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    Patient Privacy

    About Us

    Springfield Clinic is committed to the confidentiality of the protected health information of our patients in both paper and electronic form. Springfield Clinic follows strict federal and state regulations—HIPAA, FACT ACT (identify theft), HITECH (privacy breach notification) and IL Domestic Violence Act (orders of protection)—which are continually monitored and incorporated into our daily operations. Patient medical records are kept confidential. The Privacy Office monitors new regulations to stay up to date on privacy and security mandates, as well as state-of-the-art practices for patient health and billing information transactions.

    Springfield Clinic subscribes to national publications and its management is credentialed in records management and privacy by the American Health Information Management Association (AHIMA).

    You can contact the Privacy Office with questions regarding the privacy of paper or electronic health records or any other information privacy concerns by emailing our office or by calling us at 217.528.7541 and asking for Privacy.

    Patient Access

    Springfield Clinic patients have a number of ways they can access their health information:

    Request Hard Copy Records

    • Processing requests for external release of information is one of the main responsibilities of the Health Information Management (HIM) Department. In order to request hard copy medical records, patients should thoroughly complete Springfield Clinic’s Authorization to Release Medical Information form.

    • Authorization to Photograph and Release Medical Images

    • Behavioral Health Records: For patients requesting behavioral health-specific records, a Behavioral Health Authorization must be thoroughly completed. Behavioral health records include services from Springfield Clinic’s psychiatrist and licensed clinical social workers. The Behavioral Health Authorization requires a witness signature. Click on the Behavioral Health Authorization link to print a hard copy and forward to our Correspondence team.

    • Completed forms should be mailed to:
      Springfield Clinic
      Attn: Correspondence Section
      PO Box 19248
      1025 South 6th Street
      ​Springfield, IL 62794-9248

    Completed authorization forms may also be faxed to 217.527.2887.

    Access Your Personal Health Records

    • Springfield Clinic patients may choose to register to use [email protected], the online patient portal which provides electronic access to their health records.

    • FollowMyHealth offers support and assistance with [email protected] For more information, call toll free at 855.264.2872.

    Under HIPAA, patients have the right to request an amendment to their health information if they find incorrect information in their records. If you feel that your health information is incorrect or incomplete, you may request an amendment. For questions, or to initiate the amendment process, please contact the Privacy Department at 217.528.7541 ext. 14216.

    Under HIPAA, you have the right to file a complaint without being subject to coercion, discrimination, reprisal or unreasonable interruption of care. If you need to make a complaint about your care at Springfield Clinic, please contact the Privacy Officer at 217.528.7541 ext. 14216.

    Patient-centered health care initiatives are in place at Springfield Clinic to enable patients to take more responsibility for their health care. To do so, patients must be able to access and share their health information. Under the Health Insurance Portability and Accountability Act (HIPAA), patients have a right to see and obtain a copy of their medical records. At Springfield Clinic, we want to make sure that our patients are readily able to access their records. The information contained on this page provides the resources necessary for patients to request/have access to their health information.

    Springfield Clinic's Notice of Privacy Practices explains how medical information about you may be used and disclosed and how you can get access to this information. It also explains how you may file a complaint or discuss privacy-related problems.

    Sharing health care records with the providers who treat you

    Springfield Clinic, like all health care providers, share patient records without patient consent with other providers for purposes of treatment. In addition, Springfield Clinic also shares records with other organizations in our community. This sharing is done for purposes of quality and utilization review. We also permit providers to access patient records if it is a shared patient in order to provide the best treatment for our patients.

    Organized Health Care Arrangement (OCHA)

    Springfield 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, Ill., area.

    Through the use of the electronic health record system for joint quality assurance and/or utilization review activities, the participating covered entities, including Orthopedic Center of Illinois, Southern Illinois University School of Medicine, SIU HealthCare, and Memorial Health, 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 questions on who participates in the OCHA, please contact the Privacy Officer at 217.528.7541 ext. 14818.

    Request records online

    Springfield Clinic now offers an online records request tool that verifies your identity by asking for a photo of your driver's license, which can be taken via webcam or smartphone. There is no additional charge to use this service.

    Please note: Chrome, Safari and Firefox are the recommended browsers to request records online. 

    Patient Rights & Responsibilities

    Patient rights

    1. 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.

    2. You have the right to considerate, respectful care at all times and under all circumstances with recognition of your personal dignity.

    3. 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.

    4. You have the right to expect reasonable safety insofar as clinical practices and environment are concerned.

    5. 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.

    6. 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.

    7. 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.

    8. 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 health care provider.

    9. 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.

    10. You have the right to request and receive an itemized, detailed explanation of your total bill.

    Patient responsibilities

    1. 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.

    2. 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.

    3. You are responsible for keeping appointments, and, when unable to do so for any reason, to notify the doctor’s office.

