Renz Addiction Counseling Center
NOTICE OF PRIVACY
This Notice describes how medical information about you may be used and disclosed, and how you can get access to this information.
We respect your confidentiality and only release confidential information about you in accordance with Illinois and federal law. This notice describes our policies related to the use of the records of your care generated by this agency.
In order to effectively provide you with services, there are times when we will need to share your confidential information with others beyond our agency, including:
Treatment – with your written consent, we may use or disclose medical information about you to provide, coordinate, or manage your care or any related services, including sharing information with others outside our agency that we are consulting with or referring you to.
Payment – with your written consent, information will be used to obtain payment for the treatment and services provided. This will include contacting your health insurance company for prior approval of planned treatment and/or for billing purposes.
Healthcare Operations: We may use information about you to coordinate our business activities. This may include setting up your appointments, reviewing your care, and training staff. We may contact you to remind you of your appointments or to provide information to you about treatment alternatives or other health-related benefits and services that may be of interest to you. We may also contact you concerning the Center’s fundraising activities.
INFORMATION DISCLOSED WITHOUT YOUR CONSENT
Under Illinois and federal law, information about you may be disclosed without your consent in the following circumstances:
Emergencies: Information may be shared with emergency medical personnel to address the immediate emergency you are facing.
Follow Up Appointments/Care: We will be contacting you to remind you of future appointments or information about treatment alternatives or other health-related benefits and services that may be of interest to you. (We will leave appointment information on your voicemail/answering machine unless you tell us not to.)
As Required by Law: This would include situations where we have a court order, or are mandated to provide public health information, such as communicable diseases, in cases that we are mandated reporters when there is suspected abuse and neglect such as child abuse or elder abuse.
Coroners: We are required to disclose information about the circumstances of your death to a coroner who is investigating it.
Governmental Requirements: We may disclose information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections and licensure. We are also required to share information, if requested with the U.S. Department of Health and Human Services to determine our compliance with federal laws related to health care and to Illinois State agencies that fund our services, i.e. The Department of Human Services Office of Alcoholism and Substance Abuse.
Criminal Activity or Danger to Self or Others: If a crime is committed on our premises or against our personnel, we may share information with law enforcement to apprehend the criminal. We also have the right to involve law enforcement when we believe an immediate danger may occur to someone.
Fundraising: As a not for profit provider of health care services we need assistance in raising money to carry out our mission. We may contact you to seek a donation.
You have the following rights under Illinois and federal law:
Copy of Record: You are entitled to inspect the client record the Renz Addiction Counseling Center has generated about you. We may charge you a reasonable fee for copying and mailing your record.
Release of Records: You may consent in writing the release of your records to others, for any purpose you choose. This could include your attorney, employer, or others who you wish to have knowledge of your care. You may revoke this consent at any time, but only to the extent no action has been taken in reliance on your prior authorization.
Restriction of Record: You may ask us not to use or disclose part of the clinical information. This request must be in writing. Renz Addiction Counseling Center is not required to agree to your request if we believe it is in your best interest to permit use and disclosure of the information. This request will be submitted to our privacy contact.
Contacting You: You may request that we send information to another address. We will honor such request as long as it is reasonable and we are assured it is correct. We have a right to verify that the payment information you are providing is correct.
Amending Record: If you believe that something in your record is incorrect or incomplete, you may request we amend it. To do this, contact our privacy contact and ask for the Request to Amend Health Information form. In certain cases, we may deny your request, If we deny your request for an amendment you have a right to file a statement you disagree with us. We will then file our response and your statement and our response will be added to your record.
Accounting for Disclosures: You may request an accounting of any disclosures we have made related to your confidential information, except for information we used for treatment, payment, or health care operations purposes or that we shared with you or your family, or information that you gave us specific consent to release. It also excludes information we were required to release. To receive information regarding disclosure made for a specific time period, no longer than 6 years after your first date of contact after April 14, 2003, please submit your request in writing to our privacy contact. We will notify you of the cost involved in preparing this list.
