Springfield Clinic, Springfield, IL is committed to protecting your privacy and developing technology that gives you the most powerful and safe online experience. This Statement of Privacy applies to the Springfield Clinic, Springfield, IL Web site and governs data collection and usage. By using the Springfield Clinic, Springfield, IL website, you consent to the data practices described in this statement.
Collection of your Personal Information
Springfield Clinic, Springfield, IL collects personally identifiable information, such as your e-mail address, name, home or work address or telephone number. Springfield Clinic, Springfield, IL also collects anonymous demographic information, which is not unique to you, such as your ZIP code, age, gender, preferences, interests and favorites.
There is also information about your computer hardware and software that is automatically collected by Springfield Clinic, Springfield, IL. This information can include: your IP address, browser type, domain names, access times and referring Web site addresses. This information is used by Springfield Clinic, Springfield, IL for the operation of the service, to maintain quality of the service, and to provide general statistics regarding use of the Springfield Clinic, Springfield, IL Web site.
Please keep in mind that if you directly disclose personally identifiable information or personally sensitive data through Springfield Clinic, Springfield, IL public message boards, this information may be collected and used by others. Note: Springfield Clinic, Springfield, IL does not read any of your private online communications.
Springfield Clinic, Springfield, IL encourages you to review the privacy statements of Web sites you choose to link to from Springfield Clinic, Springfield, IL so that you can understand how those Web sites collect, use and share your information. Springfield Clinic, Springfield, IL is not responsible for the privacy statements or other content on Web sites outside of the Springfield Clinic, Springfield, IL and Springfield Clinic, Springfield, IL family of Web sites.
Use of your Personal Information
Springfield Clinic, Springfield, IL collects and uses your personal information to operate the Springfield Clinic, Springfield, IL Web site and deliver the services you have requested. Springfield Clinic, Springfield, IL also uses your personally identifiable information to inform you of other products or services available from Springfield Clinic, Springfield, IL and its affiliates. Springfield Clinic, Springfield, IL may also contact you via surveys to conduct research about your opinion of current services or of potential new services that may be offered.
Springfield Clinic, Springfield, IL does not sell, rent or lease its customer lists to third parties. Springfield Clinic, Springfield, IL may, from time to time, contact you on behalf of external business partners about a particular offering that may be of interest to you. In those cases, your unique personally identifiable information (e-mail, name, address, telephone number) is not transferred to the third party. In addition, Springfield Clinic, Springfield, IL may share data with trusted partners to help us perform statistical analysis, send you email or postal mail, provide customer support, or arrange for deliveries. All such third parties are prohibited from using your personal information except to provide these services to Springfield Clinic, Springfield, IL, and they are required to maintain the confidentiality of your information.
Springfield Clinic, Springfield, IL does not use or disclose sensitive personal information, such as race, religion, or political affiliations, without your explicit consent.
Springfield Clinic, Springfield, IL keeps track of the Web sites and pages our customers visit within Springfield Clinic, Springfield, IL, in order to determine what Springfield Clinic, Springfield, IL services are the most popular. This data is used to deliver customized content and advertising within Springfield Clinic, Springfield, IL to customers whose behavior indicates that they are interested in a particular subject area.
Springfield Clinic, Springfield, IL Web sites will disclose your personal information, without notice, only if required to do so by law or in the good faith belief that such action is necessary to: (a) conform to the edicts of the law or comply with legal process served on Springfield Clinic, Springfield, IL or the site; (b) protect and defend the rights or property of Springfield Clinic, Springfield, IL; and, (c) act under exigent circumstances to protect the personal safety of users of Springfield Clinic, Springfield, IL, or the public.
The Springfield Clinic, Springfield, IL Web site use "cookies" to help you personalize your online experience. A cookie is a text file that is placed on your hard disk by a Web page server. Cookies cannot be used to run programs or deliver viruses to your computer. Cookies are uniquely assigned to you, and can only be read by a web server in the domain that issued the cookie to you.
One of the primary purposes of cookies is to provide a convenience feature to save you time. The purpose of a cookie is to tell the Web server that you have returned to a specific page. For example, if you personalize Springfield Clinic, Springfield, IL pages, or register with Springfield Clinic, Springfield, IL site or services, a cookie helps Springfield Clinic, Springfield, IL to recall your specific information on subsequent visits. This simplifies the process of recording your personal information, such as billing addresses, shipping addresses, and so on. When you return to the same Springfield Clinic, Springfield, IL Web site, the information you previously provided can be retrieved, so you can easily use the Springfield Clinic, Springfield, IL features that you customized.
