FOOT MECHANICS OF LAKE COUNTY, P.C.
THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND
HOW YOU CAN GET ACCESS TO THE INFORMATION. PLEASE READ CAREFULLY
INTRODUCTION
Foot Mechanics of Lake County is committed to treating and using protected health information about you
responsibly. This Notice of Health Information Practices describes the personal information we collect, and
how we use or disclose the personal information. It also describes your rights as they relate to your protected
health information. This notice is effective April 14, 2003 and applies to all protected health information as
defined by federal regulations. Understanding Your Health Record/Information
Each time you visit Foot Mechanics of Lake County, a record of your visit is made. Typically, this record
contains your symptoms, examination, test results, diagnosis, treatment, and a plan for future care or
treatment. This information, often referred to as your health or medical record, serves as a:
• Basis for planning your care and treatment,
• Means of communication among the many health professionals who contribute to your care,
• Legal documentation describing the care you received,
• Means by which you or a third-party payer can verify that services billed were actually provided,
• A tool in educating health professionals,
• A source of data for medical research,
• A source of information for public health officials charged with improving the health of this state and
nation,
• A source of data for our planning and marketing,
• A tool with which we can assess and continually work to improve the care we render and the outcomes
we achieve,
Understanding what is in your record and how your health information is used helps you to: ensure its
accuracy, better understand who, what when, where, and why others may access your health information,
and make more informed decisions when authorizing disclosure to others.
Your Health Information Rights
• Although your health record is the physical property of Foot Mechanics of Lake County, the information
belongs to you. You have a right to:
• Obtain a paper copy of this notice of information practices upon request,
• Inspect and copy your health record as provided for in 45 CFR 164.524,
• Amend your health record as provided in 45 CFR 164.528,
• Obtain an accou8nting of disclosures of your health information by alternative means or at alternative
locations,
• Request a restriction on certain uses and disclosures of your information as provided by 45 CFR
164.522, and
• Revoke your authorization to use or disclose health information except to the extent that action has
already been taken.
Our Responsibilities
Foot Mechanics of Lake County is required to:
• Maintain the privacy of your health information,
• Provide you with this notice as our legal duties and privacy practices with respect to information we
collect about you,
• Abide by all terms of this notice,
• Notify you if we are unable to agree to a requested restriction, and
• Accommodate reasonable requests you may have to communicate health information by alternative
locations.
We reserve the right to change our practices and make new provisions effective for all protected health
information we maintain. Should our information practices change, we will mail a revised notices to the address
you’ve supplied us, or if you agree, we will mail the revised notice to you.
We will not use or disclose your health information without your authorization, except as described in this
notice. We will also discontinue to use or disclose your health information after we have received a written
revocation of the authorization according to the procedures included in the authorization.
For More Information or to Report a Problem
If you have questions and would like additional information, you may contact Foot Mechanics of Lake County
at 847-239-4756.
If you believe your privacy has been violated, you can file a complaint with Foot Mechanics of Lake County,
or with the Office for Civil Rights, U.S. Department of Health and Human Services. There will be no retaliation
for filing a complaint with either Dr Rick Ginsberg or the Office for Civil Rights. The address for the OCR is
listed below:
Office for Civil Rights
U.S Department of Health and Human Services
200 Independence Avenue, S.W
Room 509F, HHH Building
Washington, D.C. 20201
Examples of Disclosures for Treatment, Payment and Health Operations
We will use your health information for treatment.
For example: Information obtained by a nurse. Physician, or other member of your health care team will be
recorded in your record and used
to determine the course of treatment that work best for you. Your physician will document in your record his
or her expectations of the members of your health care team. Members of your health care team will them
record the actions they took and their observations. In that way, the physician will know how you are
responding to treatment.
We will also provide your physician or subsequent health care provider with copies of various reports that
should assist him or her in treating you once you’re this hospital.
We will use your health information for payment
For example: A bill may be sent to you or a third party payer. The information on or accompanying the bill may
include information that identifies you, as well as your diagnosis, procedure, and supplies used.
We will use your health information for regular health operations.
For example: Members of the medical staff, the risk or quality improvement team may use information in your health
record to assess the care and outcomes in your case and others like it. This information will then be used in an effort
to continually improve the quality and effectiveness of the healthcare and service we provide.
Business associates: There are some services provided in our organization through contacts with business associates
Examples include physician services in the emergency department, and radiology, certain lab tests, and a copy service we
use when making copies of you health record. When these services are contracted, we may disclose your health information
to our business associates that they can perform the job we’ve asked them to do and bill you our your third-party payer for
services rendered. To protect your health information, however, we require the business associate to appropriately safeguard
your information.
Directory: Unless you notify us that you object, we will use your name, location in the facility, general condition, and religious
affiliation for directory purposes. This information may be provided to members of the clergy and, except for religious
affiliation, to other people who ask for you by name.
Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or
another person responsible for your care, your location, and general condition.
Communication with family: Health professionals, using their best judgment, may disclose to a family member, other relative,
close personal friend. Or any other person you identify, health information relevant to that person’s involvement in you care
or payment related to your care.
Research: We may disclose information to researchers when their research has been approved by an institutional review
board, which has reviewed the research proposal, and established protocols to ensure the privacy of your health information.
Funeral Directors: We may disclose health information to funeral directors consistent with applicable law to carry out their
duties.
Organ procurement organizations: Consistent with applicable law, we may disclose health information to organ procurement
organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue
donation and transplant.
Marketing: We may contact you to provide appointment reminders of information about treatment alternatives or other healthrelated benefits and services that may be of interest to you.
Fund raising: We may contact you as part of a fund-raising effort.
Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect
to food, supplements, product and product defects, or post marketing surveillance to enable product recalls, repairs, or
replacement.
Workers compensation: We may disclose health information for law enforcement purposes as required by law or in response
to a valid subpoena.
Federal law makes provision for your health information to be released to an appropriate health oversight agency, public
health authority or attorney, provided that a work force member or business associate believes in good faith that we have
engaged in unlawful conduct or have violated professional of clinical standards and are potentially endangering one or more
patients, workers or the public.
No mobile information will be shared with third parties/affiliates for marketing/ promotional purposes. All the above
categories exclude text messaging originator opt-in data and consent; this information will not be shared with and
third parties.