We abide by all HIPAA laws and regulations. Your medical record is strictly private. We do not release information regarding your health to anyone including family, friends, or employers without your written permission. The only exception to this is when required by law. Should you have any questions or concerns regarding HIPAA or your privacy, please contact our HIPAA compliance officer. 

As required by the Privacy Regulations created as a result of the Health Insurance Portability and Accountability Act of 1995 (HIPAA).

MID-ILLINOIS HEMATOLOGY & ONCOLOGY ASSOCIATES, LTD.

PRIVACY NOTICE

As required by the Privacy Regulations created as a result of the Health Insurance Portability and Accountability Act of 1995 (HIPAA).

 THIS NOTICE DECRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AN HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

 This Privacy Notice is being provided to you as a requirement of a federal law, the Health Insurance Portability and Accountability Act (HIPAA). This Privacy Notice describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information in some cases. Your “protected health information” means any written and oral health information about you, including demographic data that can be used to identify you. This is health information that is created or received by your health care provider, and that relates to your past, present or future physical or mental health or condition. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future.

1. Uses and Disclosures of Protected Health Information

 Mid Illinois Hematology and Oncology Associates (hereafter, the facility) may use your protected health information for purposes of providing treatment, obtaining payment for treatment, and conducting health care operations. Your protected health information may be used or disclosed only for these purposes unless the facility has obtained your authorization or the use or disclosure is otherwise permitted by the HIPAA privacy regulations or state law. Disclosures of your protected health information for the purposes described in this Privacy Notice may be made in writing, orally, or by facsimile. 

1. Treatment.     We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination of management of your health care with a third party for treatment purposes. For example, we may disclose your protected health information to a pharmacy to fill a prescription or to a laboratory to order a blood test. Many of the people who work for our practice, including but not limited to, our doctors and nurses, may use or disclose your protected health information in order to treat you or to assist others in your treatment. We may also disclose protected health information to physicians who may be treating you or consulting with the facility with respect to your care. In some cases, we may also disclose your protected health information to an outside treatment provider for purposes of the treatment activities of the other provider. Additionally, we may disclose your protected health information to others who may assist in your care, such as your spouse, children, or parents.
 
2. Payment.         Your protected health information will be used, as needed, to obtain payment for the services that we provide. This may include certain communications to your health insurance company to get approval for the procedure that we have scheduled. For example, we may need to disclose information to your health insurance company to get prior approval for treatment. We may also disclose protected health information to your health insurance company to determine whether you are eligible for benefits or whether a particular service is covered under your health plan. In order to get payment for the services we provide to you, we may also need to disclose your protected health information to your health insurance company to demonstrate the medical necessity of the services or, as required by your insurance company, for utilization review. We may also disclose protected health information to another provider involved in our care for the other provider’s payment activities.
 
3. Operations.     We may use or disclose your protected health information, as necessary, for our own health care operations to facilitate the function of Mid Illinois Hematology and Oncology Associates and to provide quality care to all patients. Health care operation include such activities as: quality assessment and improvement activities, employee review activities, training programs including those in which students, trainees, or practitioners in health care learn under supervision, accreditation, certification, licensing or credentialing activities, review and auditing, including compliance reviews, medical reviews, legal services and maintaining compliance programs, and business management and general administrative activities.
 

For example, we may use a sign-in sheet at the registration desk where you will be asked to sign you name. Your name may be called in the waiting rooms when it is time for you provider to see you. We may use or disclose your protected health information to contact you to remind you of your appointment. 

“Business associates” perform various activities for us. We will share your protected health information with business associates, whenever appropriate. A written contract with the business associate will outline the terms that will protect the privacy of your protected health information. 

In certain situations, we may also disclose patient information to another provider or health plan for their health care operations. 

D.        Other Uses and Disclosures.We may use and disclose your protected health information in the following instances. You have the opportunity to agree or object to all or part of your protected health information, then your provider will, using professional judgment, determine whether the use is in your best interest. In any event, only the protected health information that is relevant to your health care will be disclosed. As part of treatment, payment and health care operations, we may also use or disclose your protected health information for the following purposes: to remind you of your appointment date, to inform you of potential treatment alternatives or options, to inform you of health-related benefits or services that may be of interest to you. 

Unless, you object, we may disclose to a member or you family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person’s involvement in you health care. If you are unable to object to such a disclosure, we may notify or assist in notifying a family member, personal representative or any other person that is responsible for your care. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care. 

We may use or disclose your protected health information in an emergency treatment situation. If this happens, your provider will try to obtain your consent as soon as reasonably practicable after the delivery of treatment. If your provider or another provider in the practice is required by law to treat you ant the provider has attempted to obtain your consent bit is unable, he or she may still use your protected health information to treat you. 

