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-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. 70229.

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. 

REQUEST MEDICAL RECORDS ONLINE

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. 

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. 70229.

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.

• Revocation of Authorization - Filled out when a patient chooses to revoke a previously completed authorization.

• Media release form - Fill this out if you allow us to use your image at our events or in the office on our social media. You would use this, for example, if you gave us a patient testimonial or attended a Springfield Clinic-sponsored event.

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. 70229.

Frequently asked questions