Health Options uses health information about you for treatment, to obtain payment for treatment, for

administrative purposes, and to evaluate the quality of care that you receive. Your health

information is contained in a medical record that is the physical property of Health Options.

How Health Options May Use or Disclose Your Health Information

For Treatment. Health Options may use your health information to provide you with medical

treatment or services. For example, information obtained by a health care provider, such as a

physician, nurse, or other person providing health services to you, will record information in your

record that is related to your treatment. This information is necessary for health care providers to

determine what treatment you should receive. Health care providers will also record actions take by

them in the course of your treatment and note how you respond to the actions.

For Payment. Health Options may use and disclose your health information to others for purposes of

receiving payment for treatment and services that you receive. For example, a bill may be sent to

you or a third-party payor, such as an insurance company or health plan. The information on the bill

may contain information that identifies you, your diagnosis, and treatment or supplies used in the

course of treatment.

For Health Care Operations. Health Options may use and disclose health information about you for

operational purposes. For example, your health information may be disclosed to members of the

medical staff, risk or quality improvement personnel, and others to:

provide.

Appointments. Health Options may use your information to provide appointment reminders or

information about treatment alternatives or other health-related benefits and services that may be of

interest to the individual.

Fund Raising. Health Options may use your information to contact you to raise funds for Health

Options or a group health plan, health insurance issuer, or HMO with respect to a group health plan may

disclose health information to the sponsor of the plan.

Required by Law. Health Options may use and disclose information about you as required by law. For

example, Health Options may disclose information for the following purposes:

Public Health. Your health information may be used or disclosed for public health activities such

as assisting public health authorities or other legal authorities to prevent or control disease, injury,

or disability, or for other health oversight activities.

Decedents. Health Information may be disclosed to funeral directors or coroners to enable them to

carry out their lawful duties.

Organ/Tissue Donation. Your health information may be used or disclosed for cadaveric organ,

eye or tissue donation purposes.

Research. Health Options may use your health information for research purposes when an

institutional review board or privacy board that has reviewed the research proposal and established

protocols to ensure the privacy of your health information has approved the research.

Health and Safety. Your health information may be disclosed to avert a serious threat to the health

or safety of you or any other person pursuant to applicable law.

Government Functions. Specialized government functions such as protection of public officials or

reporting to various branches of the armed services that may require use or disclosure of your

health information.

Workers Compensation. Your health information may be used or disclosed in order to comply

with laws and regulations related to Workers Compensation.

You have the right to:

CFR §164.522; however, Health Options is not required to agree to a requested restriction;

§164.524;

alternative locations;

that action has already been taken; and

CFR §164.528.

You may complain to Health Options and to the Department of Health and Human Services if you

believe your privacy rights have been violated. You will not be retaliated against for filing a

complaint.

Obligations of Health Options Option:

Care is required to:

health information;

is used or disclosed;

alternative means or at alternative locations; and

other than those listed above and permitted under law.

Health Options reserves the right to change its information practices and to make the new

provisions effective for all protected health information it maintains. Revised notices will be

made available to you in the manner prescribed in Policy and Procedure Notice of Privacy

Practices.

If you have any questions or complaints, please contact:

Health Options PRIVACY OFFICER

110 S. Market St.

Sparta, IL.  62286

Phone: (800)422-7389 or (618)443-4524