Midwest Express Clinic’s Privacy Notice
Our Pledge to Protect Your Privacy
MIDWEST EXPRESS CLINIC (“Clinic”) knows that medical information about you is personal and is committed to protecting the privacy of your information. As a patient of the Clinic, the care and treatment you receive is recorded in a medical record. So that we can best meet your medical needs, we share your medical record with all the health care providers involved in your care. We share your information only to the extent necessary to conduct our business operations, to collect payment for the services we provide you and to comply with the laws that govern health care. We will not use or disclose your information for any other purpose without your permission.
Throughout these web pages on patient privacy you may click on items that are in italics and underlined and an Adobe PDF file version of a document or form will open for your review or to be printed.
Our Notice of Privacy Practices
Beginning in January, 1 2018, the Clinic will provide you with a Notice of Privacy Practices that explains our privacy practices and your rights regarding your medical information. The first time you receive care in January, 1 2018, the Clinic will provide you with a copy of our Notice and ask you to acknowledge its receipt. The Clinic may need to change its privacy policies and practices from time to time and will update the Notice accordingly.
You may ask for a copy of our current Notice at any time. In any of the patient registration areas throughout the Clinic, the Notice is publicly posted for your convenience. You can also view and print a copy of our current Notice by clicking on Notice of Privacy Practices found at the bottom of our webpage.
Your Rights Regarding Medical Information About You
An important part of the Clinic’s Notice is the section that explains your rights regarding your medical information. Our Notice explains that you (or your personal representative) have the right to:
- Inspect or Obtain a Copy of Your Medical Record: You have the right to inspect or obtain a copy of the medical records that the Clinic uses to make decisions about you and your treatment, subject to certain limitations. This information includes your medical and billing records, but may not include some mental health information. If you request a copy of your records, the Clinic may charge a fee for the cost of providing your records to you.
To inspect or obtain a copy of your medical records, you may send a request to 40 75th Street, Willowbrook, IL 60527 or fax your request to (630) 568-3247.
Request a Correction or Add an Addendum to Your Medical Record: If you believe that the medical information the Clinic has on file about you is incorrect or incomplete, you may ask us to correct the medical information in your request. If your medical information is accurate and complete, or if the information was not created by the Clinic, we may deny your request; however, if we deny any part of your request, we will provide you with a written explanation of our reasons for doing so. Requests to make a correction to your records must be in writing and must be either faxed or mailed to our Willowbrook office (see address below). Your written request must describe each item that you want changed (for example: History and Physical on 3/1/2017 and Clinic Visit Note on 4/14/2017) and the reason you are requesting the change. In addition, an adult patient of the Clinic who believes that an item or statement in his/her medical record is incorrect or incomplete has the right to provide the Clinic with a written addendum to his/her record. The addendum is limited to 250 words per incorrect or incomplete item, and must clearly indicate that the patient wishes it to be made a part of his/her record.
Please send your requests to 40 75th Street, Willowbrook, IL 60527 or fax your request to (630) 568-3247. A Midwest Express Clinic representative will acknowledge your request when it is received and process your request within sixty (60) days of receipt. In certain situations, our offices may require an additional thirty (30) days to process your request.
- An Accounting of Clinic Disclosures of Your Medical Information: You have the right to request an “accounting of disclosures,” which is a list describing how we shared your medical information with outside parties. This accounting is a list of the disclosures we made of your medical information after _______ for purposes other than treatment, payment and health care operations as described in our Notice of Privacy Practices.
You may request, at no charge, an accounting of disclosures once every twelve (12) months. If you make more than one request in a twelve (12) month period, the Clinic will charge a processing fee for each additional request.
- Receive a Copy of the Clinic’s Privacy Notice: You may ask for a printed copy of the Clinic’s Notice of Privacy Practices anytime you are visiting the Clinic. The Notice is available in any of our offices. You may also print a copy of the Notice from this website by clicking on Notice of Privacy Practices.
- Request Confidential Communications: The Clinic considers your medical and billing information to be confidential. You have the right to request that we communicate with you about medical and billing matters by an alternative method or at alternative locations. For example, you may ask that we only contact you at work rather that at your home. The Clinic will review all requests and accept those that we may reasonably accommodate. The Clinic will not ask the reason for your request, but we may ask questions regarding how payment will be handled. If your request is accepted, it will apply to all our communications regarding treatment you receive from the acceptance date forward. Your request will be in effect until you change or withdraw it by submitting a new request.
Please send your requests to 40 75th Street, Willowbrook, IL 60527 or fax your request to (630) 568-3247. If you have questions about completing the request, please call (630) 581-5372. You may also request confidential communications during the registration process at the Clinic.
For further information, please view our Notice of Privacy Practices:
Notice of Privacy Practices
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