We may use and disclose your protected health information if your provider or another provider in the practice attempts to obtain your consent but is unable to do so due to substantial communication barriers and the provider determines, using professional judgment, that you intend to under the circumstances. 

1. Uses and Disclosures Beyond Treatment, Payment, and Health Care Operations Permitted Without Authorization or Opportunity to Object

 Federal privacy rules allow us to use or disclose your protected health information without your permission or authorization for a number of reasons including the following: 

A.        When Legally Required.       We will disclose your protected health information when we are required to do so by any federal, state, or local law. 

B.        When There Are Risks to Public Health.     We may disclose your protected health information for the following public activities and purposes:

• To prevent, control, or report disease, injury or disability as permitted by law.
• To report vital events such as birth or death as permitted or required by law.
• To conduct public health surveillance, investigations and interventions as permitted or required by law.
• To collect or report adverse events and product defects, track FDA regulated products, enable product recalls, repairs or replacements to the FDA and to conduct post marketing surveillance.
• To notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease as authorized by law.
• To report to an employer information about an individual who is s member of the workforce as legally permitted or required.
 

C.        To Report Suspected Abuse, Neglect, or Domestic Violence.        We may notify government authorities if we believe that a patient is the victim of abuse, neglect or domestic violence. We will make this disclosure only when specifically required or authorized by law or when the patient agrees to the disclosure. 

D.        To Conduct Health Oversight Activities.     We may disclose your protected health information to a health oversight agency for activities including audits; civil, administrative, or criminal investigations, proceedings, or actions; inspections; licensure or disciplinary actions; or other activities necessary for appropriate oversight as authorized by law. We will not disclose your health information under this authority if you are the subject of an investigation and your health information is not directly related to your receipt of health care of public benefits. 

E.         In Connection With Judicial and Administrative Proceedings.       We may disclose your protected health information in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order. In certain circumstances, we may disclose your protected health information in response to a subpoena to the extent authorized by state law if we receive satisfactory assurances that you have been notified of the request or that an effort was made to secure a protective order. 

F.         For Law Enforcement Purposes.       We may disclose your protected health information to a law enforcement official for law enforcement purposes as follows:

• As required by law for reporting of certain types of wounds or other physical injuries.
• Pursuant to court order, court-ordered warrant, subpoena, summons or similar process.
• For the purpose of identifying or locating a suspect, fugitive, material witness or missing person.
• Under certain limited circumstances, when you are the victim of a crime.
• To a law enforcement official if the facility has a suspicion that your health condition was the result of criminal conduct.
• In an emergency to report a crime.
 

G.        To Coroners, Funeral Directors, and for Organ Donation.We may disclose protected health information to a coroner or medical examiner for identification purposes, to determine cause of death or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose protected health information to a funeral director, as authorized by law, in order to permit the funeral director to carry out their duties. We may disclose such information in reasonable anticipation of death. Protected health information may be used and disclosed for cadaveric organ, eye or tissue donation purposes. 

H.        For Research Purposes.        We may use or disclose your protected health information for research when the use or disclosure for research has been approved by an institutional review board that has reviewed the research proposal and research protocols to address the privacy of your protected health information. 

I.          In the Event of a Serious Threat to Health or Safety.         We may, consistent with applicable law and ethical standards of conduct, use or disclose your protected health information if we believe, in good faith, that such use or disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or to the health and safety of the public. 

J.         For Specified Government Functions.          In certain circumstances, federal regulations authorize the facility to use or disclose your protected health information to facilitate specified government functions relating to military and veteran activities, national security and intelligence activities, protective services for the President and others, medical suitability determinations, correctional institutions, and law enforcement custodial situations. 

K.        For Worker’s Compensation.            The facility may release your health information to comply with worker’s compensation laws or similar programs. 

L.         Inmates.          We may use or disclose your protected health information if you are an inmate of a correctional facility and your provider created or received your protected heath information in the course of providing care to you. 

M.       Required Uses and Disclosures.       Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500 et. Seq. 

III.       Uses and Disclosures Permitted Without Authorization but with Opportunity to Object

We may disclose your protected health information to your family member or a close personal friend if it is directly relevant to the person’s involvement in your treatment or payment related to your treatment. We can also disclose your information tin connection with trying to locate or notify family members or others involved in your care concerning your location, condition or death. 

You may object to these disclosures. If you do not object to these disclosures or we can infer from the circumstances that you do not object or we determine, in the exercise of our professional judgment, that it is in your best interests for us to make disclosure of information that is directly relevant to the person’s involvement with your care we may disclose your protected health information as described. 

IV.       Uses and Disclosures Which You Authorize

Other than as stated above, we will not disclose your health information other than with your written authorization. You may revoke your authorization in writing at any time except to the extent that we have taken action in reliance up on the authorization. 

