Our Promise About Your Privacy
Automated Health Systems (AHS) promises to maintain the privacy of your health information and Illinois Medicaid status.
For the purposes of this document we will refer to your identifiable health information as Protected Health Information. AHS
will make and keep records about you and the services provided to you by AHS and your Primary Care Physician (PCP). AHS will
make every effort to keep the confidentiality of this Protected Health Information. AHS gives you this notice of our duties to
describe what AHS does with your Protected Health Information.
This notice gives you the following important information:
- How AHS may use and tell others about your Protected Health Information.
- Your privacy rights regarding your Protected Health Information.
- AHS' duties concerning the use and disclosures of your Protected Health Information.
The terms of this notice apply to all records containing your Protected Health Information that are created or kept by AHS,
and its subcontractors. AHS may change this notice at any time. Any change to this notice will 1) apply to all Protected Health
Information AHS has collected or collects in the future and 2) be effective on the publication or revision date. You may request
a copy of the notice at any time.
Understanding Your Protected Health Information
Each time you contact AHS over the phone, on the Internet, or through the mail, a record of your contact is made. Usually this
record has information about who you are, where you live, your current Medical Program eligibility status, your Health Plan, and
(in some cases) your health issues. This information, called your Protected Health Information, serves as a way to:
- Make sure you have the PCP that is right for you.
- Communicate between the doctors and others who take care of you.
- Plan your care and treatment.
- Make a record of why you contacted us.
- Make appointments for different kinds of health care.
- Tell public health officials about things to improve the health of the nation.
- Let AHS tell you about what AHS can do for you.
- Let AHS measure and improve the services we provide.
Understanding what Protected Health Information is and how it is used can help you to:
- Make sure it is right.
- Better understand who, what, when , where, and why others may look at your Protected Health Information.
- Make better decisions about who else can look at your Protected Health Information.
Although your record(s) are the property of AHS and the State of Illinois, the Protected Health Information in it belongs to you. You have the right to:
- Ask that it not be used or told to anybody else for some reasons.
- Get a paper copy of this notice.
- Look at and copy your record.
- Ask for a change in your record.
- Get an explanation from AHS of who AHS has shown your Protected Health Information to.
Your Rights about Your Protected Health Information
You have these rights about the Protected Health Information that AHS keeps about you:
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Confidential Communications. You have the right to ask that AHS tell you about your health and
other Protected Health Information in the way you like and the place you want. For instance, you may ask that AHS contact
you at home, rather than at work. In order to ask for a type of confidential communication, you must ask in writing to the
Privacy Officer/Project Manager at Automated Health Systems, 1375 East Woodfield Road, Ste. 600, Schaumburg, IL 60173. Be
sure to say how and/or where you want AHS to contact you. AHS will do it if it is reasonable. You do not need to tell AHS
why you are asking.
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Asking for Restrictions. You have the right to ask that AHS only use or tell others your
Protected Health Information so that AHS can take of you, get paid, or manage its business. Additionally, you have the
right to ask that AHS only tell your Protected Health Information to people involved in your care or the payment of your
care, such as family members, and friends. AHS does not have to say yes to what you ask; however, if AHS does say yes,
it must do what it said unless required by law, in emergencies, or when the information is necessary to take care of you.
In order to ask for a restriction on AHS' use or disclosure of your Protected Health Information, you must ask in writing
to the Privacy Officer/Project Manager at Automated Health Systems, 1375 East Woodfield Road, Ste. 600, Schaumburg, IL 60173.
You have to write: (a) what you want restricted; (b) whether you are asking AHS not to use and/or tell others; and (c) who
you don't want to use or be told your Protected Health Information.
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Inspection and Copies. You have the right to look at and get a copy of your Protected Health
Information, including medical records and billing records, but not including psychotherapy notes, social service notes,
and risk management litigation records. You must make the request in writing to the Privacy Officer/Project Manager at
Automated Health Systems, 1375 East Woodfield Road, Ste. 600, Schaumburg, IL 60173. AHS may charge you money for the cost
of copying the records you request. AHS may say no when you ask to look at and/or copy your Protected Health Information
sometimes, but you may ask for a review if that happens. These reviews will be conducted by the AHS Medical Director, a
licensed health-care professional.
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Changes. You may ask AHS to change your Protected Health Information if you think that it
is wrong or not complete, and you may ask for a change for as long as your Protected Health Information is kept by or for
AHS. To ask for a change, you have to contact the Privacy Officer/Project Director at Automated Health Systems, 1375 East
Woodfield Road, Ste. 600, Schaumburg, IL 60173 in writing. In your request, you must tell AHS what is wrong or not complete.
AHS may say no if you do not provide complete information. Also, AHS may say no if AHS thinks: (a) your Protected Health
Information is accurate and complete; (b) what you ask for is not about your Protected Health Information; or (c) what you
ask for is about Protected Health Information that AHS didn't make.
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Accounting of Disclosures. You have the right to ask for an "accounting of disclosures."
An "accounting of disclosures" is a list of whom AHS has told your Protected Health Information to and what AHS told them.
This list will NOT include disclosures AHS told others so that AHS could take care of you, get paid, manage its business or
which you requested by authorization per #8 below in this section. In order to obtain an accounting of disclosures, you must
request, it in writing, from the Privacy Officer/Project Manager at Automated Health Systems, 1375 East Woodfield Road, Ste.
600, Schaumburg, IL 60173. All requests must state the period of time you want the list for, which cannot be more than six
years or before July 1, 2006. The first list you ask for within a 12-month period is free, but AHS will charge you for
additional lists within the same 12-moth period. AHS will notify you of the costs involved each time you ask, and you may
decide not to ask if you do not want to pay.
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Right to a Paper Copy of this Notice. You may ask for a copy of this notice at any time.
To get a paper copy of this notice, contact the Privacy Officer/Project Manager at Automated Health Systems at 1375 East
Woodfield Road, Ste. 600, Schaumburg, IL 60173 or call 1-877-912-9120.
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Right to File a Complaint. If you think your privacy rights have not been followed, you
may file a complaint with AHS or with the Secretary of the Department of Health and Human Services of the United States.
To file a complaint with AHS, contact the Privacy Officer/Project Manager at Automated Health Systems, 1375 East Woodfield
Road, Ste. 600, Schaumburg, IL 60173. All complaints must be in writing.
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Right to Give an Authorization for Other Uses and Disclosures. AHS will get your permission
in writing (called an "authorization") any time AHS wants to use or tell somebody else your Protected Health Information in
a way not told to you in this notice or permitted by the law. Any authorization you provide regarding the use and telling
of your Protected Health Information you may take back at any time. This must be done in writing by contacting the Privacy
Officer/Project Manager at Automated Health Systems, 1375 East Woodfield Road, Ste. 600, Schaumburg, IL 60173. After you
take back your authorization, AHS will not use or tell your Protected Health Information the way you said AHS could in the
authorization. AHS will still keep all of it records about you.
Automated Health Systems' Responsibilities
AHS will:
- Keep your health information private.
- Give you this notice if requested.
- Do what it says in this notice.
- Tell you if AHS cannot do what you ask about your Protected Health Information.
- Do what you ask about your Protected Health Information if it is reasonable.
AHS will not use or disclose your Protected Health Information without your permission, except as it says in this notice.