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THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BEUSED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THISINFORMATION. PLEASE REVIEW IT CAREFULLY:
This Notice describes the privacy practices of McKinley Health Center (“McKinley”). Itapplies to the health care services you receive at McKinley. This Notice describesgenerally (a) the types of uses and disclosures McKinley may make with your healthinformation; and (b) your rights to access and control your health information. McKinleywill comply with laws that provide additional protections for certain medical informationrelated to services or treatment for mental health conditions, alcohol and drug abuse,and HIV/AIDS.
CONSENT FOR TREATMENT:
I consent to the provision of care, diagnostic procedures, laboratory testing, medicaltreatment, and referral to an outside provider as my physician(s) and/or other healthcareprovider(s) deem necessary. I understand that there are no warranties or guaranteesregarding the services and care provided. Some care may be provided using telehealthtechnology and I consent to participate in telehealth consultations. I understand that theproviders participating in my care have been granted the privilege of using McKinleyfacilities for the care and treatment of UIUC students or are licensed practitionersparticipating in the care of UIUC students as part of a post-graduate medical educationprogram. McKinley will attempt to honor the request to exclude a resident or clinicalstudent where feasible and if such exclusion will not be detrimental to my healthcare.
MCKINLEY MAY USE & DISCLOSE INFORMATION FOR THE FOLLOWING:
Treatment: McKinley may use or disclose your health information to provide treatmentand to coordinate or manage your healthcare and any related services. McKinley maydisclose your information to another physician or health care provider (e.g., a specialist),who, at the request of your physician, nurse practitioner, or therapist, becomes involvedin your care.
Payment: McKinley does not routinely bill patients or third parties for servicesrendered. However, should circ*mstances require billing, your health information will beused, as needed, to obtain payment for your health care services. This may includecertain activities that your health insurance plan may undertake before it approves orpays for the health care services McKinley recommends for you.
Healthcare Operations: McKinley may use or disclose your health information toperform healthcare operations. Additionally, McKinley may use or disclose your healthinformation, as necessary, to email a reminder to you of your scheduled appointment.McKinley staff may also call you by name in the waiting room when your provider isready to see you. McKinley staff may leave a voicemail on your phone asking you tocontact McKinley in order to ensure adequate follow-up care. McKinley may provide certain services through contracts with others. When servicesare contracted, your health information may be disclosed in order to carry out specificoperational functions. Whenever an arrangement for services involves the use ordisclosure of your health information, McKinley will have a written contract to protect theprivacy of your health information.
OTHER USES AND DISCLOSURES MCKINLEY MAY MAKE WITHOUT YOURAUTHORIZATION, CONSENT OR OPPORTUNITY TO OBJECT:
McKinley may use or disclose your health information to the extent that the use ordisclosure is required or permitted by federal, state, or local law.
YOUR HEALTH INFORMATION RIGHTS:
- Right to Obtain a Copy of this Privacy Notice: Additional copies of this Notice canbe obtained at theregistration areas of McKinley.
- Right to Inspect and Request a Copy of your Health Record: You have the right toinspect and obtain a copy of your health record, except in limited circ*mstances definedby federal and state law.
- Right to Request an Amendment to your Health Record: You may make a writtenrequest to amend your health information, if the information is kept by or for McKinley.You must give McKinley a reason for the amendment. In certain cases, McKinley maydeny your request for an amendment. If McKinley denies your request for amendment,you have the right to file a statement of disagreement with McKinley, and McKinley mayprepare a rebuttal to your statement. McKinley will provide you with a copy of any suchrebuttal.
- Contact McKinley’s Privacy Administrator: To exercise any of the rights describedabove, or if you have any questions about this Notice, please contact the Privacy Administrator. If you believe that your privacy rights have been violated by McKinley,you may file a complaint with McKinley by contacting the Privacy Administrator at (217)333-2711 or by mail to: McKinley Health Center, Attention: Privacy Administrator, 1109South Lincoln Avenue, Urbana, IL 61801.
- Changes to this Notice: McKinley reserves the right to change this Notice at anytime. McKinley reserves the right to make the revised or changed Notice effectivefor information already obtained about you as well as any information received inthe future.