V.        Your Rights

You have the following rights regarding your health information: 

1. The right to inspect and copy your protected health information.   You may inspect and obtain a copy of your protected health information that is contained in a designated record set for as long as we maintain the protected health information. A “designated record set” contains medical and billing records and any other records that your physician and the facility use for making decisions about you.
 

Under federal law, however, you may not inspect or copy the following records: psychotherapy notes; information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding; and protected health information that is subject to a law that prohibits access to protected health information. Depending on the circumstances, you may have the right to have a decision to deny access reviewed. 

We may deny your request to inspect or copy your protected health information if, in our professional judgment, we determine that the access requested is likely to endanger your life or safety or that of another person, or that it is likely to cause substantial harm to another person referenced within the information. You have the right to request a review of this decision.

To inspect and copy your medical information, you must submit a written request to the Privacy Officer whose contact information is listed on the last page of the Privacy Notice. If you request a copy of your information, we charge you a fee for the costs of copying, mailing or other costs incurred by us in complying with your request. 

Please contact our Privacy Officer if you have questions about access to your medical record. 

B.        The right to request a restriction on uses and disclosures of your protected health information.            You may ask us not to use or disclose certain parts of your protected health information for the purposes of treatment, payment of health care operations. You may also request that we no disclose your health information to family members or friends who may be involved in your care or for notification purposes as described in this Privacy Notice. Your request must state the specific restriction requested and to whom you want the restriction to apply. 

The facility is not required to agree to a restriction that you may request. We will notify you if we deny your request to a restriction. If the facility does agree to the requested restriction, we may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment. Under certain circumstances, we may terminate our agreement to a restriction. You may request a restriction by contacting the Privacy Officer. 

1. The right to request to receive confidential communications from us by alternative means or at an alternative location.   You have the right to request that we communicate with you in certain ways. We will accommodate reasonable requests. We may condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not require you to provide an explanation for you request. Requests must be made in writing to our Privacy Officer.
 
2. The right to request amendments to your protected health information.   You may request an amendment of protected health information about you in a designated record set for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Requests for amendment must be in writing and must be directed to our Privacy Officer. In this written request, you must also provide a reason to support the requested amendments.
 
3. The right to receive an accounting.   You have the right to request an accounting of certain disclosers of your protected health information made by the facility. This right applies to disclosures for purposes other than treatment, payment or health care operations as described in this Privacy Notice. We are also not required to account for disclosures that you requested, disclosures that you agreed to by signing an authorization form, disclosures for a facility directory, to friends or family members involved in you care, or certain other disclosures we are permitted to make without your authorization. The request should specify the time period sought for the accounting. We are not required to provide an accounting for disclosures that take place prior to April 14, 2003. Accounting requests may not be made for periods of time in excess of six years. We will provide the first accounting you request during any 12-month period without charge. Subsequent accounting requests may be subject to a reasonable cost-based fee.
 
4. The right to obtain a paper copy of this notice.        Upon request, we will provide a separate paper copy of this notice even if you have already received a copy of the notice or have agreed to accept this notice electronically.
 

VI.       Our Duties

The facility is required by law to maintain the privacy of your health information and to provide you with this Privacy Notice of our duties and privacy practices. We are required to abide by terms of this Notice as may be amended from time to time. We reserve the right to change the terms of the Notice and to make the Notice provisions effective for all future protected health information that we maintain. If the facility changes its Notice, we will provide a copy of the revised Notice by sending a copy to the revised Notice by sending a copy of the revised Notice via regular mail or through in-person contact. 

VII.     Complaints

You have the right to express complaints to the facility and to the Secretary of Health and Human Services if you believe that your privacy rights have been violated. You may complain to the facility by contacting the facility’s Privacy Officer verbally or in writing, using the contact information below. We encourage you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way for filing a complaint. 

VIII.    Contact Person

Information regarding matters covered by this Notice can be requested by contacting the Privacy Officer. If you feel that your privacy rights have been violated by this facility you may submit a complaint to our Privacy Officer by sending it to: 

Mid Illinois Hematology and Oncology Associates

407 East Vernon Avenue, Suite 104

Normal, IL 61761

ATTN: Privacy Officer 

The Privacy Officer can be contacted by telephone at (309) 451-2246. 

IX.       Effective Date

This Notice is effective April 14, 2003

Our billing department in located in our Normal office. We will bill your insurance company for you, but to do so, we require your complete insurance information at your first visit.

Should your insurance company change, please notify our office immediately.

We accept all forms of insurance and are “In-network” with most insurance companies.

