At DePaul we value your privacy and rights. As a result of federal law, you have rights over the use of certain health related information about you. There are also rules and limits about who can see what information about you.

Your Rights Regarding Your Health Information

You have the right to:

• Ask to see or get a copy of your
• Ask that we make corrections to the record if the information is
• Receive a notice that tells you how your information can be used and
• Give permission for certain uses of your (ie. Marketing)
• Get a report of when and why your information was
• File a complaint with DePaul or the federal government if you think your privacy was violated.

How We Can Use and Share Your Health Information

• For your treatment and coordination of
• To receive payment for services we provide to
• With your relatives or other people you identify to us unless you
• To protect public *
• To report crimes on our premises or make other required reports to law *

Your Written Authorization

For all other releases of your information we will ask that you sign a written form allowing us to share information with specific people or organizations. You have the right not to agree to release this information.

To File a Complaint

If you think your privacy was violated:

• You can file a complaint with DePaul by contacting Quality Management
• You can file a complaint with the Federal Office of Civil Call 1-866-627-7748 (toll free) for more information.

For More Information

• For more information regarding the federal law refer to the DePaul Notice of Privacy Practices or you can call the Federal Office of Civil Rights at

1-800-368-1019 (toll free) or visit their Web site at http://www.hhs.gov/ocr/privacyhowtofile.htm.

*Another Federal Law provides additional privacy protection for persons in substance abuse programs. Ask your program staff if you need more information regarding this law.