Effective April 14, 2003
This Notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
This Notice of Privacy Practices describes how Children's Memorial Hospital and Pediatric Faculty Foundation, Inc. (together, "we" or "us") may use and disclose patient information at the Uplift School Health Center (formerly known as Arai School Health Center) to provide treatment, obtain payment for treatment and for other purposes that are permitted or required by law. "Patient information" is information that may identify the patient and that relates to the patient's past, present or future physical or mental health or condition and related health care services or payment for such services.
The doctors, nurses and other personnel in the Health Center understand that patient information about students and student health is personal. We are committed to maintaining the confidentiality of patient information.
We are required by law to:
- Assure that patient information that identifies you is kept confidential in accordance with law;
- Give you this Notice of our legal duties and patient information privacy practices with respect to patient information; and
- Follow the terms of this Notice or, if this Notice is later revised, a future notice then in effect.
Generally, when this Notice uses the words, "you" or "your," it is referring to the student who is the subject of patient information. However, when this Notice discusses rights regarding patient information, including rights to access or authorize the disclosure of patient information, "you" and "your" may refer to a student's parents, legal guardian or other personal representative.
If you have any questions about this Notice, please contact the Health Center Manager at Uplift School Health Center, 900 West Wilson Avenue, Chicago, IL 60640 or by phone at 773.534.2850.
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 patient information we already have about you as well as any information we receive in the future. We will post a copy of our current Notice of Privacy Practices in the Health Center and here on this page. Upon your request to our Privacy Office, we will provide you a revised Notice.
If you believe your privacy rights have been violated, you may file a complaint with us or with the Director of the Office for Civil Rights of the U.S. Department of Health and Human Services. Upon request, Patient Relations will provide you with the correct address of the Director. To file a complaint with us, please contact the Health Center Manager at 1.773.534.2850. We will not retaliate against you or end our services to you if you file a complaint with us or the Director of the Office of Civil Rights.