|Advocate Dreyer Creates Complex Pediatric Care Clinic|
Under the guidance of physician Nisha Kakodkar, M.D., Advocate Dreyer is opening a Complex Pediatric Care Clinic at their Fox Valley Villages location. Dr. Kakodkar’s special interests include working with children who have chronic illnesses and developmental or behavioral challenges.
The Complex Pediatric Care Clinic provides a comprehensive medical home model with the inclusion of on-site walk in care, occupational therapy, speech therapy, lab, imaging, child & adolescent behavioral health sciences.
Downloadable Privacy Policies
Click here to learn how you can get a copy of your medical records.THIS NOTICE OF PRIVACY PRACTICES (“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.
This Notice applies to any health care facility or physician practice now or in the future controlled by or under common control with Advocate Health Care Network and any of its affiliates or subsidiaries (collectively referred to as "Advocate Health Care"), which includes without limitation the following:
Hospitals and Medical Staffs
Although this Notice does address the sites listed above, any independent physicians are and remain independent contractors and are not agents, servants or employees of Advocate Health Care and are solely responsible for their judgment and (medical) conduct in treating or providing professional services to the patient and for their compliance with state and federal privacy laws. Nothing in this Notice is meant to imply, infer or create any agency or employment relationship between any independent physician and Advocate Health Care, either actual or implied; nor is it intended to create reliance on the part of the patient; nor is this Notice intended to alter or limit any other consents for treatment or procedures the patient may sign during the time the patient is provided care at this site.
UNDERSTANDING YOUR MEDICAL INFORMATION
We understand that medical information about you and your health is personal. We are committed to protecting your medical information. Each time you visit a hospital, physician, or other health care provider, they document information about you and your visit. Typically, this record contains, among other information, your name, symptoms, health history, examination and test results, diagnoses, current and future treatment, and billing-related information (“Medical Information”). This Medical Information is used to provide you with quality care and to comply with certain legal requirements.
This Notice will tell you how we may use and disclose Medical Information about you. It also describes your rights and certain obligations we have regarding the use and disclosure of your Medical Information.
USES AND DISCLOSURES OF YOUR MEDICAL INFORMATION
The following categories describe different ways in which we may use and disclose your Medical Information. With respect to use and disclosure of your Medical Information for Treatment, Payment and Health Care Operations, we may share your Medical Information with any of the entities referenced in this Notice, or any physician or other health care provider as allowed by law.
For Treatment. We may use your Medical Information to provide, coordinate or manage your medical treatment and related services. Your Medical Information can be shared with physicians, nurses, technicians and others involved in your care and these individuals will collect and document information about you in your medical record. To assure immediate continuity of care, we may disclose information to a physician or other health care provider who will be assuming your care. For example, different departments may share your Medical Information to coordinate the different services you may need such as prescriptions, lab work, meals and X-rays or other diagnostic tests.
For Payment. In most cases, we may use and disclose your Medical Information so that the treatments and services you receive may be billed and payment may be collected from you, an insurance company or a third party. For example, we may need to give information about the surgery you received to your health plan so your health plan will pay us or reimburse you for the surgery. We also may tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
If you are receiving mental health or alcohol/substance abuse services in an inpatient behavioral health unit during this hospitalization, we will not disclose any information without your prior written authorization.
Individuals Involved in Your Care or Payment for Your Care. We may disclose the minimum necessary Medical Information about you to a family member, other relative, close personal friend or any other person you identify who is involved in your medical care. We also may disclose the minimum necessary information to someone who helps pay for your care. In an emergency or other situation where you are not able to identify your chosen person(s) to receive communications about you, we may exercise our professional judgment to determine whether such a disclosure is in your best interest, who is the appropriate person(s) and what Medical Information is relevant to their involvement with your health care. We may also disclose your Medical Information to an organization, such as the American Red Cross which is assisting in a disaster relief effort, so that your family can be notified about your condition, status and location.
