THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY:

This Notice describes the privacy practices of McKinley Health Center (“McKinley”). It applies to the health care services you receive at McKinley. This Notice describes generally (a) the types of uses and disclosures McKinley may make with your health information; and (b) your rights to access and control your health information. McKinley will comply with laws that provide additional protections for certain medical information related to services or treatment for mental health conditions, alcohol and drug abuse, and HIV/AIDS. 

CONSENT FOR TREATMENT: 

I consent to the provision of care, diagnostic procedures, laboratory testing, medical treatment, mental health treatment, and referral to an outside provider as my physician(s) and/or other healthcare provider(s) deem necessary. I understand that there are no warranties or guarantees regarding the services and care provided. Some care may be provided using telehealth technology and I consent to participate in telehealth consultations. I understand that the providers participating in my care have been granted the privilege of using McKinley facilities for the care and treatment of University of Illinois students or are licensed practitioners participating in the care of Illinois students as part of a post-graduate medical education program. McKinley will attempt to honor the request to exclude a resident or clinical student where feasible and if such exclusion will not be detrimental to my healthcare.

MCKINLEY MAY USE & DISCLOSE INFORMATION FOR THE FOLLOWING: 

Treatment: McKinley may use or disclose your health information to provide treatment and to coordinate or manage your healthcare and any related services. McKinley may disclose your information to another physician or health care provider (e.g., a specialist), who, at the request of your physician, nurse practitioner, or therapist, becomes involved in your care. 

Payment: McKinley does not routinely bill patients or third parties for services rendered. However, should circumstances require billing, your health information will be used, as needed, to obtain payment for your health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services McKinley recommends for you. 

Healthcare Operations: McKinley may use or disclose your health information to perform healthcare operations. Additionally, McKinley may use or disclose your health information, as necessary, to email a reminder to you of your scheduled appointment. McKinley staff may also call you by name in the waiting room when your provider is ready to see you. McKinley staff may leave a voicemail on your phone asking you to contact McKinley in order to ensure adequate follow-up care. McKinley may provide certain services through contracts with others. When services are contracted, your health information may be disclosed in order to carry out specific operational functions. Whenever an arrangement for services involves the use or disclosure of your health information, McKinley will have a written contract to protect the privacy of your health information. 

OTHER USES AND DISCLOSURES MCKINLEY MAY MAKE WITHOUT YOUR AUTHORIZATION, CONSENT OR OPPORTUNITY TO OBJECT: 

McKinley may use or disclose your health information to the extent that the use or disclosure is required or permitted by federal, state, or local law. 

YOUR HEALTH INFORMATION RIGHTS: 

• Right to Obtain a Copy of this Privacy Notice: Additional copies of this Notice can be obtained at the registration areas of McKinley.
• Right to Inspect and Request a Copy of your Health Record: You have the right to inspect and obtain a copy of your health record, except in limited circumstances defined by federal and state law. 
• Right to Request an Amendment to your Health Record: You may make a written request to amend your health information, if the information is kept by or for McKinley. You must give McKinley a reason for the amendment. In certain cases, McKinley may deny your request for an amendment. If McKinley denies your request for amendment, you have the right to file a statement of disagreement with McKinley, and McKinley may prepare a rebuttal to your statement. McKinley will provide you with a copy of any such rebuttal. 
• Contact McKinley’s Privacy Administrator: To exercise any of the rights described above, or if you have any questions about this Notice, please contact the Privacy Administrator. If you believe that your privacy rights have been violated by McKinley, you may file a complaint with McKinley by contacting the Privacy Administrator at (217) 333-2711 or by mail to: McKinley Health Center, Attention: Privacy Administrator, 1109 South Lincoln Avenue, Urbana, IL 61801. 
• Changes to this Notice: McKinley reserves the right to change this Notice at any time. McKinley reserves the right to make the revised or changed Notice effective for information already obtained about you as well as any information received in the future.