Normal Business Hours: 8 a.m.-4:30 p.m.

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.

Your Rights

  • Receive a copy of your medical information
    • You have the right to obtain a copy of your medical record on paper or electronically. Contact our medical records department or ask us how to do this. 
    • We will usually provide a copy of your medical record within 30 days of your request. 
    • A fee may be charged by SIU for copying your medical records. 
    • We may deny your request to get a copy of your medical record in very limited circumstances. If you are denied access to your health information, you may request that the denial be reviewed.
  • Ask us to correct your medical record
    • You can ask us to correct any information we have about you that you think is incorrect or incomplete. Contact the Privacy Officer to find out how to do this.
    • We will respond to your request in writing within 60 days. In our response, we will either agree to make the correction or inform you of our denial, including the reason why. 
  • Request confidential communications
    • You can ask us to communicate with you about your health care in a certain way or at a certain location. 
    • We will try to grant all reasonable requests. 
  • Ask us to limit what we use or share
    • You can request that we not use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request.
    • If you pay for a service or healthcare item out of pocket in full, you can ask us not share the information related to that service or item for purposes of payment or our operations with your health insurance provider.
    • Restrictions on sharing information that we approve will not affect any use or disclosure that we are required to make under law.
  • Find out who we shared your information with
    • You can ask for an accounting of the times we have shared your health information. 
    • The accounting will not include disclosures for treatment, payment or operations purposes. It also will not include disclosures made directly to you, those made with your authorization. 
  • Get a copy of this notice
    • You can ask us 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 copy promptly upon receipt of your request.
  • File a complaint
    • If you feel your rights are violated, you can file a complaint by contacting us using the information in this notice for the Privacy Officer. 
    • You can also 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 www.hss.gov/ocr/privacy/hipaa/complaints/. 
    • We will not retaliate against you for filing a complaint.

Your Choice

For certain health information, you can make a choice about what we share. If you have a preference for how we share your information in the situations described below, tell us.

You have the choice to tell us to:

  • Share information with your family, close friends, or others involved in your care.
  • Share information in a disaster relief situation.
  • Contact you for fundraising efforts. 

If you are not able to tell us a preference, for example, if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

We never share your information in these cases unless you give us written permission:

  • Marketing purposes
  • Sale of your information
  • Disclosure of psychotherapy notes

Other uses and disclosures of your information not otherwise described in this notice will not be made without your authorization. You can revoke any authorization you have provided to SIU Medicine by contacting the Privacy Officer at the information listed in this document. 

In the case of fundraising, we may contact you for fundraising efforts but you can tell us not to contact you again and you may do so by sending a notice to the Privacy Officer using the information listed in this document. Please include a brief statement that you do not wish to receive fundraising materials or communications from us. 

How We Can Use and Disclose Your Information

The most common reasons we use or share your information include:

  • Treatment: we can use your information to treat you 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.
  • Operations: we can use and share your health care information to run our practice, improve your care, and contact you
    • Example: we use health information about you to manage your treatment and the services we offer
  • Payment:  we can use and share your health information to bill you or your insurance and get payment from health plans or other entities 
    • We give information about you to your health insurance provider so it will pay for the services we provided

How else can we use or share your information?

We can or may be required to share your health information without your authorization if we meet certain conditions in the law. Those may include:

  • Public health and safety: We can share health information about you for certain situations such as:
    • Preventing disease
    • Helping with product recalls
    • Reporting adverse reactions to medications
    • Reporting suspected abuse, neglect, or domestic violence
    • Preventing or reducing a serious threat to anyone’s health or safety
  • Research: we can use or share your information for health research
  • Comply with the law: we will share information about you if state or federal laws require us to, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
  • Organ and Tissue Donation Requests: We can share information about you with organ procurement organizations
  • Medical examiner or funeral director: we can share health information with a coroner, medical examiner, or funeral director when an individual dies
  • Workers’ compensation, law enforcement, and other government requests: we can use or share information about you for:
    • Workers’ compensation claims
    • Law enforcement purposes or with a law enforcement official
    • Health oversight activities authorized by law
    • Special government functions such as military, national security and presidential protective services
  • Respond to lawsuits and legal actions: we can share your information in response to a court or administrative order or in response to a subpoena.
  • Confidentiality of alcohol and drug abuse records: we will not share information on any alcohol or drug use without your permission or court order except when needed by medical personnel in a medical emergency, or needed for research, auditing or program evaluation. 

Our Responsibilities

  • We are required by federal law to protect the privacy of your protected health information. 
  • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
  • We will not use or share your information 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.

Organized Health Care Arrangement

  • We participate in an organized health care arrangement (OHCA). That means that we engage in some joint activities including joint quality assurance and/or joint utilization review activities with the other participating organizations.
  • The other participating organizations include Memorial Health, Springfield Clinic and Orthopedic Center of Illinois. 
  • All of the organizations participating in the OHCA may use and disclose the health information contained in our electronic health record for the treatment, payment and healthcare operations of each of the OHCA participants. 
  • The organizations that participate in the OHCA share an electronic health record system. That means that the health information of SIU is combined with the health information of the other participating organizations into one single record. All providers at the organizations participating in the OCHA have access to the common medical record. 

We are required to abide by the terms of this Notice currently in effect. We can change the terms of this notice and the changes will apply to all information that we have about you. If we change it, the new notice will be available by request and on our website. 

This Notice of Privacy Practices applies to Southern Illinois University (SIU) School of Medicine and SIU Physicians & Surgeons, collectively known as SIU Medicine.

To request a copy of your medical records you can contact SIU Medicine Central Medical Records department by mail at SIU Medicine Central Medical Records, 201 E. Madison St., Box 19641, Springfield, IL 62794, by telephone at 217-545-4331, by fax at 938-218-2057, or by email at roi@siumed.edu.  

If you believe your privacy rights have been violated, if you would like additional information or if you would like to revoke a previously provided authorization, contact the SIU Medicine Privacy Officer at:

SIU Medicine, Attn: Privacy Officer, P.O. Box 19639, Springfield, IL 62794-9639, 217-545-6632

Effective Date: March 15, 2022