Research. Under certain circumstances, we may use or disclose your Medical Information to identify you as a potential candidate for a research study that has been approved by an Institutional Review Board. This approval is given after an evaluation of a proposed research project and its uses of Medical Information, and always with an effort to balance the requirements of sound research with patients’ need for privacy of their Medical Information. We may disclose Medical Information about you to people preparing to conduct a research project, for example, to help them look for patients with specific medical needs, so long as the Medical Information they review does not leave the site. We may use or disclose your Medical Information without your consent or authorization if an Institutional Review Board or Privacy Board approves a waiver of authorization for disclosure.
To Avert a Serious Threat to Health or Safety. We may use or disclose your Medical Information to prevent or lessen a serious and imminent threat to a person’s or the public’s health or safety.
Business Associates. We provide some services through other persons or companies that need access to your health information to carry out these services. The law refers to these persons or companies as our Business Associates. We may disclose, as allowed by law, your health information to our Business Associates so that they can do the job we have contracted with them to do. Examples of Business Associates include companies that assist with billing services or copying medical records. We may send other business associates called registries (such as a Cancer Registry) summarized information about patients who have been treated with similar problems such as cancer or trauma, to help physicians improve the quality of care for other patients with similar problems. We require through a written contract that our Business Associates use appropriate safeguards to ensure the privacy of your Medical Information.
Advocate Charitable Foundation, mission and spiritual care, or others on their behalf may on occasion visit you during your stay in the hospital in order to inquire about the quality of your stay or to offer any needed assistance. If you do not want Advocate Charitable Foundation, mission and spiritual care, or others on their behalf to be informed about your hospital stay, please inform your nurse or a registration coordinator during your stay at the hospital.
Law Enforcement. We may disclose your Medical Information to the police or other law enforcement officials as part of law enforcement activities, in investigations of criminal conduct, in response to a court order, in emergency circumstances, or when otherwise required to do so by law.
Coroners, Medical Examiners and Funeral Directors. We may release Medical Information about you to a coroner or medical examiner as necessary to identify a deceased person or to determine the cause of death. We also may release your Medical Information to funeral directors as necessary for them to carry out their duties.
Organ and Tissue Donation. If you are an organ donor, we may release your Medical Information to organizations that obtain organs or handle organ, eye or tissue transplantation. We may also release your Medical Information to an organ bank to arrange for organ or tissue donation and transplantation.
Military and Veterans. If you are a member of the military or a veteran, we may release your Medical Information to the proper authorities so they may carry out their duties under the law.
Workers’ Compensation. We may disclose your Medical Information as allowed or required by state law relating to workers’ compensation benefits for work-related injuries or illness or to other similar programs.
USES AND DISCLOSURES REQUIRING YOUR WRITTEN AUTHORIZATION
Use or Disclosure with Your Authorization. We must obtain your written authorization for most uses and disclosures of psychotherapy notes, uses and disclosure of Medical Information for marketing purposes and disclosures that constitute the sale of Medical Information. Additionally, other uses and disclosures of Medical Information not described in this Notice will be made only when you give us your written permission on an authorization form (“Your Authorization”). For instance, you will need to sign and complete an authorization form before we can send your PHI to your life insurance company or to the attorney representing the other party in a lawsuit in which you are involved.
Uses and Disclosures of Your Highly Confidential Information. Federal and state laws require special privacy protections for certain highly confidential information about you (“Highly Confidential Information”). This Highly Confidential Information may include the subset of your Medical Information that is maintained in psychotherapy notes. In order for us to disclose your Highly Confidential Information for a purpose other than those permitted by law, we must have Your Authorization.
Revocation of Your Authorization. You may withdraw (revoke) Your Authorization or any written authorization regarding your Highly Confidential Information (except to the extent we have taken action in reliance upon it) by delivering a written statement to the Privacy Officer identified below. A form of Written Revocation is available upon request from the Privacy Officer.
You have the following rights regarding the Medical Information we maintain about you:
Right to Inspect and Copy. You may request access to your medical record file and billing records maintained by us in order to inspect and request copies of the records. Under limited circumstances, we may deny you access to a portion of your records. If you would like to access your records, you must submit your request in writing. The Authorization for Release of Patient Health Information form is available from the medical records department at each Advocate Health Care site of care.