    4. You are responsible for your actions if you refuse treatment or do not follow the doctor’s instructions.

    5. You are responsible for assuring that the financial obligations of your health care are fulfilled as promptly as possible.

    6. You are responsible for checking in at the reception desk upon each arrival so that the receptionist is aware of your presence.

    7. You are responsible for informing Springfield Clinic about new addresses, new telephone numbers, changes of names or new family members as soon as possible.

    8. You are responsible for being considerate of the rights of other patients and Springfield Clinic personnel and for being respectful of the property of other persons and that of the clinic.

    9. You are responsible for providing a responsible adult to transport you home from the facility and remain with you for 24 hours if required by your provider.

    10. You are responsible for informing your provider about any advance directive you may have that could affect your care. 

    Business Associates

    Per the Omnibus Rule, a business associate is "defined as an entity that performs functions, activities or services on behalf of covered entities that involve use or disclosure of PHI. (create, receive, maintain, transmit or store PHI).” Business associate responsibilities now apply to all business associate subcontractors and agents. Lack of contract between parties will not prevent this designation. We request all of our business associates to review the Omnibus Regulations, as numerous provisions of the rules now expressly apply to business associates (and their subcontractors).

    Contact information

    If you are a Business Associate of Springfield Clinic and you are not a HIPAA- or HITECH-Covered Entity, the Privacy Office can assist with HIPAA training. Call the Privacy Officer at 217.528.7541 ext. 14216.

    Terms of Use

    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, website 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 website 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, website.

    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 websites you choose to link to from Springfield Clinic, Springfield, IL, so that you can understand how those websites collect, use and share your information. Springfield Clinic, Springfield, IL, is not responsible for the privacy statements or other content on websites outside of the Springfield Clinic, Springfield, IL, and Springfield Clinic, Springfield, IL, family of websites.

    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 websites 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, websites 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.

    Use of cookies

    The Springfield Clinic, Springfield, IL, website uses "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 the 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, website, 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 websites 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 websites, it is protected through the use of encryption, such as the Secure Sockets 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.

    Contact 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 [email protected]. We will use commercially reasonable efforts to promptly determine and remedy the problem.

    Please read carefully to understand how medical information about you may be used and disclosed and how you can get access to this information.

    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-Springfield 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 Springfield Clinic, to the extent your health information is required to perform these duties. We may disclose your health information to Springfield 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 Springfield 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 Springfield Clinic. We may disclose your health information to those treatment providers outside Springfield 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

    Springfield 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, Springfield 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 Springfield 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 Springfield 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 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.

    Fundraising activities

    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 protected] or calling 1.800.444.7541 and asking for the Privacy Department.

    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. Springfield 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, Ill., 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 217.528.7541.

    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. 

    Your Rights

    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 Springfield 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 Springfield 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 Springfield 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 Springfield Clinic has not adequately addressed your concerns.

    Springfield 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.

    Our responsibilities

    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 Springfield Clinic has created or maintained in the past, and for any records we may create and maintain in the future. Springfield Clinic will provide a copy of our current privacy practices on the Springfield Clinic website (www.SpringfieldClinic.com), posted in public areas of Springfield 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, wish 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. Springfield Clinic will not take any retaliatory action against you for filing a complaint.

    10/6/2014

    As a patient of Springfield Clinic, your rights under HIPAA (Health Insurance Portability and Accountability Act) and HITECH (Health Information Technology for Economic and Clinical Health) include:

    The right to receive a copy of Springfield Clinic’s Notice of Privacy Practices: The patient has a right to a paper notice of our Notice of Privacy Practices. HIPAA requires that patients receive the Notice of Privacy Practices before their first Springfield Clinic service. The patient may ask for a copy of the notice at any time.

    The right to review their medical records and receive copies of their health information: The patient has the right to inspect and receive a copy of their health information that is used to make decisions about their care or payment for their care.

    The right to request an amendment to their health information: If the patient feels that their health information is incorrect or incomplete, they may ask us to amend the information.

    The right to request confidential communications: The patient has the right to request that we communicate with them about medical matters in a certain way or at a certain location. For example, the patient can request that we contact them only at their work or by mail. The patient will be notified if their request is denied.

    The right to an accounting of disclosures: The patient may request an accounting of disclosure of their health information that Springfield Clinic personnel have made in the six years prior to the request date. An accounting will not include disclosures made by Springfield Clinic personnel to carry out treatment, payment or health care operations or include disclosures authorized by the patient.

    The right to request restriction or limitation of their health information: The patient has the right to request a restriction or limitation on the medical information that we use or disclose for the purpose of treatment, payment or health care operations. The patient also has the right to request a limit on medical information we disclose about them to someone who is involved in their care, such as a family member or friend.

    The right of notification in the event of privacy or security breach involving your protected health and billing information if there is a risk to you personally.

