NOTICE OF PRIVACY PRACTICES

THIS 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.

EFFECTIVE DATE: September 22, 2013

We respect confidentiality of the people we support and only release medical information about you in accordance with the Illinois and federal law. This notice describes our policies related to the use of the records of your care generated by Marcfirst.

Privacy Officer: If you have any questions about this policy or your rights, contact the Privacy Officer at 309-451-8888.

Definition: "You" refers to individuals supported by Marcfirst, parents, guardians, wards.


USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION

In order to effectively provide you care, there are times when we will need to share your medical information with others beyond our practice. This includes for:

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

Payment. 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.

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.

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.

Coroners, Funeral Directors, and Organ Donation. We may disclose medical information to a coroner or medical examiner and funeral directors for the purposes of carrying out their duties. When organs are donated, sufficient information will be provided to the program as necessary to facilitate the organ or tissue donation.

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 Department of Health and Human Services to determine our compliance with federal and state laws related to health 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. 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. If you would prefer not to be solicited, please notify Marcfirst's Privacy Officer.

Breach Notification Notice. Notice will be provided to you if unsecured PHI (protected health information) has been breached.


RIGHTS OF PEOPLE RECEIVING SERVICES

You have the following rights under Illinois and federal law:

Copy of Record. You are entitled to inspect all records that Marcfirst has
generated about you, and if copies are requested, they will be provided to you within 14 days.

Release of Records. You may consent in writing the release of your records to others, for any purpose you choose. This could include your attorney, employer, or others who you wish to have knowledge of your services. You may revoke this consent at any time, but only to the extent no action has been taken in reliance on your prior authorization.

Restriction on Record. You may ask us not to use or disclose part of your
records. This request must be in writing. Marcfirst 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 Officer.

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 information you are providing is correct. We also will be glad to provide you information by e-mail if you request it. If you wish us to communicate by e-mail or if you want us to accommodate any special requests, please contact the Privacy Officer.

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 Officer 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 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 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 specific time period no longer than seven years and after April 14, 2003, please submit your request in writing to our Privacy Officer.

Questions and Complaints. If you have any questions, you may contact our Privacy Officer in writing at our office for further information. You may also complain to the Secretary of Health and Human Services, if you believe Marcfirst has violated your privacy rights. We will not retaliate against you for filing a complaint.

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

SHORT TITLE VI NOTICE:
Marcfirst operates its programs and services without regard to race, color, and national origin in accordance with Title VI of the 1964 Civil Rights Act. To find out more about our non-discrimination obligations or to file a complaint, please contact us at (309)451-8888 or via the web at www.marcfirst.org.