Address: 24821 w 135th St, Plainfield IL 60544

Call: 815.254.7400

Notice of Privacy Practices

You have the right to:
 Get a copy of your paper or electronic PHI ***Please Note The practice destroys records after 6 years, and therefore, cannot respond to any record request within the requested time frame. 
 Correct or make changes to your paper or electronic PHI  Request confidential communication
 Ask us to limit the PHI we share
 Get a list of those with whom we’ve shared your PHI
 Get a copy of this privacy notice
 Choose someone to act for you with appropriate legal documentation
 File a complaint if you believe your p rivacy rights have been violated Get an electronic or paper copy of your PHI
 You can ask to see or get an electronic or paper copy of your PHI.
  Your request must be in writing and submitted to the FBH Health Information Management Team via our MAIN ADDRESS (see Below). Please make sure you submit a notorized copy of your current Drivers License or State Identifcation Card with legal signature.
 We will provide a copy or a summary of your health information, usually within 30 days of your written request by mail. We may charge you a reasonable, cost-based fee for the copy.
 In certain circumstances,  we may say “no” to your request, but we’ll give you the reason why in writing within 30 days.You must give us  permission to respond back to you. If you do not give us permission to respond back to you then you are not allowing us to communicate accordingly. Does HIPAA provide extra protections for mental health information compared with other health information? Generally, the Privacy Rule applies uniformly to all protected health information, without regard to the type of information. One exception to this general rule is for psychotherapy notes, which receive special protections. The Privacy Rule defines psychotherapy notes as notes recorded by a health care provider who is a mental health professional documenting or analyzing the contents of a conversation during a private counseling session or a group, joint, or family counseling session and that are separate from the rest of the patient’s medical record. Psychotherapy notes do not include any information about medication prescription and monitoring, counseling session start and stop times, the modalities and frequencies of treatment furnished, or results of clinical tests; nor do they include summaries of diagnosis, functional status, treatment plan, symptoms, prognosis, and progress to date. Psychotherapy notes also do not include any information that is maintained in a patient’s medical record. See 45 CFR 164.501. Psychotherapy notes are treated differently from other mental health information both because they contain particularly sensitive information and because they are the personal notes of the therapist that typically are not required or useful for treatment, payment, or health care operations purposes, other than by the mental health professional who created the notes. Therefore, with few exceptions, the Privacy Rule requires a covered entity to obtain a patient’s authorization prior to a disclosure of psychotherapy notes for any reason, including a disclosure for treatment purposes to a health care provider other than the originator of the notes. See 45 CFR 164.508(a)(2). A notable exception exists for disclosures required by other law, such as for mandatory reporting of abuse, and mandatory “duty to warn” situations regarding threats of serious and imminent harm made by the patient (State laws vary as to whether such a warning is mandatory or permissible).
Content created by Office for Civil Rights (OCR)
Content last reviewed on September 12, 2017
Main Addresses
24821 W 135th Plainfield Il, 60544
Privacy Officer
(815) 254-7400 Does a parent have a right to receive a copy of psychotherapy notes about a child’s mental health treatment? No. The Privacy Rule distinguishes between mental health information in a mental health professional’s private notes and that contained in the medical record. It does not provide a right of access to psychotherapy notes, which the Privacy Rule defines as notes recorded by a health care provider who is a mental health professional documenting or analyzing the contents of a conversation during a private counseling session or a group, joint, or family counseling session and that are separate from the rest of the patient’s medical record. See 45 CFR 164.501. Psychotherapy notes are primarily for personal use by the treating professional and generally are not disclosed for other purposes. Thus, the Privacy Rule includes an exception to an individual’s (or personal representative’s) right of access for psychotherapy notes. See 45 CFR 164.524(a)(1)(i). However, parents generally are the personal representatives of their minor child and, as such, are able to receive a copy of their child’s mental health information contained in the medical record, including information about diagnosis, symptoms, treatment plans, etc. Further, although the Privacy Rule does not provide a right for a patient or personal representative to access psychotherapy notes regarding the patient, HIPAA generally gives providers discretion to disclose the individual’s own protected health information (including psychotherapy notes) directly to the individual or the individual’s personal representative. As any such disclosure is purely permissive under the Privacy Rule, mental health providers should consult applicable State law for any prohibitions or conditions before making such disclosures.
Content created by Office for Civil Rights (OCR)
Content last reviewed on September 12, 2017

Ask us to correct/amend your PHI
 You may request us to correct health information about you that you think is incorrect or incomplete. Your request must be in writing and submitted to the FBH Health Information Department.
 We may refuse your request, but we’ll explain in writing within 60 days.
If you would like to amend, restrict or make arrangements for copies of your PHI, please submit your written request to our FBH Health Information Management Department at FBH
Attn: FBH Health Information Management Dept 24821 W 135th St Plainfield, IL 60544
Phone: 815-254-7400