You have the ability to accept or decline cookies. Most Web browsers automatically accept cookies, but you can usually modify your browser setting to decline cookies if you prefer. If you choose to decline cookies, you may not be able to fully experience the interactive features of the Springfield Clinic, Springfield, IL services or Web sites you visit.
Security of your Personal Information
Springfield Clinic, Springfield, IL secures your personal information from unauthorized access, use or disclosure. Springfield Clinic, Springfield, IL secures the personally identifiable information you provide on computer servers in a controlled, secure environment, protected from unauthorized access, use or disclosure. When personal information (such as a credit card number) is transmitted to other Web sites, it is protected through the use of encryption, such as the Secure Socket Layer (SSL) protocol.
Changes to this Statement
Springfield Clinic, Springfield, IL will occasionally update this Statement of Privacy to reflect company and customer feedback. Springfield Clinic, Springfield, IL encourages you to periodically review this Statement to be informed of how Springfield Clinic, Springfield, IL is protecting your information.
Springfield Clinic, Springfield, IL welcomes your comments regarding this Statement of Privacy. If you believe that Springfield Clinic, Springfield, IL has not adhered to this Statement, please contact Springfield Clinic, Springfield, IL at firstname.lastname@example.org. We will use commercially reasonable efforts to promptly determine and remedy the problem.
Notice of Privacy Practices
Notice of Privacy Practices
- How medical information about you may be used and disclosed.
- How you can get access to this information.
- Please read carefully.
How we may use and disclose your medical information
The following categories describe different ways that we use and disclose your medical information. For each category of uses or disclosures we will explain what we mean and give some examples. Not every use or disclosure in any category is listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
We will use and disclose your health information for treatment purposes
We may use and disclose your health information to provide you with treatment and health care services. This may include sharing information through an electronic Health Information Exchange and other electronic systems with non-Clinic providers also involved in your treatment; with nurses conducting screening for eligibility in research projects; and with employees of the health care providers' offices who treat you. We also may disclose your health information to residents and students who perform duties at the Clinic, to the extent your health information is required to perform these duties. We may disclose your health information to Clinic employees in the support services areas, such as medical records and transcription, such that they may support your care. We also may disclose your health information to pharmacies for the purpose of filling your prescriptions and to other health care providers outside the Clinic for diagnostic purposes. We may also disclose your health information to your family members or friends or any other individual identified by you as involved in your care or in the payment for your care. We may also release your health information to your legal representative upon request. If a person has the authority by law to make health care decisions for you, we will treat that legal representative the same way we would treat you with respect to your health information.
Notwithstanding the above, we will comply with the requirements of laws that limit the use and disclosure of certain health information with regard to treatment activities. Some information, such as STD and HIV-related information, genetic information, alcohol and/or substance abuse records, and mental health records may be entitled to special confidentiality protections under applicable state or federal law. We will abide by these special protections as they pertain to applicable cases involving these types of records. We will not disclose genetic testing information for underwriting purposes.
We will use and disclose your health information for payment
We may disclose your health information to those family members who are helping you pay for your health care. Payment activities include billing, collections, claims management and determinations of eligibility and coverage to obtain payment from you, an insurance company, or another third party. For example, we may disclose your health information to your health plan or other third-party payer to obtain payment or assist you in receiving reimbursement from your plan or such other payer. This may include employers or their designees for on-the-job injuries. As necessary, we may disclose your health information to collection agencies working with the Clinic. We may disclose your health information to those treatment providers outside the Clinic who are involved in your care, such that they may be paid for their services rendered. If federal or state law requires us to obtain a written release from you prior to disclosing health information for payment purposes, we will ask you to sign a release.
We will use and disclose your health information for regular health care operations
The Clinic and our contractors and business associates may use and disclose your health information for our health care operations. For example, we may use your health information to review, improve, and assess the quality of care provided; to obtain the input of prudent professionals when developing policies and procedures; and to seek areas of improvement within our facility. As an ethical business, the Clinic also may make your health information available for internal review and consultations regarding its business practices and management.
