UChicago Medicine Ingalls Memorial and certain specified entities are acting as an organized health care arrangement (“OHCA”) solely for purposes of compliance with the Health Insurance Portability and Accountability Act (“HIPAA”). This designation is not intended and shall not be construed to have any other legal effect or create between the parties a partnership, joint venture, employment relationship, or any other relationship. The following entities are included in this OHCA: Ingalls Memorial, Ingalls Home Care, Ingalls Provider Group, Ingalls Care Network, LLC, as well as any health care professional providing services to you in the Ingalls’ clinically integrated setting, regardless of whether such services are provided by Ingalls’ employees or by independent members of the medical staff. Ingalls Memorial will use health information about you for treatment, to obtain payment for treatment, for administrative purposes, and to evaluate the quality of care that you receive. Your health information is contained in a medical record that is the physical property of Ingalls Memorial.

How Ingalls Memorial May Use or Disclose Your Health Information - We use and disclose health information for many different reasons. For some of these uses or disclosures, we need your prior consent or specific authorization. Below, we describe the different categories of our uses and disclosures and give you some examples of each category.

A. Uses and Disclosures Relating to Treatment, Payment, or Health Care Operations.

1. For treatment. Ingalls Memorial may use your health information to provide you with medical treatment or services. For example, a physician, nurse, or other person providing health services to you will record information in your record that is related to your treatment. This information is necessary for health care providers to determine what treatment you should receive. Health care providers will also record actions taken by them in the course of your treatment and note how you respond to the actions.

2. For payment. Ingalls Memorial may use and disclose your health information to others for purposes of receiving payment for treatment and services that you receive. For example, a bill may be sent to you or a third-party payor, such as an insurance company or health plan. The information on the bill may contain information that identifies you, your diagnosis, and treatment or supplies used in the course of treatment.

3. For health care operations. Ingalls Memorial may use and disclose health information about you for operational purposes. For example, your health information may be disclosed to members of the medical staff, risk or quality improvement personnel, and others to:

  • evaluate the performance of our staff;
  • assess the quality of care and outcomes in your case and similar cases;
  • learn how to improve our facilities and services;
  • determine how to continually improve the quality and effectiveness of the health care we provide.

B. Other Permitted Uses and Disclosures That May Be Made Without Your Consent.

1. Required by Law. Ingalls Memorial may use and disclose information about you as required by law. For example, Ingalls Memorial may disclose information for the following purposes:

  • for judicial and administrative proceedings pursuant to legal authority;
  • to report information related to victims of abuse, neglect or domestic violence;
  • to assist law enforcement officials in their law enforcement duties.

2. Public Health. Your health information may be used or disclosed for public health activities such as assisting public health authorities or other legal authorities to prevent or control disease, injury, or disability, or for other health oversight activities.

3. Decedents. Health information may be disclosed to funeral directors or coroners to enable them to carry out their lawful duties.

4. Organ/Tissue Donation. Your health information may be used or disclosed for cadaveric organ, eye, or tissue donation purposes.

5. Research. Ingalls Memorial may use your health information for certain approved research purposes once its institutional review board has reviewed the research proposal and established protocols to ensure the privacy of your health information.

6. Health and Safety. Your health information may be disclosed to avert a serious threat to the health or safety of you or any other person pursuant to applicable law.

7. Government Functions. Specialized government functions such as protection of public officials or reporting to various branches of the armed services that may require use or disclosure of your health information.

8. Appointments/Treatment Alternatives and Services. Ingalls Memorial may use your information to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

9. Fundraising. Ingalls Memorial may use your information to contact you to raise funds for our organization. The money raised through these activities is used to expand and support the health care service and educational programs we provide to the community. If you do not wish to be contacted as part of our fundraising efforts, please contact the Ingalls Privacy Hotline at 708-915-6789.

10. Workers Compensation. Your health information may be used or disclosed in order to comply with laws and regulations related to Worker’s Compensation.

Your Health Information Rights.

You have the right to:

  • Request a restriction on certain uses and disclosures or your health information. However , Ingalls Memorial is not required to agree to a requested restriction unless the disclosure is to a health plan for purpose of carrying out the payment or health care operations (and is not for purpose of carrying out treatment) and the health information pertains solely to a health care item or service for which the health care provider involved has been paid out-of-pocket in full;
  • Obtain a paper copy of the Notice of Privacy Practices upon request; Inspect and obtain a copy of your health record that we use to make decisions about your care. If we maintain your health record in an electronic health record, you may obtain an electronic copy of your health record. You must submit a written request to the Medical Records Office in order to inspect and/or copy your health information. If you request a copy of the information, we may charge a fee for the costs of copying and mailing. We may deny your request to inspect and/or copy your information in certain limited circumstances. If you are denied access to your health information, you may ask that the denial be reviewed;
  • Amend your health record as provided if you believe the health information we have about you is incorrect or incomplete. To request an amendment, complete and submit a Medical Records Amendment/Correction Form to the Medical Records Office. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that: (a) we did not create, unless the person or entity that created the information is no longer available to make the amendment, (b) is not part of the health information that we keep, (c) you would not be permitted to inspect and copy, or (d) is accurate and complete;
  • Request confidential communications of your health information by alternative means or at alternative locations;
  • Revoke your authorization to use or disclose health information except to the extent that action has already been taken;
  • Receive an accounting of disclosures made of your health information. The accounting will not include disclosures for treatment, payment, or health care operations. If we maintain your medical records in an electronic health record system, you may request that include disclosures for treatment, payment or health care operations made during the previous three years. To obtain this list, you must submit your request in writing to the Medical Records Office. It must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (paper or electronically). We may charge you for the costs of providing the list; and
  • Receive notice of a breach of your unsecured protected health information within sixty days of discovery if the breach compromises the security or privacy of your health information.


You may express complaints about your care or if you feel your rights have been violated to Ingalls Memorial 708-915-6789, to Illinois Department of Human Services 1-800-843-6154, or to Det Norske Veritas (DNV) at 1-866-523-6842 or “You may also file a written complaint with the Office of Civil Rights (OCR) of the U.S. Department of Health and Human Services; Ingalls Memorial will provide you with the corresponding contact information.” You will not be retaliated against for filing a complaint.


Other than the uses and disclosures described in this Notice, Ingalls Memorial will not use or disclose your health information without your written authorization. Ingalls Memorial requires your written authorization for most uses and disclosures of psychotherapy notes, for marketing (other than a face-to-face communication between you and an Ingalls Memorial workforce member or a promotional gift of some nominal value), or before selling your health information. If you provide Ingalls Memorial with written authorization, you may revoke it at any time unless disclosure is required to obtain payment for services already provided, we have otherwise already relied on the authorization, or the law prohibits revocation.

Obligations of Ingalls Memorial

Ingalls Memorial is required to:

  • maintain the privacy of protected health information;
  • provide you with this Notice;
  • abide by the terms of this Notice;
  • notify you if we are unable to agree to a requested restriction;
  • accommodate reasonable requests you may make to communicate health information by alternative means or at alternative locations; and
  • obtain your written authorization to use or disclose your health information for reasons other than those listed above and permitted under law.

Changes to this Notice

Ingalls Memorial reserves the right to change its information practices and to make the new provisions effective for all protected health information it maintains. Revised Notices will be made available to you as they become available.

Contact Information

If you have any questions or complaints, please contact:

Ingalls Memorial
One Ingalls Drive
Harvey, IL 60426-3558

Effective: April 2003
Revised: February 2010, August 2013, January 2018