Questions and Complaints: If you have any questions, or wish an additional copy of this Policy or have any complaints you may contact our privacy contact in writing at our office for further information. You also may complain to the Secretary of U.S. Department of Health and Human Services if you believe our agency has violated your privacy rights. We will not retaliate against you for filing a complaint.
Our services include: Adult Services; Adolescent Services; Passage Program for Women; DUI Services; Problem & Compulsive Gambling Programs; Family Programs. If you have questions regarding this policy or your rights, contact:
Jerry Skogmo, Executive Director , Renz Addiction Counseling Center One American Way, Elgin IL 60120 (847) 742-3545 x232 Jerry Skogmo
PATIENT AND CLIENT RIGHTS
Although each of the Renz Addiction Counseling’s programs vary in the type of care they offer, the following policies and procedures are designed to enhance the dignity and to protect the patient’s/client’s rights.
1. Access to treatment at the Renz Addiction Counseling Center will not be denied on the basis of race, religion, ethnicity, handicap conditions, sexual orientation, or HIV status.
2. All patients and clients have the right to non-discriminatory access to services as specified in the American’s with Disabilities Act of 1990 (42 USC 12101).
3. All patients and clients shall be eligible to receive treatment services offered in the facility, regardless of their ability to pay for such treatment, according to a pre-arranged agreement.
4. Patient and client services will be provided in the least restrictive environment available, as long as it is clinically appropriate.
5. All patients will receive an assessment to determine that the level of services provided is the most appropriate in the least restrictive environment.
6. All patients have the right to participate in individualized treatment planning. Upon request, all patients may have access to their individualized treatment plan(s).
7. Patient/client records are protected by federal and state statutes as well as by program policy.
No information will be released to, or sought from, any other agency unless the patient/client has signed a form consenting to a release of confidential information to or from any other agency. In the case of medical emergencies, information contained in the patient/client record may be released to emergency responding staff such as paramedics, the physician, or other hospital staff providing emergency treatment to the client in accordance with federal and state statutes. Excluded from protection under confidentiality regulations are matters pertaining to child abuse or threats of harm to self and/or others. Excluded also is the authorization to disclose information by an appropriate court order upon showing of good cause, after appropriate procedures and notice, and with appropriate safe guards against unauthorized disclosure contained in the order as set forth 42 CFR 2.61 – 2.67 (1987).
Information needed in order to facilitate co-ordination between program units may be released by counselors and/or designated staff members. The client’s voluntary participation in the program shall constitute consent for staffing discussions.
1. All patients/clients have the right to ask and receive an explanation and rationale of any method of treatment used by Renz Addiction Counseling Center staff. All patients/clients have the right to refuse any treatment or any specific treatment procedures. Further, all patients/clients will be informed of the consequences resulting from a refusal of treatment or of a treatment procedure.
2. All patients/clients have the right to appeal in the event of disagreements with Renz Addiction Counseling Center’s decisions, policies and/or procedures. The appeals procedure is posted in the reception area of each Renz Addiction Counseling Center facility.
CONFIDENTIALITY—HIV ANTIBODY/AIDS STATUS
The confidentiality of the following information is protected by the AIDS Confidentiality Act (410 IL CS 305) and the AIDS confidentially and testing code (77 ILL ADM code 697).
1. A request for and/or signed consent to do HIV antibody testing.
2. An individual’s HIV antibody or AIDS status.
3. The fact that an individual has been tested for HIV antibodies, and/or the result of an HIV antibody test, whether negative, positive, or inconclusive.
4. An HIV antibody or AIDS test cannot be required as a condition of treatment, and, an individual cannot be required to sign an authorization of release of information concerning his/her HIV antibody test or HIV or AIDS status as a condition of treatment.
5. An individual is not required to tell program staff, the Executive Director and/or the Medical Director, or anyone else whether he/she has been tested for HIV antibodies and/or the results of such test.
6. An individual who wishes to be tested for HIV antibodies shall be informed that he/she may undergo testing on an anonymous basis. The client has the option of seeing an HIV Health Education counselor at any time during treatment.
7. No information governed by the AIDS Confidentiality Act and the AIDS Code shall be released by the program, or by any staff member of its staff, to other staff members, including but not limited to the Medical Director, and/or to any other person or entity, unless and until the individual in question has signed a legally effective release of information form, in accordance with the statue and rule.