We will disclose your health information to our contractors
We will disclose your health information to our “Business Associates” –those vendors with whom we contract to provide a service to the Clinic. Examples of such vendors include the copy service we may use when making copies of your health record, attorneys, auditors, certain health care providers and other agencies. When services are contracted, we may disclose your health information to our vendors such that they can perform the job we have asked them to do, and to bill for their services. To protect your health information, however, we require these vendors to appropriately safeguard your information by requiring that they enter into an appropriate agreement with the Clinic.
We may use your health information to notify you of items of interest
We may use your medical information to contact you to provide you with appointment reminders or to inform you of potential treatment options or alternatives and to inform you of health related benefits or services that may be of interest to you. Appointment reminders will be left with family members or on phone message machines.
We will disclose your health information as required by law and regulations
We may use and disclose your health information as required by law. For example, we may disclose your health information to the FDA to report adverse events with medical devices, food, or prescription drugs. We may disclose your health information to the extent authorized by and necessary to comply with laws relating to workers compensation and similar programs established by law. We may disclose your health information for public health activities including disclosures to prevent or control disease, injury or disability; report births and deaths; report child abuse or neglect; or notify a person who may have been exposed to a disease or condition. We may disclose information for law enforcement purposes as required by law or in response to a valid subpoena, summons, court order, or similar process.
We may use and disclose your health information for research
Under certain circumstances, we may use and disclose health information about you for research purposes, subject to the requirements of applicable law. All research projects, however, are subject to a special approval process, which establishes protocols to ensure that your health information will continue to be protected. When required, we will obtain a written authorization from you prior to using your health information for research.
We may use and disclose your health information to avert a serious threat to health and safety
We may disclose your health information when necessary to prevent a serious threat to your health or safety, or the health and safety of the public, or another person. Any disclosure, however, would comply with applicable law and standards of ethical conduct.
We may contact you to provide you with information about our sponsored activities, including fundraising programs, as permitted by applicable law. If you do not wish to receive such information from us, you may opt out of receiving the communications by contacting the Information Privacy Officer at email@example.com, or call 1(800)444-7541.
We may use and disclose your health information in the following special situations:
Military and Veterans. If you are a member of the armed forces, we may release your health information as required by military command authorities, or to the Red Cross to coordinate family emergency leave of absence, as authorized or required by law.
Public Health Risks. We may release your health information for public health activities while state or federal laws require it. A few examples of such activities are disease control, child abuse or neglect, reactions to medications, or problems with medical products.
Protective Services for the President, National Security and Intelligence Activities. We may release your health information to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state, or to conduct special investigations, or for intelligence, counter-intelligence and other national security activities authorized by law.
Inmates. If you are an inmate of a correctional institution, or under the custody of a law enforcement official, we may release your health information to the correctional institution or law enforcement official as necessary (1) for the institution to provide you with care; (2) to protect your health and safety or the health or safety of others; or (3) for the safety or security of the correctional institution.
Organ and Tissue Donation. If you are an organ donor, we may release health information to organizations that handle organ procurement or organ, eye or tissue transplantation, or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation, in accordance with applicable law.
Coroners, Medical Examiners and Funeral Directors. We may release health information to coroners, medical examiners, and funeral directors as necessary for them to carry out their duties.
Disaster-Relief Efforts. When permitted by law, we may also use and disclose health information about you with other health care providers and entities assisting in a disaster relief effort. If you do not want us to disclose your health information for this purpose, you must communicate this to your caregiver so that we do not disclose this information unless done so in order to properly respond to the emergency.
Organized Health Care Arrangement. The Clinic maintains some of its medical records through the use of a shared electronic health record system. The shared electronic health record system combines protected health information of Springfield Clinic patients with that of other covered entities so that each patient has a single health record with respect to physician office services provided by the participating covered entities in the Springfield, Illinois area. Through the use of the electronic health record system for joint quality assurance and/or utilization review activities, the participating covered entities, including Southern Illinois University School of Medicine, SIU HealthCare, and Memorial Health Systems (MHS), qualify as an Organized Health Care Arrangement (“OHCA”), as defined by HIPAA. As OHCA participants, all participating covered entities may use and disclose the protected health information contained within the electronic health record for treatment, payment and health care operations purposes of each of the OHCA participants. For more information on which MHS (for example, Memorial Physician Services (MPS)) covered providers are OHCA participants, please contact our Privacy Department at the number in this notice
Other Uses and Disclosures of Your Health Information
Other uses and disclosures of your health information not covered by the categories included in this Notice or applicable laws, rules or regulations will be made only with your written permission or authorization. If you provide us with such written permission, you may revoke it at any time. We are not able to take back any uses or disclosures that we already made with your authorization. We are required to retain your medical information regarding the care and treatment that we provided to you. We will ask for either an electronic authorization (usually signed by clicking “I agree”) or a signature on a paper authorization to use your health information in such circumstances.
