This is the web site of Union Associated Physicians Clinic, LLC.
Our postal address is
221 South Sixth Street
Terre Haute, IN 47807
If you have any questions about this Notice, please call the UAP Administration Office at (812) 242-3244
Union Associated Physicians Clinic, LLC is concerned about maintaining our customer's privacy. For each visitor to our web pages, our web server automatically recognizes the consumer's domain name and e-mail address (where possible).
We collect the domain name and e-mail address (where possible) of visitors to our web page, the e-mail addresses of those who communicate with us via e-mail, aggregate information on what pages consumers access or visit, user-specific information on what pages consumers access or visit and information volunteered by the consumer, such as survey information and/or site registrations.
The information we collect is used to improve the content of our web pages and used to notify consumers about updates to our web site. The information collected via this web site will not be sold to any other company or person.
If you do not want to receive e-mail from us in the future, please let us know by writing to us at the above address.
NOTICE OF PRIVACY PRACTICES
For Union Hospital Terre Haute, Union Hospital Clinton and Union Medical Group patients.
Effective Date of this Notice: April 14, 2003
Revised Date of this Notice: September 23, 2013
Revised Date of this Notice: August 2, 2016
If you have any questions about this Notice, please call the Compliance Department at 812.238.7533.
Union Hospital, Inc.
1606 N. 7th Street
Terre Haute, IN 47804
Union Hospital Clinton
801 S. Main Street
Clinton, IN 47842
Union Medical Group
221 S. 6th Street
Terre Haute, IN 47807
THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.
How We May Use and Disclose Your Medical Information
The following categories describe different ways that we use and disclose medical information. Information may be disclosed in writing, orally or electronically. Not every use or disclosure in each category will be listed; however, all of the ways we are permitted to use and disclose information fall within one of the categories. Other uses and disclosures not described in this Notice will be made only with the authorization from the individual patient or qualified patient representative.
Our Pledge Regarding Medical Information
We understand that medical information about you and your health is personal. We are committed to protecting your privacy. We create a record of the care and services you receive at this facility. We need this record to provide you with quality care and to comply with certain legal requirements. This Notice applies to all records of your care generated by this facility whether in paper or electronic form.
We are required by law to:
- Make sure that medical information that identifies you is kept private;
- Give you this notice of our legal duties and privacy practices;
- Follow the terms of this Notice currently in effect;
- Notify you in the event of a breach of your unsecured health information.
The rights listed in this Notice will not apply to inmates of a correctional institution.
We will collect only the personal information that is necessary to conduct our business, i.e., only the information necessary to provide quality health care and accurately bill you or your insurance carrier.
Who has access to your information?
We restrict access to your personal information to only those persons with a need to know. We maintain physical, electronic, and procedural safeguards that meet state and federal regulations to guard your personal medical information. We will not use or disclose your medical information without your authorization, except as otherwise described in this Notice.
1. For Treatment:
We will use your medical information to provide you with quality treatment or services. Your information may be accessed by various people who are involved in your care (example: doctors, nurses, technicians, students, clerks, laboratory personnel, etc.). Different departments may share medical information about you to coordinate your care. For
example, a doctor may share your medical information with another physician if you are referred for specialized care. We may also share your medical information with a family member or friend who will assist with your care outside this facility.
2. For Payment:
We will use and disclose your medical information so that we can bill for the services you received and collect payment. For example: we may share information with your insurance company to obtain prior approval for treatment when applicable, or to bill and receive payment for treatment you received. We may also share your information with other affiliated or contracted entities who performed a service for you during your visit to our facility (examples include other physicians, technicians, labs, and diagnostic services such as x-ray, CT, or MRI).
3. For Operations:
We may use and disclose your medical information as necessary for internal operations. Examples of uses and disclosures include, but are not limited to, the following:
- to send you appointment reminders;
- to inform you about or recommend possible treatment options or alternatives that may be of interest to you;
- to provide you with information about health-related benefits and services that may be of interest to you;
- to review our services, evaluate our performance, and decide what additional services we should offer;
- to maintain our admission directory so that if your friends and family inquire, limited information about you may be given;
- to volunteers and/or clergy who assist our patients;
- for research purposes under certain circumstances;
- for fund raising efforts, but you have the right to opt out of such communications;
- to outside organizations called our Business Associates who perform a task on our behalf, such as an outside billing agency;
- to doctors, nurses, students, and other personnel for review and learning purposes;
- to schools requiring record of immunizations.