8. Records which document an individual’s risk for HIV infection, and/or which identify an individual as having requested an HIV antibody test, and/or having undergone such a test, and/or which identify an individual’s HIV status or AIDS status, shall be maintained in a separate, secured record held in the Clinical Director’s office, and to be accessible only in accordance with the AIDS Confidentiality Act and Section 697-140 (c) of the AIDS code.
9. The exception to the above (8) section is all HIV counseling and testing files are kept in a designated separated locked file cabinet in a locked room. The only staff that have access to this drawer are qualified HIV counseling and testing staff.
All patients/clients shall receive and have explained to them a copy of their rights as patients/clients of the Renz Addiction Counseling Center. Receipt of the patient’s/client’s rights is acknowledged on the consent for treatment form by having the patient/client sign and witness the signature with the date.
The statement of patient/client rights is posted in the reception area of each Renz Addiction Counseling Center facility. The patient/client shall be informed of all elements in the statement of patient/client rights in a language which she/he understands.
This following outlines how Renz Addiction Counseling Center uses and protects any information that you provide when you use this website. Renz Center is committed to ensuring that your privacy is protected. Should we ask you to provide certain information by which you can be identified when using this website, you can be assured that it will only be used in accordance with this privacy statement.
Renz Center may change this policy from time to time by updating this page. You should check this page from time to time to ensure that you are happy with any changes. This policy is effective from August 14, 2013.
WHAT WE COLLECT
We may collect the following information:
• Name and job title
• Contact information including email address
• Demographic information such as postcode preferences and interests
• Other information relevant to customer surveys and/or offers
WHAT WE DO WITH THE INFORMATION WE GATHER
We require this information to understand your needs and provide you with a better service, and in particular for the following reasons:
• Internal record keeping.
• We may use the information to improve our products and services.
• We may periodically send promotional email about new services, special offers or other information which we think you may find interesting using the email address which you have provided.
• We may use the information to customize the website according to your interests.
• We will never sell your information.
We are committed to ensuring that your information is secure. In order to prevent unauthorized access or disclosure we have put in place suitable physical, electronic and managerial procedures to safeguard and secure the information we collect online.
A cookie is a small file which asks permission to be placed on your computer’s hard drive. Once you agree, the file is added and the cookie helps analyze web traffic or lets you know when you visit a particular site. Cookies allow web applications to respond to you as an individual. The web application can tailor its operations to your needs, likes and dislikes by gathering and remembering information about your preferences.
We use traffic log cookies to identify which pages are being used. This helps us analyze data about web page traffic and improve our website in order to tailor it to customer needs. We only use this information for statistical analysis purposes and then the data is removed from the system.
Overall, cookies help us provide you with a better website, by enabling us to monitor which pages you find useful and which you do not. A cookie in no way gives us access to your computer or any information about you, other than the data you choose to share with us.
You can choose 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. This may prevent you from taking full advantage of the website.
LINKS TO OTHER WEBSITES
Our website may contain links to enable you to visit other websites of interest easily. However, once you have used these links to leave our site, you should note that we do not have any control over that other website. Therefore, we cannot be responsible for the protection and privacy of any information which you provide whilst visiting such sites and such sites are not governed by this privacy statement. You should exercise caution and look at the privacy statement applicable to the website in question.
CONTROLLING YOUR PERSONAL INFORMATION
You may choose to restrict the collection or use of your personal information in the following ways:
• Whenever you are asked to fill in a form on the website, look for the box that you can click to indicate that you do not want the information to be used by anybody for direct marketing purposes
• If you have previously agreed to us using your personal information for direct marketing purposes, you may change your mind at any time by writing to or emailing us at email@example.com
We will not sell, distribute or lease your personal information to third parties unless we have your permission or are required by law.
You may request details of personal information which we hold about you under the Data Protection Act 1998. A small fee will be payable. If you would like a copy of the information held on you please write to One American Way, Elgin, IL 60120
If you believe that any information we are holding on you is incorrect or incomplete, please write to or email us as soon as possible, at the above address. We will promptly correct any information found to be incorrect.