Notice of Privacy Practice

PLEASE REVIEW THIS INFORMATION CAREFULLY

Your confidential health-care information may be released:

1. To health-care professionals within the Center for the purpose of providing you with quality healthcare.
2. To your insurance provider for the purpose of receiving payment for the services provided.
3. To public or law enforcement officials in the event of an investigation in which you are a victim of abuse, a crime or domestic violence.
4. To other health-care providers in the event you need emergency care.
5. To public health or federal organizations in the event of a communicable disease or to report a defective device or untoward event to a biological product (food or medication).
6. To others only after receiving your written authorization. You may revoke your permission at any time, in writing.

You may be contacted by the Center:

1. To remind you of any appointments, health-care treatment options or other health services that may be of interest.
2. For the purposes of raising funds to support the Center’s operations.

You have the right:

1. To restrict the use of your information. However, the Center may choose to refuse your restrictions if it is in conflict with providing you quality health care or in the event of an emergency situation, or if it is required by law.
2. To receive confidential communication about your health status.
3. To review and photocopy any/all portions of our healthcare information.
4. To amend your health-care information; request must be in writing and provide a valid reason to support the amendment.
5. To know who has accessed your confidential health-care information and for what purpose.
6. To receive a copy of the Privacy Notice upon request. This copy can be obtained by written request sent to the address listed below.

Your confidential health-care information may not be released for any other purpose than that which is identified in this notice.

The Center is required by law to protect the privacy of its patients. It will keep confidential any and all patient health-care information.

The Center will abide by the terms of this notice. The Center reserves the right to make changes to this notice and continue to maintain the confidentiality of all health-care information. Patients may receive a revised copy of this notice on their next visit.

You have the right to notify Chicago Family Health Center if you believe your privacy rights have been violated. Please mail your complaint to the Center. Contact:

Chicago Family Health Center
9119 S. Exchange Ave.
Chicago, Illinois 60617
Attention: Privacy Officer


For further information about this Privacy Notice, please contact:
Chicago Family Health Center Privacy Officer
(773) 785-6800

This notice is in compliance with the guidelines set forth in the Health Insurance Portability and Accountability Act (HIPAA) of 1996

Effective 4/03
Revised 3/06