Union Hospital and its entities’ medical record data are managed by Indiana University Health, also a HIPAA Covered Entity. IU Health performs medical research. We may disclose your protected health information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure, among other things, the privacy of your protected health information. Union may release information about you to researchers who need to know how many patients have a specific health issue in preparation for proposed research.
4. As Required by Law:
We may use and disclose your medical information as required in the following situations:
- to prevent a serious threat to your health and safety or the health and safety of another person or the public;
- to report public health activities or risks, such as infectious diseases or abuse cases;
- to report births or deaths;
- for health oversight activities, which could include audits, investigations, inspections and licensure;
- to a court or in response to an administrative order, subpoena, discovery request or other process if you are involved in a lawsuit or dispute;
- to law enforcement officials in response to a criminal investigation, court order, warrant, or subpoena;
- to federal officials for intelligence and other national security activities authorized by law;
- to coroners, medical examiners or funeral directors;
- to workers’ compensation programs when applicable;
- to organ donation or procurement programs when applicable;
- to military command authorities, as applicable, if you are a member of the Armed Forces.
5. Other Uses of Medical Information:
Other uses and disclosures of medical information not covered by this Notice or law will be made only with your written permission. If you provide us permission to use or disclose your medical information, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. Please understand that we are unable to take back any disclosures we may have already made while we had your permission, and that we are required by law to retain our records of the care we provided to you.
Your written authorization will be required to use or disclose most psychotherapy notes as well as uses and disclosures of medical information for marketing purposes or sale of medical information.
Your Rights Regarding Your Medical Information
1. Right to Inspect and Copy:
You may read your information or request a copy of your records. This includes medical and billing records, but does not include psychotherapy notes. If you request a copy of the records, we may charge a reasonable fee for the costs of copying, mailing or other supplies associated with your request. To review or request a copy of your record, contact the Medical Records Department at Union Hospital 812.238.7648 / Union Hospital Clinton 765.832.1234.
2. Right to Amend:
If you believe that medical information in your records is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept. To request an amendment, contact the Compliance Department at 812.238.7533. A representative will give you the appropriate form to request an amendment (which must include the reason for your request). We will deny your request for an amendment if it is not in writing or does not include a reason for the request. In addition, we may deny your request if it is deemed that our information is accurate and complete.
3. Right to Accounting of Disclosures:
You have the right to request an accounting of disclosures, that is, a list of the persons to whom we sent some or all of your medical information. This accounting can begin no earlier than our HIPAA Privacy Standards compliance effective date of April 14, 2003, and can include a maximum six-year period. Contact the Compliance Department at 812. 238.7533 to begin this process. We will charge you for the cost of providing more than one accounting during a 12-month period. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any charges are incurred.
4. Right to Request Restrictions:
You have the right to request a restriction or limitation of the medical information we use or disclose about you for treatment, payment or other health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, such as a family member or friend. For example, you could ask that we not use or disclose information about this visit. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, contact the Compliance Department at 812.238.7533. You will be given the appropriate form to complete your request which must include:
- what information you want to limit;
- whether you want to limit our use, disclosure or both; and
- to whom you want the limits to apply, for example, disclosures to your spouse.
You have the right to restrict certain disclosures of PHI to your health plan when you agree to pay out-of-pocket in full for the healthcare item or services.
5. Right to Request Confidential Communications:
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. You may request confidential communication during your registration process. Any request made after you have been registered, should be made to the Compliance Department at 812.238.7533.
For More Information or to Report a Problem
If you have questions or would like additional information about our privacy practices or this Notice, you may contact our Compliance Department during normal business hours,
Monday - Friday, 8 a.m.-5 p.m. at 812.238.7533.
If you believe your privacy rights have been violated, you can file a complaint with the Privacy Officer located in our Compliance Department, at:
1606 N. 7th Street
Terre Haute, IN 47804
or with the Office of Civil Rights at:
Centralized Case Management Operations
U.S. Department of Health and Human Services
200 Independence Avenue S.W.
Room 509F HHH Bldg.
Washington, D.C. 20201
You will not be penalized for filing a complaint.
Changes to this Notice
We reserve the right to change our practices and this Notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you, as well as any information we receive in the future. We will post a copy of the current Notice in the facility.