be amended is accurate and complete or other special circumstances apply.

Right to an Accounting of Disclosures

You have the right to request an “accounting of disclosures.” This is a list of certain disclosures we have made of your patient information. We are not required to account for all disclosures, such as, disclosures for your treatment, to obtain payment for treatment or our health care operations.

To request this accounting of disclosures, you must submit your request in writing, to the Children’s Memorial Hospital Health Information Management Department. Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003. The first accounting you request within a twelve-month period is free of charge. For additional accountings, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before you incur any costs.

Right to Request Confidential Communications

You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you may ask that we only contact you at work or by mail. We will not ask you the reason for your request. We will accommodate only reasonable requests. Your request must specify how or where you wish to be contacted.

Right to a Paper Copy of this Notice

You have the right to a copy of this Notice. You may request a copy of this Notice at any time from our Privacy Office.

Right to Request Restrictions

You have the right to request a restriction on the patient information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the patient information we disclose about you to a family member or someone else who is involved in your care or the payment for your care. Finally, you have the right to request a restriction on the patient information that we may use or disclose to notify or assist in the notification of your caregivers regarding your location and general condition. While we will consider all requests for additional restrictions carefully, we are not required to agree to a requested restriction. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.

Right to Revoke Your Authorization

You may revoke any written authorization that you have given us to authorize our use or disclosure of your patient information, except to the extent that we have acted upon it. A form of written revocation is available from us upon request.