Notice of Privacy Practice
The Rush SurgiCenter takes great care to protect your personal health information. This Notice of Privacy Practice describes how medical information about you may be used and disclosed and how you can get access to this information.
Affordable Care Act (ACA) Nondiscrimination Notice
The Rush SurgiCenter abides by nondiscrimination policies. The information below is a requirement of Section 1557 of the Affordable Care Act and is provided to help people who may need assistance with the English language or translation to a different language.
Request Medical Records
We want to make it as easy as possible for you to request copies of your medical records. In compliance with state and federal regulations, you must submit your request in writing.
How to request your records
- Download a form authorizing Rush SurgiCenter to release your health information.
- Fill out the information on the form, indicating the records you are requesting and the specific date of your visit.
- Sign the form and send it to the address below or to firstname.lastname@example.org
ATTN: Medical Records Department
1725 W. Harrison St., Suite 556
Chicago, IL 60612
Fee Schedule for Medical Record Requests
Rush SurgiCenter shall charge a fee for medical records which are not sent directly to another medical facility. There is no cost for records sent directly to another medical provider, hospital, clinic or doctor.
All patients requesting their records directly will be charged a flat fee of $6.50.
All other requests will be charged in alignment with the current fees as regulated by Illinois Code of Civil Procedure 735 ILCS 5/8-2001(d). The following are the current rates as published by the Illinois Comptroller (these rates are adjusted annually based upon the Consumer Pricing Index):
- Handling Charge - $27.33
- Copy pages 1 through 25 - $1.02
- Copy pages 26 through 50 - $.68
- Copy pages in excess of 50 - $.34
- Postage for records which are mailed will also be charged if applicable
Please allow 7 to 14 days for processing.
If you have questions
Please contact the Medical Records Department with any questions.
Phone: (312) 563-2913
Patient Rights and Responsibilities
Rush SurgiCenter wants you to know that you have certain rights as a patient that we respect and honor. Our promise to you is to protect and promote your patient rights. We have listed below your rights as a patient. In the event that you believe your rights or our obligation to meet your patient rights are not being met, please call (312) 563-2880. Our administrator will provide you with information regarding initiation, review and resolution of your complaints. You may also report issues to the Illinois Department of Public Health at (1-800) 252-4343 or (217) 782-7412, to the Joint Commission at (1-800) 994-6610 or, if Medicare related, (1-800) 633-4227 or the local office at (312) 353-3255.
The following are your rights as a patient at Rush SurgiCenter:
- A patient has the right to participate in the development and implementation of his/her plan of care.
- A patient has the right to make informed decisions regarding his/her care. This includes being informed of his/her health status, being involved in care planning and treatment, and being able to request or refuse treatment. If he/she is unable, for whatever reason, to act on his/her behalf, a representative may act for the patient.
- A patient has the right to have a family member or representative of your choice to be notified of your admission to Rush SurgiCenter.
- A patient has the right to personal privacy.
- A patient has the right to receive care in a safe setting.
- A patient has the right to be free from all forms of abuse and harassment.
- A patient has the right to confidentiality of his/her medical records.
- A patient has the right to obtain information contained in his/her medical records within a reasonable period of time.
- A patient has the right to be free from any form of restraints that are not medically necessary.
- A patient has the right to effective pain management.
- A patient has the right to examine and receive an explanation of the bill for your services.
- A patient has the right to file a grievance with Rush SurgiCenter. This may be done orally or in writing.
- A patient has the right to an advance directive, such as a living will or health care proxy. A patient who has an advance directive should provide a copy to the facility and his/her physician. It is the policy of this facility NOT to honor an advance directive. Information is available regarding advance directives.
The collaborative nature of health care requires that patients—or their families/surrogates—participate in their care. The effectiveness of care and a patient's satisfaction with the course of treatment depends, in part, on the patient fulfilling certain responsibilities.
Patients are responsible for providing information about past illnesses, hospitalizations, medications and other matters related to health status. To participate effectively in decision making, patients must be encouraged to take responsibility for requesting additional information or clarification about their health status or treatment when they do not fully understand information and instructions. Patients are also responsible for ensuring that the health care institution has a copy of their written advance directive if they have one. Advance directives are written instructions that convey to your doctors and your family what kinds of treatments you want in case you become unable to make medical decisions for yourself. Advance directives include:
- Durable Power of Attorney for Health Care - a document that appoints someone to make health care decisions on your behalf if you are unable to express your wishes.
- A Living Will - a document that allows you to describe your wishes about the discontinuance of death-delaying procedures if you become terminally ill and are unable to express your wishes.
Patients should also be aware of the SurgiCenter's obligation to be reasonably efficient and equitable in providing care to other patients. The SurgiCenter's rules and regulations are designed to help meet this obligation. Patients and their families are responsible for making reasonable accommodations to the needs of the SurgiCenter, other patients, medical staff and employees. Patients are responsible for providing necessary information for insurance claims and for working with the SurgiCenter to make payment arrangements. A person's health depends on much more than health care services. Patients are responsible for recognizing the impact of their lifestyle on their personal health.