If you request a copy of your Medical Information, we may charge you a cost-based fee, consistent with Illinois law, that includes labor for copying the Medical Information; supplies for creating the paper copy or electronic media if you request an electronic copy on portable media; our postage costs, if you request that we mail the copies to you; and if you agree in advance, the cost of preparing an explanation or summary of the Medical Information. If you are denied access to your Medical Information, you may request that the denial be reviewed. A licensed health care professional chosen by Advocate Health Care will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the decision that is the outcome of the review.
Right to Amend. If you feel that the Medical Information we have on record is inaccurate or incomplete, you have the right to request an amendment as long as the information is kept by or for Advocate Health Care. If the Medical Information is kept by another hospital or provider, we cannot act on your request. You must contact them directly. Your request for an amendment must be in writing and must state the reasons for the request. The written request can be made on the Request for Amendment to the Record form available in the medical records department at each Advocate Health Care site of care. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. We are not obligated to make all requested amendments, but will give each request careful consideration. If your request is denied, you have the right to send a letter of objection that will then be attached to your permanent medical record. Please note that even if we accept your request, we may not delete any information already documented in your medical record.
Right to an Accounting of Disclosures. You have the right to ask us for an “accounting of disclosures.” This is a listing of those individuals or entities that have received your Medical Information from Advocate.
The listing will not cover Medical Information that was given to you or your personal representative or to others with your permission. In addition, it will not cover Medical Information that was given in order to:
Right to Request Restrictions. You have the right to ask us to restrict or limit the Medical Information we use or disclose about you for treatment, payment or healthcare operations. In addition, if you pay for a particular service in full, out-of-pocket, on the date of service, you may ask us not to disclose any related Medical Information to your health plan for payment or health care operations purposes. Unless required by law, we are not required to agree to all requests. If we do agree, we will comply unless the information is needed to provide emergency treatment.
Right to Request Confidential Communications. You have the right to ask us to communicate with you about medical matters in a certain way or at a certain location. For example, you may ask that we contact you only by sending materials to a P.O. Box instead of your home address. We will not ask the reason for your request and we will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of this Notice. Upon your request, you may obtain a copy of this Notice, either by email or in paper format. To do so, please submit your request to Privacy Officer, Advocate Health Care, 3075 Highland Parkway, Suite 600, Downers Grove, Illinois 60515, phone: 630-929-5922. You also may access a copy of this Notice on our web site at www.advocatehealth.com.
EFFECTIVE DATE AND DURATION OF THIS NOTICE
This Notice is effective on September 23, 2013.
We reserve the right to change our privacy practices, policies and procedures and our Notice of Privacy Practices at any time. We also reserve the right to make the revised privacy policies, procedures and Notice effective for Medical Information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice in Advocate Health Care facilities and on our Internet site. You may also obtain any new notice by contacting the Privacy Officer. In addition, each time you register or are admitted to Advocate Health Care as an inpatient or outpatient, a copy of the current Notice will be available upon request
If you would like more information about your privacy rights, if you are concerned that we may have violated your privacy rights, or if you disagree with a decision that we made about access to your Medical Information, you may contact our Privacy Officer. Also, you may make a complaint by calling our Privacy Office at 630-929-5922. You may also file written complaints with the Director, Office for Civil Rights of the U.S. Department of Health and Human Services. Upon request, the Privacy Officer will provide you with the correct address for the Director. We will not retaliate against you if you file a complaint with us or the Director.
You may contact the Privacy Officer at:
All requests for copies of medical records should be directed to the Release of Information area in the Medical Records Department on the lower level of Dreyer Medical Clinic's West Aurora site at 1870 West Galena Boulevard, Aurora, Illinois, 60506, between the hours of 8:00 a.m. and 5:00 p.m. Monday through Friday. You may also call 630-859-7266 for assistance. All requests are processed within three to five days after the appropriate completed release forms have been received.
Fees have been established for the copying of medical records in accordance with legislation enacted by the State of Illinois in September of 2001. Fees will vary depending on the volume of the records requested. Contact the Medical Records Department at 630-859-7266 to determine the exact costs for the records you need.
Downloadable Authorization Release Form
Click Here to download an English version of the authorization form.
Click Here to download a Spanish version of the authorization form.
(Adobe Acrobat Reader required.)