Notice of Privacy Practices
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. The privacy of your personal and health information is important. This requires no action your part unless you have a request or complaint.
Our commitment here at the Southeast Alcohol and Drug Abuse Center (SEADAC) is to serve our customers with professionalism and caring, being sure at all times to protect the privacy and security of all Protected Health Information.
Protecting All of SEADAC's Patients Personal and Health Information
SEADAC understands the importance of keeping your personal and health information private. Personal
health information includes both medical and individually identifiable information, such as your name, address, telephone number or Social Security number. We are required by applicable federal and state laws to maintain the privacy of your personal and health information.
Both under law and our policy, SEADAC has a responsibility to protect the privacy of your personal and health information (PHI). We:
- Protect your privacy by limiting who may see your personal health information
- Limit how we may use or disclose your personal health information
- Inform you of our legal duties with respect to your personal health information
- Explain our privacy polices
- Strictly adhere to the policies currently in effect
This is a notice of SEADAC's privacy practices, our legal duties, and your rights concerning your personal and health information. We follow the privacy as described in this notice while it is in effect. This notice takes effect April 15, 2003 and will remain in effect until we replace it and provide you notice of such changes.
We reserve the right to change our privacy practices and terms of this notice at any time as allowed by applicable law, rules and regulations. We reserve the right to make changes in our privacy practices, the new terms of our notice effective for personal and health information that we maintain, including information created or received before we made the changes. When we make a significant change in our privacy practices, we will change this notice. For more information about our privacy practices, please contact us using the contact information listed at the end of this notice.
SEADAC's Uses and Disclosures of Patients Personal and Health Information
During the course of serving you it may be necessary to share information with other heath-care providers or business associates. The following are examples of instances where information might be shared:
- During treatment, we may find it necessary to perform laboratory analysis.
- To conduct quality improvements, including outcome evaluation and development of clinical guidelines, population based activities, care coordination, case management, or utilization management activities.
- To review the competence or qualifications of health care professionals, conducting training programs of non-health care professionals, accreditation, certification, licensing or credentialing activities.
- To conduct and arrange for medical review, legal services and audit functions, including fraud and abuse detection and compliance programs.
- We may use your personal and health information to contact you with appointment reminders and follow-up. You may opt out of receiving further information by notifying us by using the contact information listed at the end of notice.
- We may use or disclose your personal and health information for research purposes in limited circumstances.
Authorizing Use and Disclosure of SEADAC Members Personal and Health Information
SEADAC will request written authorization from you to use your personal and health information or to disclose it to anyone for purpose or situation not included in this document.
All patients accepted for treatment are protected by federal confidentiality rules (42 CFR Part 2). The federal rules prohibit SEADAC from making any disclosure of information unless it is expressly permitted by you to whom it pertains or as otherwise permitted by 42 CFR Part 2. In order for SEADAC to release any information about you to another party we must have written authorization in your case record. This means we cannot give any information to husbands, wives, mothers, fathers, sisters, brothers, partners, significant others, friends and others.
If you give us authorization you may revoke it in writing at any time. Your revocation will not affect any use our disclosures permitted by your authorization while it was in effect. We will not use or disclose your personal and health information for any reason except those described in this notice without your written authorization.
Individual Rights For All SEADAC Patients
As a SEADAC patient, the following are your rights concerning your personal health and information:
Access: You have the right to review or obtain copies of your personal and health information, with certain exceptions. You may request that we provide copies in a format other than photocopies. You may submit this request in writing by obtaining a form from SEADAC using the contact information listed at the end of this notice. If you request copies, we may charge a fee for each page and per hour of staff time to locate and copy your personal and health information, and postage.
Disclosure Accounting: You have the right to receive a list of instances in which SEADAC has disclosed your personal and health information. Effective April 15, 2003, SEADAC will begin maintaining these types of disclosures for up to five (5) years. If you request this list more than once in a twelve (12) month, period we may charge you a reasonable, cost based fee for responding to these additional requests. You may submit this request in writing by obtaining a form from SEADAC using the contact information listed at the end of this notice.
Restriction Request: You have the right to request that we place additional restrictions on our use or disclosure of your personal and health information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement. You also have the right to agree to terminate a previous submit restriction. You may submit this request in writing by obtaining a form from SEADAC using the contact information listed at the end of this notice.
