Heartland Health Centers Privacy Policy

2015 Version



Effective Date: April 14, 2003 and modifications as of July 09, 2015.

We respect patient confidentiality and only release confidential information about you in accordance with Illinois and federal law. This notice describes our policies related to the use of the records of your care generated by Heartland Health Centers.

Privacy Contact:

If you have any questions about this policy or your rights contact
the Director of Quality at 773-296-7576


In order to effectively provide you care, there are times when we will need to share your confidential information with others beyond Heartland Health Centers. This includes for:

Treatment We may use or disclose treatment information about you to provide, coordinate, or manage your care or any related services, including sharing information with others outside Heartland Health Centers that we are consulting with or referring you to.

Payment With your written consent, information will be used to obtain payment for the treatment and services provided. This will include contacting your health insurance company for prior approval of planned treatment or for billing purposes. You have a right to restrict certain disclosures of your protected health information if you pay out of pocket in full for the services provided to you.

Healthcare Operations We may use information about you to coordinate our business activities. This may include setting up your appointments, reviewing your care, training staff.

Information Disclosed Without Your Consent. Under Illinois and federal law, information about you may be disclosed without your consent in the following circumstances:

Emergencies Sufficient information may be shared to address the immediate emergency you are facing.

Follow Up Appointments/Care We will be contacting you to remind you of future appointments or information about treatment alternatives or other health-related benefits and services that may be of interest to you. We will leave appointment information on your voice mail or leave an email or text message unless you tell us not to.

As Required by Law This would include situations where we have a subpoena, court order, or are mandated to provide public health information, such as communicable diseases or suspected abuse and neglect such as child abuse, elder abuse, or institutional abuse.

Coroners We are required to disclose information about the circumstances of your death to a coroner who is investigating it.

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 to Illinois state agencies that fund our services or for coordination of your care.

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 may occur to someone.

Fundraising/Marketing As a not-for-profit provider of health care services we need assistance in raising money to carry out our mission. We may contact you to seek a donation. You will have the opportunity to opt-out of receiving such communication. You may also opt-out of our providing your contact information for any marketing that results in compensation to Heartland Health Centers.

Research Heartland Health Centers periodically participates in research in order to improve health care and develop new knowledge. Your health care information may be important to further research efforts and the development of new knowledge. All research projects conducted Heartland Health Centers must be approved through a special review process to protect patient safety, welfare and confidentiality. We may use and disclose medical information about our patients for research purposes, subject to the confidentiality provisions of federal and state law. On occasion, researchers contact patients regarding their interest in participating in certain research studies. Enrollment in those studies can only occur after you have been informed about the study, had an opportunity to ask questions and indicated your willingness to participate by signing a consent form. Other studies may be performed using your medical information without requiring your consent when approved though a special review process and in compliance with applicable laws. These studies will not affect your treatment or welfare, and your medical information will continue to be protected.


You have the following rights under Illinois and federal law:

Copy of Record You are entitled to inspect the patient record Heartland Health Centers has generated about you. We may charge you a reasonable fee for copying and mailing your record.

Release of Records You may consent in writing to release your records to others for any purpose you choose. This can include your attorney, employer, or others who you wish to have knowledge of your care. You may revoke this consent at any time, but only to the extent no action has been taken in reliance on your prior authorization. Except as described in this Notice or as required by Illinois or Federal law, we cannot release your protected health information without your written consent.

Restriction on Record You may ask us not to use or disclose part of the clinical information. This request must be in writing. Heartland Health Centers is not required to agree to your request if we believe it is in your best interest to permit use and disclosure of the information. The request should be given to the Privacy Contact.

Contacting You You may request that we send information to another address or by alternative means. We will honor such request as long as it is reasonable and we are assured it is correct. We have a right to verify that the payment information you are providing is correct.

Amending Record If you believe that something in your record is incorrect or incomplete, you may request we amend it. To do this contact the Privacy Contact and ask for the Request to Amend Health Information form. In certain cases, we may deny your request. If we deny your request for an amendment you have a right to file a statement that you disagree with us. We will then file our response and your statement and our response will be added to your record.

Accounting for Disclosures You may request an accounting of any disclosures we have made related to your confidential information, except for information we used for treatment, payment, or health care operations purposes or that we shared with you or your family, or information that you gave us specific consent to release. It also excludes information we were required to release. To receive information regarding disclosure made for a specific time period no longer than six years. Please submit your request in writing to our Privacy Contact. We will notify you of the cost involved in preparing this list.

Notification of Breach You have a right to be notified if there is a breach of your unsecured protected health information. This would include information that could lead to identity theft. You will be notified if there is a breach or a violation of the HIPAA Privacy Rule and there is an assessment that your protected information may be compromised.

Questions and Complaints If you have any questions, or wish a copy of this Policy or have any complaints you may contact our Privacy Contact, in writing at our office at 3048 North Wilton Avenue Chicago, IL 60657. You also may complain to the Secretary of U.S. Department of Health and Human Services, Office for Civil Rights at 200 Independence Avenue, S.W., Room 509F HHH Bldg.
Washington, D.C. 20201 if you believe Heartland Health Centers has violated your privacy rights. We will not retaliate against you for filing a complaint.

Policy Changes Heartland Health Centers reserves the right to change its Privacy Policy based on the needs of Heartland Health Centers and changes in state and federal law.

Language and Interpreter Services Preference Heartland Health Centers will provide this Notice of Privacy Practice in any language you need. Additionally, Heartland Health Centers will provide sign-language interpreter services and language interpreter services to assist you with understanding this policy or any policy, and/or answer any of your questions.

Póliza de privacidad