Midwest Wellness Center Privacy Policy


How we may use and disclose your health information: The law requires us to inform you that we use and disclose your health information for the following purposes.



We will use your health information to provide you with healthcare services. We may share your health information with doctors, nurses or other healthcare providers (such as physical therapy, lab and pharmacy) who are involved in your care and who are part of the entity providing your care.


Who this notice applies to:

• Any healthcare professional authorized to enter information into your record.

• All employees, staff, and other personnel.

• Any volunteer, intern, or student we allow to assist you while you are a patient.


With your written consent, we may disclose certain health information specified by you to your family, others involved in your care or organizations outside of Midwest Wellness Center providing healthcare to you.



In order to assist in getting your healthcare services paid for, we may have to provide your medical information to the party responsible for paying. Your insurance company or health plan may need your information for activities such as determining your eligibility for coverage, and/or reviewing the medical necessity of the healthcare services.


This may include:

• Your insurance or healthcare plan

• Any other payer or programs

• Medical Assistance


Appointment Reminders

We may use and disclose your health information to provide you with an appointment reminder.



We will not use or disclose any health information that can be used to identify you for research purposes.


Required Disclosures Permitted Without Your Authorization

We will release health information about you as required for workers' compensation or similar programs to comply with related laws. We may also be required to use or disclose your health information without your authorization:

• to the government for public health activities as permitted or required by law to report disease exposures and statistics, births and deaths, abuse or neglect, reactions to medication and problems with products

• to a health oversight agency for audits, investigations, inspections and licensure activities

• to prevent a serious and imminent threat to the health or safety of a person or the public

• to a law enforcement official in response to a court or administrative order, subpoena, warrant, summons or similar process; to identify or locate a suspect, witness or missing person; to identify a victim of crime if, under certain limited circumstances, we are unable to obtain the victim's agreement; or in emergency circumstances to report the location and perpetrator of a crime

• to a private party in litigation in response to a valid court order or administrative order

• to a coroner or funeral director as permitted or required by law to identify a deceased person, determine the cause of death or to carry out their necessary duties

• for military, national security or lawful intelligence activities

• otherwise as permitted or required by law

• Other uses and disclosures of your health information will be made only with your written authorization. You may revoke that authorization at any time for future uses and disclosures by writing Midwest Wellness Center, Inc.


Your Rights to Your Health Information

You have the following rights regarding the health information we maintain about you.


Rights to Inspect and Copy

With some exceptions, you have the right to see and request a copy of records that include your health information and are maintained or used by us.


Right to Request an Amendment

You may ask us to amend a record containing your health information if you feel it is incorrect or incomplete. Your request must be submitted in writing and you must provide a reason for your request. We may deny your request if, among other reasons, the information was not created by us; is not included in your medical, billing or other records; or is otherwise accurate and complete.


Right to an Accounting of Disclosure

You have the right to request a written report of where we sent your health information for up to a six-year period. This does not include disclosures to or authorized by you or disclosures for treatment, payment and healthcare operations as described in this notice. You must submit your request in writing. Your request must state a time period of six years or less, and may not include dates before April 14, 2003. The first report you request within a 12-month period will be free. After that, there will be a charge for providing the report.


Right to Request Restrictions

You may request that we restrict or limit the health information we use or disclose about you for treatment, payment or healthcare operations. We may not be able to agree with your request. If we agree, we will honor your request unless the information is needed to provide emergency treatment. You must make your request in writing. In your request, you must tell us: 1) what information you want to limit; 2) how you want to limit our use or disclosure; and 3) to whom you want the limits to apply.


Right to Request Confidential Communications

You have the right to request that we communicate your health information in a certain method or place (such as at work or by mail). You must make your request in writing. We will try to meet all reasonable requests.


Our Legal Duties and Rights

The law requires us to protect the privacy of your health information and to provide this notice of our practices. We reserve the right to change our health information practices and the terms of this notice. We reserve the right to make the changed notice effective for health information we already have about you and for new information.



If you believe your privacy rights have been violated, you may file a complaint with

Region V, Office for Civil Rights, U.S. Department of Health and Human Services

233 N. Michigan Ave., Suite 240, Chicago, IL 60601, or fax 312-886-1807.

All complaints must be made in writing. You will not be penalized for filing a complaint.


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At Midwest Wellness Center, protecting the confidentiality of your health and medical information is important to us.


We are required by law to maintain the privacy of your medical information. We are also required to notify you of our legal duties and privacy practices regarding your medical information, and abide by the practices of this notice, unless more stringent laws or regulations apply.


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


Please review it carefully.