While your health record is the physical property of Springfield Clinic, the information contained in your health record ultimately belongs to you.
You have the right to:
- To receive a copy of the Clinic’s Notice of Privacy Practices. You have the right to a paper copy of this Notice at any time, even if you have previously agreed to electronically receive this Notice. You can always request a written copy of our most current version of this Notice from the Information Privacy Officer.
- With certain exceptions, to review your medical records. Upon your request, you have the right to obtain a copy of your medical records in electronic format if we maintain the health information electronically. You must request to review or receive a copy of your medical records in writing and we may charge you a fee for the cost of copying and mailing your records, as well as other costs associated with your request. If you are denied a request for access, you have the right to have the denial reviewed in accordance with the requirements of applicable law.
- To request laboratory test results directly from the laboratory for yourself, or by your personal representative. You or your personal representative may also request the laboratory test results from your provider.
- To designate in writing with a mailing address, a third party to receive a copy of your records.
- To request that we communicate with you about your health information in a certain way or at a certain location. For example, you can request that we contact you only at work or by mail. You must make your request in writing to the Information Privacy Officer.
- To request a restriction or limitation on the health information we use or disclose for the purpose of treatment, payment or health care operations. We are not required to agree to your request except in the case where the disclosure is to a health plan for purposes of carrying out payment or health care operations, and the information pertains solely to a health care item or service for which the health care provider has been paid out of pocket in full. To request a restriction, you must make your request in writing to the Information Privacy Officer. You also have the right to request a limit on health information we disclose about you to someone who is involved in your care, such as a family member or friend.
- To request amendments to your health information in accordance with established Clinic Policy. In order to request an amendment to your health information, you must submit your request in writing to the Information Privacy Officer, along with a description of the reason for your request. If we agree to your request, we will amend your record(s) and notify you of the amendment. We do not have to agree to your request for amendment. If your request is denied, we will provide you with a written explanation of why we denied the request and your rights in that circumstance.
- To request an accounting of disclosures of your health information that the Clinic has made in the six (6) years prior to the request date, in accordance with applicable laws and regulations. To request an accounting of disclosures of your health information, you must submit your request in writing to the Information Privacy Officer. Your request must include the requested time period for the accounting (e.g., the past three months). The first accounting that you request within any 12-month period will be free. For additional accountings, we may charge you for the production cost. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
- To revoke an Authorization to Release Medical Information, except to the extent that action has already been taken in reliance of your authorization. This revocation must be in writing.
- To register a complaint about any areas where you feel there was a deviation from these rights to the Information Privacy Officer and to expect a response from the Information Privacy Officer addressing your complaint.
- To address your complaint to the Secretary of Health and Human Services of the United States, if you feel that the Clinic has not adequately addressed your concerns.
The Clinic places the highest priority on protecting your health information. For any use or disclosure of patient information other than those listed in this Notice or covered by the laws that apply to us, we will request a written authorization signed by you or your legal representative. We will not use or disclose your health information for marketing activities, sell your health information or disclose certain behavioral health records or psychotherapy notes without your written authorization.
- To maintain the privacy of your health and billing information.
- To provide you with this Notice of our legal duties and privacy practices concerning your health information.
- To restrict disclosure of your health information to your insurance company if you request it and pay cash out of pocket before the service.
- To follow the terms of the Notice that we have in effect at the time.
- To notify you if we are unable to agree to a requested amendment.
- To accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.
- To notify you of breaches of your unsecured protected health information as required by law.
We reserve the right to revise or amend this Notice. Any revision or amendment to this Notice will be effective for all of your records that the Clinic has created or maintained in the past, and for any records we may create and maintain in the future. The Clinic will provide a copy of our current privacy practices on the Clinic web site (www.SpringfieldClinic.com), posted in public areas of clinic locations, and at the time of consent.
For further information or to report a problem:
Should you have further questions, wish to request restrictions regarding certain disclosures described in this Notice, to make a change to your health information, or if you believe your privacy rights have been violated, you may file a complaint with the Information Privacy Officer at 217.528.7541.
