n Request restrictions on the sharing of your health information to your health insurance, if you pay for the service completely on your own n File a complaint


To make sure that your health information is protected in a way that doesn’t interfere with your healthcare, your


information can be used and shared: n For your treatment and care coordination n To pay doctors and hospitals for your healthcare and help run their businesses


n With your family, relatives, friends or others you identify who are involved with your healthcare or your healthcare bills, unless you object


n To make sure doctors give good care and nursing homes are clean and safe


n To protect the public’s health, such as by reporting when the flu is in your area


n To make required reports to the police, such as reporting gunshot wounds


In all of the above cases, the minimum amount of information needed for that situation will be used or shared.


Without your written permission, your provider cannot: n Give your health information to your employer n Use or share your health information for marketing or advertising purposes


n Share private notes about your mental health counseling sessions


n Sell your health information


Adapted fom U.S. Department of Health & Human Services Office for Civil Rights


How do I get copies of my medical records? If you would like a copy of your medical records, you need to complete an authorization form that you may download at our website, www. AlexianBrothersHealth. org, or request from the Health Information Management office at 847-843-2000, extension 6229. Alexian Brothers Medical Center charges a nominal fee for obtaining copies of your medical records. However, this will be waived if the copies are mailed directly to your physician or another healthcare facility, or you have the person/ agency to whom you want the information sent request the copies themselves with your signed authorization attached. Please allow seven business days to process your request.


www.alexianbrothershealth.org 847-843-2000 : 25


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48