For the Community

Notice of Health Information Privacy Practices



At Erie Family Health Centers, we are committed to treating and using protected information about you responsibly. This Notice of Health Information Privacy Practices ("Notice") describes the personal information we collect, and how and when we use or disclose that information. It also describes your rights as they relate to this protected health information. This Notice is effective November 3, 2017 and applies to all protected health information as defined by federal regulations.

Understanding Your Health Record/Information

Each time you visit Erie Family Health Centers, a record of your visit is created. This record normally contains your symptoms, examination and test results, diagnoses, treatment, and plan for future care or treatment. This information, often referred to as your health or medical record, serves to plan, communicate, educate and provide legal documentation for the many professionals who contribute to your case, including the Case Management programs personnel.

Understanding what your record is 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 toothers.

Your Health Information Rights

You have a right to all of the following actions, each of which may be exercised at Erie Family Health Centers by contacting the Privacy Officer. Each of the following rights may be limited in certain circumstances, please contact the Privacy Officer for additional details.

  • Obtain a copy of this Notice;
  • Request to inspect or obtain copies of your medicalrecord;
  • Suggest changes or corrections to your medical record;
  • Obtain a list of disclosures of your health information;
  • Request confidential communications of your health information at alternativelocations;
  • Request restrictions on certain uses and disclosures of your information (Erie Family Health Centers is not required to agree to any such restrictions except for certain disclosures to a health plan, as described in the "Our Responsibilities" section); and
  • Revoke your authorization to disclose health

Our Responsibilities

  • Maintain the privacy of your health information;
  • Provide you with this Notice;
  • Abide by the terms of this Notice;
  • Comply with your request to restrict disclosure of your protected health information to a health plan if the information pertains solely to a health care item or service for which you, or any person other than the health plan on behalf of you, has paid Erie Family Health Centers in full;
  • Notify you if we are unable to agree to any other requestedrestriction;
  • Accommodate reasonable requests you have for confidential communication at alternative locations; and
  • Notify you of a breach of unsecured protected health information that

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will have all changes posted at all treatment centers and will post such changes to the website.

For More Information or to Report a Problem

If you have questions and would like additional information, you may contact Erie Family Health Centers' Director of Compliance and Risk Management, Mary Bogasky, at 312.432.7465 or

If you believe your privacy rights have been violated, you can file a complaint with Erie Family Health Centers’ Privacy Officer at the phone number above or with the Office for Civil Rights, U.S. Department of Health and Human Services at the address below. You will not be retaliated against for filing a complaint. The address for the Office for Civil Rights is listed below:

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

Appointment Reminders: We may use and disclose your health information to contact you as a reminder that you have an appointment for treatment or medical care at Erie Family Health Centers.

Information Regarding Treatment Alternatives or Health-Related Benefits and Services: We may use and disclose your health information to tell you about or recommend possible treatment options or alternatives that may be of interest to you. We also may use and disclose your health information to tell you about health-related benefits or services that may be of interest to you.

We will use your health information for treatment: Any health information obtained by a nurse, physician or other member of Erie Family Health Centers’ patient care service team will be recorded in your medical record and used to determine the most effective treatment for you. Your physician will

document your treatment plan and record his or her expectations for the members of Erie Family Health Centers’ patient care service team. Staff members will then 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 other physicians and health care providers (including case managers) with copies of various reports to assist them with coordination of your treatment, such as lab work.

We will use your health information to obtain payment: 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, procedures, and supplies used.

We will use your health information for our routine health care operations: We may disclose your health  information to medical students,  residents  and other  trainees  that  see  patients  at  Erie Family Health Center. Members of the 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 health care services we provide.

Business Associates: There are some services provided in our organization through contracts with outside business associates such as physician services in the emergency department, radiology, certain laboratory tests, auditors and a company that stores inactive medical records. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we have asked them to do and bill you or your third-party payer for the services rendered. We require the business associate to safeguard your information.

