Spectrum Services Logo
One Illinois Boulevard Suite LL-107 · Hoffman Estates, IL 60169 · (847) 884-6212

Effective Date: APRIL 14, 2003



TOWNSHIP OF SCHAUMBURG
SPECTRUM YOUTH AND FAMILY SERVICES 
(DEPARTMENT)
ONE ILLINOIS BOULEVARD
HOFFMAN ESTATES, IL 60169
(847)884-6212




Privacy Officer: Jerald Lipsch 
1st Assistant Privacy Officer: Doreen Rohr
2nd Assistant Privacy Officer: Annie Kot


Notice of Privacy Practices



This Notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Information we obtain about you in connection with services you receive at this entity and agency may qualify as health information under the federal Health Insurance Portability and Accountability Act (HIPAA) Therefore, we are required to issue this official Notice of our Privacy Practices. Please be assured that we care deeply about our clients’ privacy and strive to protect the confidentiality of your protected health information at this agency/entity. 

Basically, you have the right to the confidentiality of your health information, and this agency/entity is required by law to maintain the privacy of that protected health information. This agency/entity is required to abide by the terms of the Notice of Privacy Practices currently in effect, and to provide notice of its legal duties and privacy practices with respect to protected health information. If you have any questions about this Notice, please contact any of the Privacy Officers for this agency whose names are listed above.

Who Will Follow This Notice

Any health care professional authorized to enter information into your service records, all employees, staff and any other personnel at this agency/entity who may need access to your information must abide by this Notice. All subsidiaries, business associates (e.g., a billing service), sites and locations of this agency may share health information with each other for the purpose of treatment, payment for services or health care operations described in the Notice. Except where treatment is involved, however, only the minimum necessary information needed to accomplish the task will be shared.

Keep in mind, however, that State law regarding mental health and developmental disabilities records and communications, regarding the practice of counseling and social work, regarding substance abuse matters, and regarding certain other health issues - as well as federal laws about substance abuse matters - may be even more restrictive about disclosure of clients’ health information than the HIPAA law mentioned above. When those more restrictive laws apply, the HIPAA law itself says we must follow the more restrictive state and federal laws.

How We May Use and Disclose Health Information About You
The following categories describe different ways that we may use and disclose health information without your specific consent or authorization. Although examples are provided for each category of use or disclosure, not every possible use or disclosure in a category is listed.

For Treatment: We may use health information about you to provide you with treatment or services. Example:: In counseling you about a specific problem, a counselor or supervisor may check your record to see what may have been mentioned about that problem during your intake appointment.

For Payment: We may use and disclose health information about you so that the treatment and services you receive from us may be billed and payment may be collected from you, from an insurance company or from a third party, if you have authorized such billing. Example: We may need to send your protected health information, such as your name, address, office visit date, and codes identifying your diagnosis and treatment to your insurance company for payment if you are using insurance to pay for services.

For Health Care Operations: We may use and disclose health information about you for health care operations to help assure that you receive high quality care. Example: We may use health information in your records to review and supervise the services you receive and evaluate the performance of our staff in serving you. 


Other Uses or Disclosures That Can Be Made Without Consent or Authorization

Because Illinois law is more restrictive than HIPAA, we will disclose what HIPAA calls Protected Health Information without consent or authorization only when doing so is also in accord with Illinois law. Examples of such unusual situations are:

  • If you communicate to us a specific threat of imminent harm to another individual, or if we believe there is a clear, imminent risk of injury being inflicted against another individual, we may make disclosures that we think are necessary to protect that person from harm.

  • If we believe that you present an imminent, serious risk of injury to yourself, we may make disclosures we consider necessary to protect you from harm.

  • We may make disclosures necessary to forestall a serious threat to public health or safety.

  • We will make disclosures in child abuse or neglect situations as mandated by Illinois law.

  • We may disclosures to our attorney, if we need to consult him or her about a legal question or matter related to the services we have provided to you.