Request confidential communications
 We may contact you to remind you of an appointment or to give you instruction about a scheduled procedure, etc.
 We usually communicate in person, by telephone, or in writing, including secure e-mail or secure patient portal.
 We may leave messages for you on your answering machine or voicemail.
 You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. You do not need to provide the reason for your request.
 We will agree to all reasonable requests.
 To request confidential communications in a certain way or at a certain location, you must make your request in writing, to the FBH Health Information Management Department. Your request must clearly state how or where you want to be contacted.
 If we are unable to contact you using the ways or locations you have requested, we may contact you using any information we have. Ask us to limit what we use or share
 You can ask us not to use or share certain PHI for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care or is required by law.For certain PHI, you can tell us your choices about what we share.
If you have a clear preference for how we share y our PHI in the situations described below, talk to us. Tell us what you want us to do and we will follow your instructions. In these cases, you have both the right and choice to tell us to:
 Share PHI with your family, close friends, domestic partner, care partner or others involved in your care
 Share PHI in a disaster relief situation
 Include your information in an FBH hospital directory
If you are not able to tell us your preference, for example, if you are unconscious, we may go ahead and share your  PHI if we believe it is in your best interest. We may also share your  PHI when needed to lessen a serious and imminent threat to health or safety. If there is someone to whom you do not wish us to disclose the above information, please notify Registration or your healthcare staff. If you pay for a service or health care item out-of-pocket, in full, before or at the time of your care, you can ask us not to share that information with your health plan or insurer. We will say “yes” unless the law requires us to share that information.
– If you would like this request to apply to third-party billers such as pharmacies, radiologists, and physicians, you must make your request to them separately.
How do we typically use or share your PHI?
Disclosures We typically use or share your  PHI in the following ways:
Treatment We can use your PHI and share it with other professionals who are treating you. Example: A doctor treating you for an injury asks another doctor about your overall health condition.
Facility Operations We can use and share your PHI to operate our facilities, improve your care, and contact you when necessary. Example: We may use your PHI to assess quality, train our staff, and improve our services.
Billing We can use and share your PHI to bill and get payment from health plans or other entities. Example: We give information about you to your health insurance plan so it will pay for your services. Family Behavioral Health will accept cash payments as well as most insurances and will work with your insurance company to seek payment through electronic, paper or whatever HIPAA appropriate method required, per insurance rules. However, patients are ultimately financially responsible for paying all fees owed to Family Behavioral Health.
Help with public health and safety issues We can share PHI about you for certain situations such as:
 Preventing or controlling disease
 Helping with product recalls
 Reporting vital statistics such as births or deaths
 Reporting adverse reactions to medications
 Reporting suspected abuse, neglect, or domestic violence
 Preventing or reducing a serious threat to anyone’s health or safety
 Disaster relief
 Do research
 We can use or share your  PHI for clinical research.
 We may use or share your  PHI, without your permission, if the Board that oversees research formally approves the use or sharing of your PHI consistent with requirements under the law.
Comply with the law
 We will share PHI about you if state or federal laws or judicial or administrative proceedings require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
 We can share PHI regarding suspected child or elder abuse, neglect or physical injury; violent crimes and death; animal bites; injuries related to firearm discharge, and other information in order to comply with the law.
 We can also share PHI regarding infants relinquished 30 days old or less. Respond to organ and tissue donation requests We can share  PHI about you with organ procurement organizations. Work with a medical examiner or funeral director
We can share PHI with coroners, medical examiners, or funeral directors when an individual dies.
Notice of Privacy Practices
Address workers’ compensation, law enforcement, and other government requests
We can use or share PHI about you
 For worker’s compensation claims
 For law enforcement purposes or with a law enforcement official
 With health oversight agencies for activities authorized by law
 For special government functions such as military, national security, and presidential protective services  If you are a member of the armed forces, we may share PHI with military command
Respond to lawsuits and legal actions
 We can share PHI about you in response to a court or administrative order, and also, if required, in response to a subpoena, warrant, or summons.
How else can we use or share your PHI?
 We can share your children’s immunization record with his or her school
 We can share your PHI with our Business Associates. Busi ness Associates are individuals or businesses that we contract with to perform jobs or services for FBH and may require them to maintain, use, and/or disclose your PHI.
Get a copy of this privacy notice
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy.
Choose someone to act for you
 If you have given someone power of attorney for healthcare or if someone is your legal guardian, that person can exercise your rights and make choices about your PHI.
 We will make sure the person has this authority and can act for you before we take any action. File a complaint if you feel your rights have been violated
 You can complain if you feel we have violated your rights by contacting the FBH Privacy Officer.
 You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling
1-877-696-6775, or visiting
 We will not retaliate against you for filing a complaint.If you have concerns regarding your privacy, please contact the FBH Privacy Officer at (815) 254-7400 or
Our Responsibilities
 We are required by law to maintain the privacy and security of your PHI.
 We will let you know promptly if the privacy or security of your PHI has been compromised.
 We must follow the duties and privacy practices described in this notice and give you a copyof it.
 We will not use or share your PHI other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
 We will protect your genetic information.
 We will make every effort to provide your PHI to you in the electronic format you wish. We may say “no” to your request only because we do not have the capacity to do so and will make other arrangements with you.
For more information see:
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our FBH Compliance Department, and on the FBH web site.
Effective date of this Notice: (Date after approved by Committee): January 1st, 2017