Other Permitted and Required Uses and Disclosures That May Be Made with Your Consent, Authorization, or Opportunity to Object:

Uses and Disclosures of Protected Health Information Based Upon Your Written Authorization

Specific Uses and Disclosures That Require Your Authorization: Uses and disclosures of your psychotherapy notes, if any, and disclosures that constitute a sale of your protected health information only will be made with your written authorization, unless otherwise permitted or required by law, as described in this Notice.

Other Uses and Disclosures: Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke this authorization, at any time, in writing, except authorization for those actions your physician took while relying on the authorization.

Uses and Disclosures as Permitted or Required by Law

Individuals Involved in Your Care or Payment for Your Care: We may release health information about you to a friend or family member who is involved in your medical care, including information regarding your medical condition. We may do this with your permission, or if you have appointed the person as your medical power of attorney, or if the person is you next of kin or surrogate decision-maker. We may

also give information to someone who helps pay for your care. Additionally, we may disclose information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.

To Avert a Serious Threat to Health or Safety: We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.

Organ and Tissue Donation: If you are an organ donor, we may release health information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.

Military and Veterans: If you are a member of the armed forces, we may release health information about you as required by military command authorities. Additionally, if you are foreign military personnel, we may release health information about you to the appropriate foreign military authority.

Workers’ Compensation: We may release health information about you for workers’ compensation or similar programs.

Public Health Risks: We may disclose health information about you for public health activities. These activities generally include the following: (i) preventing or controlling disease, injury or disability; (ii) reporting births and deaths; (iii) reporting child abuse or neglect; (iv) reporting reactions to medications or problems with products, or notifying people of recalls of products they may be using, subject to the jurisdiction of the Food and Drug Administration; (v) notifying a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and (vi) notifying the appropriate government authority if it is believed that a patient has been the victim of abuse, neglect or domestic violence. (This last type of disclosure will only be made if you agree, or as required or authorized by law.)

Health Oversight Activities: We may disclose health information to a health oversight agency for activities authorized by law. These oversight activities may include, for example, audits, investigations, inspections and licensure, and are necessary for the government to monitor the health care system, government programs and compliance with civil rights laws.

Law Enforcement: We may release health information if asked to do so by a law enforcement official under the following circumstances: (i) in response to a court order, administrative request authorized under law, subpoena, warrant, summons or similar process; (ii) to identify or locate a suspect, fugitive, material witness or missing person; (iii) to report information about the victim of a crime if, under

certain limited circumstances, we are unable to obtain the person’s agreement; (iv) to report information about a death that we believe may be the result of criminal conduct; (v) to report information about criminal conduct at Erie Family Health Centers; and (vi) in emergency circumstances, to report a crime, the location of the crime or its victims or the identity, description or location of the person who committed the crime.

Coroners, Medical Examiners and Funeral Directors: We may release health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine cause of death. We may also disclose health information about patients of Erie Family Health Centers to funeral directors as necessary to carry out their lawful duties.

Government Functions: Information about you may be used and disclosed for specialized government functions, such as protection of public officials or reporting to various branches of the armed services.

Research: We may use and share your health information for certain kinds of research. All research projects, however, are subject to a special approval process. You may also be contacted about research projects for which you qualify for participation.

Fundraising Purposes: We may contact you for the purpose of fundraising for the benefit of Erie Family Health Centers. You have the right to opt out of receiving any fundraising communication received from, or on behalf of, Erie Family Health Centers. To opt out call our Development Department at 312- 432-7378 and we will place you on a “Do Not Contact” list.

As Required by Law: We will disclose health information about you when required to do so by federal, state or local law.

Additional Rights

This Notice has been prepared to reflect your rights under the Health Insurance Portability and Accountability Act. If state law provides you with greater access to information, or provides greater protection to that information, than as described in this policy, then we shall follow the provisions of state law. Examples of such state laws are the Mental Health and Developmental Disabilities Confidentiality Act, the AIDS Confidentiality Act and the Genetic Information Privacy Act. In addition, if a Federal law creates greater protection for the information described in this Policy, Erie Family Health Centers shall follow the provisions of such federal law. An example of such a Federal law is the Federal Drug Abuse, Prevention, Treatment and Comprehensive Alcohol Abuse and Alcoholism Prevention Treatment, and Rehabilitation Act of 1970.

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