Alternative Communications: You have the right to request that we communicate with you in confidence about your personal and health information by alternative means or to an alternate location to avoid a life-threatening situation. You must make your request in writing, and you must state that the information could endanger you if it is not communicated in confidence. We will accommodate your request if it is reasonable and the request specifies the alternate means or location. If such a request is urgent, we will attempt to accommodate your request for alternate communications received verbally with the understanding that your request be followed in writing at a later date. Routine request may be submitting in writing by obtaining a form from SEADAC using the contact information listed at the end of this notice.
Amendment: You have the right to request that we amend your personal and health information. Your request must in writing and it must explain why the information should be amended. We may deny your request if we did not create the information you want amended, we do not maintain the information, or the information is accurate and complete. If we deny your request, we will provide you a written explanation of the denial. If we accept your request to amend the information, we will make reasonable efforts to inform others of the amendment and to include any changes in any future disclosures of that information. You may submit this request in writing by obtaining a form from SEADAC using the contact information listed at the end of this notice.
If You Have a Complaint
If you are concerned that we may have violated your privacy rights or you disagree with the decision we made about access to your personal and health information, you may files a complaint with us using the contact information listed at the end of this notice.
You may submit a written complaint to the United States Department of Health and Human Services. We will provide you with the address to file your complaint with the United States Department of Health and Human Services upon request.
We support you right to protect the privacy of your personal and health information. We will not retaliate in any way if you chose to file a complaint with us or with the United States Department of Health and Human Services.
If You Have a Request
If you would like to request a member's rights form, place an urgent request for alternate communications, or file a complaint regarding your privacy rights you may telephone us at 773-731-9100 during normal business hours. You will be asked to provide information including a picture ID from a governmental authority to authenticate your identity. This information is necessary to process your request. If you want more information regarding our privacy practices, have questions or concerns regarding you privacy, or would like to request a patient rights form, you may contact us in the following ways:
- Email us at:
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- Mail us at: SEADAC Privacy Office, 8640 S. South Chicago Avenue, Chicago, IL 60617
- For general questions, you can telephone us at 773-731-9100 during normal business hours
It has always been SEADAC's goal to ensure the protection and integrity of our patients personal and health information. Therefore, we will notify you of any potential situation where your information would be used for reasons other than described above.
We here at SEADAC are committed to obeying all federal, state and local laws and regulations regarding privacy policies. If any other uses of our disclosures than the ones listed above are needed, information will only be released with written authorization of the individual in question. The individual, as provided for by law, may revoke this written authorization at any time.
In the private health care system the client's responsibility to pay for services rendered are clear and unquestioned. The South East Alcohol and Drug Abuse Center (SEADAC) being a part of the health care system, needs to communicate to the client that she/he is responsible to pay for services rendered. All clients will be expected to pay the established charge unless that person's individual situation calls for a special review of the client's fee.
Since SEADAC is partially funded by the State of Illinois, no client can be denied service because of the inability to pay. State funds are made available to SEADAC, so people in need of treatment due to substance abuse can be served regardless of their income. However, all clients will be expected to contribute toward the cost of their treatment, unless treatment is fully paid for by a third-party or a funding source prohibits SEADAC from collecting an additional fee, above the rate paid by a third entity (i.e. Medicaid). As stated earlier, all of SEADAC's clients will be expected to pay the established charge for services rendered. If a client believes she/he cannot afford the fee that person may apply for a discount. Any discount granted will be approved by the Executive Director or his/her appointee, after the client has requested such a reduction. A discounted fee will be based on the client's family income and size. Unusual outstanding financial responsibilities may, also, be taken into account when setting the client discount.
SEADAC will establish a graduated client fee discount schedule based on family size and income. This schedule will be used as a guide to setting the clients discount, but can be altered, by the Executive Director of his/her designee.
The client will be responsible to prove income in order to be considered for a discount. SEADAC will then determine the client's ability to pay, and expect that client to pay his/her fee as established or discounted. Should the client not pay the fee as determined, service can be discontinued upon approval of the Executive Director or his/her designee. Should a client later request service and there is an outstanding balance the client may be required to pay his/her past due account before any further service can be rendered.
In an atmosphere of fairness to the client, taxpayer, appropriate treatment, and sound fiscal operation, SEADAC, must expect all clients to pay for the full cost of treatment or their fair share as determined by SEADAC.
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