• Medicare
• Medicaid
• Blue Cross/Blue Shield
• Cigna
• Most United Healthcare
• Health Alliance
• Healthlink

However, our office cannot guarantee payment of your claims.  Prior to your first infusion, our office will call your insurance company to verify your benefits and obtain any prior authorizations that may be required.

It is your responsibility to pay any deductible amount, co-payment or any other amount not paid by your insurance company.  We accept cash, check, VISA, MasterCard & Discover.

Please remember that your insurance policy is a contract between you and your insurance company. It is important that you understand its provisions and our Financial Policy.

Should you ever have any questions regarding your insurance or bills you may receive from us, please do not hesitate to contact our Billing Department by phoning (309) 451-2247 or (309) 451-2248. They are available Monday thru Friday, 8:30 am – 5 pm.
 

Mid-Illinois Hematology & Oncology Associates, Ltd., is a practice that focuses on the treatment of blood disorders (Hematology) and the treatment of cancer (Oncology). Our practice is comprised of four dedicated physicians:

Pramern Sriratana, M.D.

Dr. Sriratana is Board Certified in Internal Medicine, Hematology, and Medical  Oncology. He received his medical degree from Ramthibodi Hospital Mahidol University, Bangkok, Thailand. He completed his internship and residency in Internal Medicine and his fellowship in Hematology/Oncology at St. Francis Hospital, Evanston, Illinois. He has been in practice at Mid-Illinois Hematology & Oncology Associates, Ltd. since its inception in 1979.

He has served as Cancer Committee Chairman for both BroMenn Regional Medical Center and OSF St. Joseph Medical Center, Consultant to the Cancer Information Service of the Illinois Cancer Council Comprehensive Cancer Program, Liaison Physician for the American College of Surgeons, Director of Hospice Programs at BroMenn Regional Medical Center, President of the Medical Staff at BroMenn Regional Medical Center, and President of the McLean County American Cancer Society.

His areas of interest include lung, breast, gastrointestinal, genitourinary, and central nervous system cancers, as well as hematology and hematologic malignancies.

Hwan Gon Jeong, M.D.

Dr. Jeong is Board Certified in Internal Medicine, Hematology, and Medical Oncology. He received his medical degree from Kyungpook National Univeristy, School of Medicine, in Taegu, Korea. He completed his internship at Maryknoll General Hospital, Pusan, Korea, and his residency in Internal Medicine from St. Elizabeth Hospital Medical Center, Youngstown, OH. He completed his fellowship in Hematology/ Oncology at Cleveland Clinic Foundation Hospital in Cleveland, OH, and University of California, Los Angeles. He has been in practice at Mid-Illinois Hematology & Oncology Associates, Ltd. since 1990.

He has served as a Principal Investigator with the Southwest Oncology Group clinical research group, member of the Cancer Committees for both BroMenn Regional Medical Center and OSF St. Joseph Medical Center, and member of the OSF St. Joseph Medical Center Institutional Review Board.

His areas of interest include hematology, including blood disorders, such as clotting disorders and anemias, and hematologic malignancies, including leukemia, myeloma, and lymphoma. However, his practice is not limited to these areas.

John J. Migas, M.D.

Dr. Migas is Board Certified in Internal Medicine and Medical Oncology. He received his medical degree from Rush Presbyterian Saint Luke’s Medical Center in Chicago. He completed his internship and residency at University of Minnesota Hospitals & Clinics, Minneapolis, MN, and completed his fellowship at University of Iowa Hospitals & Clinics, Iowa City, IA. He has been in practice at Mid-Illinois Hematology & Oncology Associates, Ltd., since 1997.

He has served as member of the Clinical Practice Committee for the Community Cancer Center, member of the BroMenn Regional Medical Center Institutional Review Board, principal investigator for Southwest Oncology Group, National Adjuvant Breast and Bowel Project, and National Cancer Institute Canada clinical research groups.

His area of interests include general oncology.

All of our physicians admit patients at Advocate BroMenn Regional Medical Center, OSF St. Joseph Medical Center, and OSF St. James Hospital.

We also have two nurse practioners available to see patients, Lyndi Alberts and Pamela Madden.

Our office has a staff of registered nurses ready to care for you. These nurses are:

• Sabrina, R.N., BSN, OCN
• Laurie, R.N.
• Jeanne, R.N., OCN
• Jeanne, R.N., BSN
• Jodi, R.N.
• Laura, R.N., BSN
• Beth, R.N., BSN
• Colleen, R.N., BSN
• Jenna, R.N., BSN

In addition, Mid-Illinois Hematology and Oncology Associates, Ltd. has a full-service, on-site laboratory which is open from 8:00 - 4:00 M-F. This is staffed by: 

• Andrea, MT, ASCP
• Nikki, MLT, ASCP
• Sherry, PBT, ASCP
• Amber