    Resources

    Downloadable patient forms

    • Authorization of Medical Information - The authorization for release of information is needed for hard copy medical records.

      • Authorization to Treat Minor Children - Parents of minor children may request to have an alternate designee accompany the child for treatment, such as a family member, friend or other caregiver.

    • Notice of Privacy Practices (NPP) - HIPAA requires patients receive the Notice of Privacy Practices (NPP) before their first service. The Notice explains the patient privacy rights, Springfield Clinic's responsibilities, how we may use and disclose their medical information and how to report a problem.

    Contact us

    Our skilled and friendly staff are happy to assist all patients with their important questions about privacy and confidentiality. Patients may call us at our main line 217.528.7541 during office hours (Monday - Friday, 8 a.m. - 4:30 p.m.).

    Springfield Clinic Privacy Officer
    217.528.7541 ext. 14216

    Frequently asked questions

    You may call 217.528.7541 (toll free 800.444.7541) and ask for the Privacy Department.

    • You have a right to receive, upon request, a copy of Springfield Clinic’s Notice of Privacy Practices. This can be made available in braille, large print, Spanish and other accommodations upon request through our office.

    • HIPAA allows patients access to their health and billing information that is listed in the provider’s “Designated Record Set Policy.” Call us in the Privacy Department and request a Health Information Review.

    • You have the right to receive a copy of your records (behavioral health records are a potential exception to that rule).

    • You have the right to an accounting of disclosures. This details where Springfield Clinic has externally disclosed your protected health information in the past six years without your consent, for purposes of treatment, payment and operations.

    • You have the right to be notified by Springfield Clinic if your protected health information is compromised by our staff or business associates.

    • If you are on a Springfield Clinic account as the guarantor (billing responsible party), you may have access to the details of billing on the account for all family members on that account, with the exception of protected minor services or other visits being paid for with cash (HITECH cash restriction not being billed to insurance).

    • You may obtain access to our patient portal, [email protected], which provides a copy of your Springfield Clinic record at no charge. This service includes record updates, diagnostic results, office visits and records from the last 2 years excluding the Eye Institute (Ophthalmology and Optometry), Occupational Medicine (MOHA) and Behavioral Health Department records. The portal also allows access to your family account, secure messaging with your providers, requests to submit records from other sources into your Springfield Clinic record, and forms to fill out in advance of your appointment with a new provider.

    The Notice of Privacy Practices exists to inform patients of the following:

    • Their rights under HIPAA.

    • Where to submit comments within Springfield Clinic if they feel their rights have been violated.

    • How Springfield Clinic may use or disclose their protected health information without their knowledge or authorization.

    HIPAA, or the Health Insurance Portability and Accountability Act, is a federal law that was enacted to protect your health and billing information (known as protected health information, or PHI) and to create standardized rules and regulations for the transfer of that information. It defines who is allowed access to your information and for what purpose, and outlines circumstances which may require the disclosure of your information without your prior written consent.

    HIPAA is complex and can be confusing. All of us at Springfield Clinic care deeply about your privacy and take our role very seriously as a trusted keeper of your PHI. We want to ensure you know your rights and understand our role in protecting your information.

    Verbal authorization allows designated individuals to request verbal information regarding a patient in whose care they participate. It allows Springfield Clinic to orally discuss that patient's health care issues or account information with these approved individuals, including medication instructions and post-visit care. Authorized individuals are also able to set, change and cancel appointments on behalf of the patient and assist with pickup of certain items, such as disability forms and X-ray images.

    The verbal authorization does not authorize release of a patient’s printed information; it only authorizes the verbal sharing of patient-related information.

    In order to allow verbal authorization a 5:1 form will need to be completed. Request the form from any Springfield Clinic receptionist. It can be filled out on the spot and submitted for processing.

    Unless there is a verbal authorization in place, our staff members are unable to confirm whether or not someone is a Springfield Clinic patient, or if they are or have been in a Springfield Clinic office.

    The only exceptions are:

    1. If a patient provides explicit instructions during that particular visit that the family member/friend is allowed access to see them or to be informed of their presence on site

    2. If that person/service is providing transportation to the patient.

    Upon request, Springfield Clinic reception staff may print out your information so you are able to verify it privately. If time and space allow, our staff can attempt to review this information with you in a more private location in the office.

    As an exception to the rule, HIPAA allows for certain information to be included under “incidental disclosure.” This includes a person’s name on a sign-in sheet, or calling a person’s name out loud in a waiting room. Therefore, incidents such as these that fall under “incidental disclosure” are not HIPAA violations. It is important for clinical accuracy that Springfield Clinic offices ensure the treatment of the correct patient, and, as many patients may have common or similar names, it is necessary to use both one’s first and last names. We continuously work to protect your privacy and safety, and this is an issue we frequently review for improvement.