Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information.

Please read this information carefully.

If you have any questions, please contact our Privacy Officer at the address or phone number on the bottom of this notice.

Who will follow this notice?

Carlinville Area Hospital & Clinics provides health care to patients in partnership with physicians as well as other professionals and organizations. The information privacy practices in the notice will be followed by:

  • All health care professionals who treat you at our hospital.
  • All departments and units of the hospital, including Outpatient Specialty Clinic.
  • All employees, medical staff members, volunteers and other hospital personnel.
  • All business associates or partners of the hospital with who we share health information.

Our pledge to you:

We understand that medical information about you is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive to provide quality care and to comply with legal requirements. This notice applies to all of the records of your care that we maintain, whether created by hospital staff or your personal doctor. Your personal doctor may have different policies and notices regarding the doctor’s use and disclosure of your medical information created in the doctor’s office. We are required by law to:

  • Keep medical information about you private.
  • Give you this notice of our legal duties and privacy practices with respect to medical information about you.
  • Follow the terms of this notice that are currently in effect.

Our Uses and Disclosures

How do we typically use or share your health information?

To treat you

We can use your health information and share it with other professionals who are treating you.

Example: A doctor treating you for an injury asks another doctor about your overall health condition.

To run our organization

We can use and share your health information to run our practice, improve your care and contact you when necessary.

Example: We use health information about you to manage your treatment and services.

To bill for your services

We can use and share your health information to bill and get payment from health plans or other entities.

Example: We give information about you to your health insurance plan so it will pay for your services.

How else can we use or share your health information?

We are allowed or required to share your information in other ways—usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.

For more information see:

Help with public health and safety issues

We can share health information about you for certain situations, such as:

  • Preventing disease
  • Helping with product recalls
  • Reporting adverse reactions to medications
  • Reporting certain instances of suspected abuse, neglect or domestic violence
  • Preventing or reducing a serious threat to anyone’s health or safety

Do research

We can use or share your information for health research, in certain instances.

Comply with the law

We will share information about you if state or federal laws require it, including with the U.S. Department of Health and Human Services if it wants to see that we’re complying with the federal privacy law. 

Respond to organ and tissue donation requests 

We can share health information about you with organ procurement organizations, if you choose to be a donor.

Work with a medical examiner or funeral director

We can share health information with a coroner, medical examiner or funeral director when an individual dies.

Address workers’ compensation, law enforcement and other government requests

We can use or share health information about you:

  • For workers’ compensation claims
  • For law enforcement purposes or with a law enforcement official
  • With health oversight agencies for activities authorized by law
  • For special government functions, such as military, national security and presidential protective services

Respond to lawsuits and legal actions

We can share health information about you in response to a court or administrative order, or in response to a subpoena

Other uses of medical information

In any other situation not covered by this notice we will ask for your written authorization before using or disclosing medical information about you. If you choose to authorize use or disclosure, you can later revoke that authorization by notifying us in writing of your decision.

Changes to this notice:

We may change our policies at any time. Changes will apply to medical information we already hold as well as new information after the change occurs. Before we make significant change in our policies, we will change our notice and post the new notice in the hospital and outlying clinics. You can request a copy of the current notice at any time. The effect date is list below.


If you are concerned that your privacy rights may have been violated, or you disagree with a decision we made about access to your records, you may contact our Privacy Officer. You may also file a complaint with the United States Dept. of Health and Human Services Office of Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C., 20201, by calling 1-877-696-6775 or by visiting Under no circumstances will you be penalized or retaliated against for filing a complaint.

Privacy Officer

Carlinville Area Hospital & Clinics
20733 N Broad St.
Carlinville, IL 62626