  • In certain legal proceedings when we have been specifically ordered to disclose information by a court. However, we will argue in the court to maintain the privacy of the information whenever we believe it is not in your interest for it to be disclosed or it is not truly relevant to the matters before the court.

  • If you are under the age of 18, your parent or guardian has the right to certain basic information about your condition and services rendered or needed.

  • If you are under 12 years of age, your parent or guardian has the right to know most information about services you receive. 

  • Other uses and disclosures allowed or required by law.

Aside from the above, we may contact you to provide appointment reminders and scheduling, or information about treatment alternatives or other services that may be of interest to you.


Uses and Disclosures of Protected Health Information Requiring Your Written Authorization

Other uses and disclosures of health information not covered by this Notice above, or the laws that apply to us, will be made only with your written authorization. If you give us authorization to use or disclose health information about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will thereafter no longer use or disclose the information about you for the reasons covered by your written authorization. Please understand, however, that will not be able to take back any disclosures we have already made with your authorization; and that we are required to retain our records of the care and services we have provided to you for a reasonable time period.



Your individual Rights Regarding Your Health Information

Complaints. If you believe your privacy rights have been violated, you may file a complaint with any of the Privacy Officers at this agency listed above, or with the Secretary of the United States Department of Health and Human Services. All complaints must be submitted in writing. You will not be penalized or discriminated against for filing a complaint.

Right to Request Restrictions. You have the right to request a restriction or limitation on the information we use or disclose about you for treatment, payment or health care operations or to someone who is involved in your care or the payment for your care. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you with emergency services. To request restrictions, you must submit your request in writing to one of the Privacy Officers listed above. In your request, you must tell us what information you want to limit.

Right to Request Confidential Communications. You have the right to request how we should send communications to you about service-related matters, and where you would like those communications sent. For example, you can tell us not to phone you at your work phone number. To request confidential communication, you must make your request to one of the Privacy Officers at this agency. We will not ask you the reason for your request, and we will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted. We reserve the right to deny a request if it imposes an unreasonable burden on the agency/entity.

Right to Inspect and Copy. You have the right to inspect and copy the health information that may be used to make decisions about services you receive. Usually this includes billing and formal service records, but does not include psychotherapy notes (i.e., the personal notes of your counselor); information compiled for use in certain civil, or administrative action or proceeding; and protected health information to which access is prohibited by law. To inspect and copy health information that may be used to make decisions about you, you must submit your request in writing to one of the Privacy Officers at this agency. If you request a copy of the information, we reserve the right to charge a reasonable fee for the costs of copying, mailing or other supplies associated with your request. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to health or service information, you may request that the denial be reviewed. Another licensed health care professional chosen by this agency will review you request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.

Right to Amend. If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept. To request an amendment, your request must be made in writing and submitted to one of the Privacy Officers at this agency. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if the information was not created by us, is not part of the health information kept at this agency, if it is not part of the information which you would be permitted to inspect and copy, or if we deem the information you seek to amend is accurate and complete. If we deny your request for amendment, you have the right to file a statement of disagreement with us. We may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Statements of disagreement and any corresponding rebuttals will be kept on file and sent out with any future authorized requests for information pertaining to the appropriate portion of your record.

Right to an Accounting of Non-Standard Disclosures. You have the right to request a list of any disclosures we made of health information about you to outside parties that you did not authorize or to which you did not consent. To request this list, you must submit your request to one of the Privacy Officers at this agency. Your request must state the time period for which you want to receive a list of disclosures that is no longer than six years, and we may not honor your request in respect to dates before April 14, 2003. Your request should indicate in what form you want the list (example: on paper or electronically). The first list you request within a 12-month period will be free. For additional lists, we reserve the right to charge you for the cost of providing the list.

Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy. To obtain a paper copy of the current Notice, please request one in writing from one of the Privacy Officers at this agency.

Changes To This Notice
We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice, with the effective date near the top of the first page.