You may also contact the Secretary of Health and Human Services at www.hhs.gov/ocr. The Clinic will not take any retaliatory action against you for filing a complaint.
Patient Rights & Responsibilities
- You have the right to impartial access to all treatments, or accommodations that are available or medically indicated, regardless of race, creed, sex, national origin, religion or disability. You will be accorded accommodation under the Americans with Disabilities Act, such as the services of an interpreter or other accessibility accommodation, if needed.
- You have the right to considerate, respectful care at all times and under all circumstances with recognition of your personal dignity.
- You have the right to expect our staff members to display the highest regard for your privacy. You have the right to expect that all communications and records pertaining to your care are confidential.
- You have the right to expect reasonable safety insofar as the clinic practices and environment are concerned.
- You have the right to know the identity and professional status of individuals providing your service, and to know which physician or other practitioner is primarily responsible for your care. You have the right to refuse to participate in research projects or to be interviewed for such purposes. You have the right to a full explanation or purposes and uses of the information if you do participate.
- You have the right to obtain from your physician complete and current information concerning your diagnosis, treatment and any known prognosis. When it is not medically advisable to give such information to you, the information can be made available to a legally authorized individual.
- You have the right to reasonably informed participation in decisions involving your care. You should not be subjected to any procedure without your voluntary, competent, and understanding consent, or that of your legally authorized representative. Where medically significant alternatives for care or treatment exist, you should be so informed.
- You have the right to consult with another specialist, at your own request and expense. You have the right to end your relationship with your healthcare provider.
- You have the right to refuse treatment to the extent permitted by law. When refusal of treatment by you or your legally authorized representative prevents the provision of appropriate care in accordance with ethical and professional standards, your doctor may terminate the relationship with you upon reasonable notice.
- You have the right to request and receive an itemized, detailed explanation of your total bill.
- You are responsible to provide, to the best of your knowledge, accurate and complete information about present complaints, past illnesses, hospitalizations, medications and other matters relating to your health. You are responsible for making it known whether you clearly comprehend a contemplated course of action and what is expected of you.
- You are responsible for following the treatment plan recommended by your physician. This may include following the instructions of nurses and allied health personnel as they follow the orders of your physician.
- You are responsible for keeping appointments, and when unable to do so for any reason, to notify the doctor’s office.
- You are responsible for your actions if you refuse treatment or do not follow the doctor’s instructions.
- You are responsible for assuring that the financial obligations of your health care are fulfilled as promptly as possible.
- You are responsible for checking in at the reception desk upon each arrival so that the receptionist is aware of your presence.
- You are responsible for informing the clinic about new addresses, new telephone numbers, changes of names, or new family members as soon as possible.
- You are responsible for being considerate of the rights of other patients and clinic personnel and for being respectful of the property of other persons and that of the clinic.
- You are responsible to provide a responsible adult to transport you home from the facility and remain with you for 24 hours if required by your provider.
- You are responsible to inform your provider about any Advance Directive you may have that could affect your care.
Nondiscrimination and Accessibility Information (PDF)
Nondiscrimination Policy and Section 504 Grievance Procedure (PDF)
Nondiscrimination & Accessibility
Springfield Clinic complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Springfield Clinic does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Springfield Clinic provides free aids and services to people with disabilities to communicate effectively with us, such as:
- Qualified sign language interpreters
- Written information in other formats
Springfield Clinic provides free language services to people whose primary language is not English, such as:
- Qualified interpreters
- 2 dedicated language lines, Spanish 1-855-226-1738 and French 1-866-802-3558
If you need these services, please contact Interpreter Services at 217-528-7541 ext. 43024 during normal business hours.
Each department of Springfield Clinic is equipped to meet the accessibility needs of patients with mobility disabilities. If you need accommodations because you use a wheelchair or other mobility assistive device, please be sure to inform the receptionist when you call for an appointment with your primary care physician, specialty care physician, or those providers in testing, such as radiology or mammography. If our staff makes your appointment for you, there is no need for you to call as this information will be provided by our staff.
If you believe that Springfield Clinic has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:
Director of Quality Management
1025 S 6th St. Springfield, IL 62794
Phone: 217.528.7541 or 800.444.7541
You can file a grievance in person, by mail or fax. If you need help filing a grievance, The Director of Quality Management is available to help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf , or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 1-800-368-1019, 800-537-7697 (TDD).
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
Non-Discrimination Policy and Section 504 Grievance Procedure (PDF)