Effective Date: 7/31/2025
THIS NOTICE DESCRIBES HOW PROTECTED HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
OUR DUTY TO PROTECT YOUR INFORMATION
Champions Benchmark is required by federal and state law to maintain the privacy of your protected health information (“PHI”). PHI includes information that can identify you and relates to your past, present, or future physical or mental health condition, the provision of services to you, or payment for those services.
We must provide you with this Notice to explain our legal duties, our privacy practices, and your rights concerning your PHI. We are required to follow the terms of this Notice while it is in effect.
HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION
We may use and disclose your PHI for the following purposes:
1. For Treatment
We may use and disclose your PHI to provide, coordinate, or manage your care. This may include sharing information with doctors, counselors, social workers, or other providers involved in your treatment.
2. For Payment
We may use and disclose your PHI to bill for services and to obtain payment. This may include contacting your insurance company or other funding sources.
3. For Health Care Operations
We may use and disclose your PHI for business and administrative purposes, such as:
- Quality assessment and improvement
- Staff training and supervision
- Accreditation and licensing
- Auditing and compliance activities
4. When Required by Law
We will disclose PHI when required to do so by federal, state, or local law.
5. To Prevent Serious Threats
We may disclose PHI to prevent a serious threat to your health and safety or the health and safety of others.
6. Public Health and Safety Purposes
We may disclose PHI for:
- Reporting abuse, neglect, or domestic violence
- Preventing or controlling disease, injury, or disability
- Reporting adverse events or product recalls
7. Oversight Activities
We may disclose PHI to government agencies for audits, inspections, and licensing reviews.
8. Legal Proceedings
We may disclose PHI in response to a court order, subpoena, or other lawful process.
9. Research
We may use and disclose PHI for research purposes when permitted by law, with safeguards in place.
10. Special Government Functions
We may disclose PHI for military, national security, or correctional purposes as required by law.
11. Coroners, Funeral Directors, and Organ Donation
We may release PHI to medical examiners, funeral directors, or for organ donation purposes.
OTHER USES AND DISCLOSURES WITH AUTHORIZATION
Other uses or disclosures of your PHI not covered by this Notice will be made only with your written authorization. You may revoke your authorization in writing at any time, except to the extent that we have already acted on it.
YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
You have the following rights regarding PHI we maintain about you:
- Right to Access: You may review or obtain copies of your records. We may charge a reasonable fee.
- Right to Amend: You may request corrections to information you believe is inaccurate or incomplete.
- Right to an Accounting of Disclosures: You may request a list of certain disclosures of your PHI.
- Right to Request Restrictions: You may request limitations on how we use or disclose your PHI. We are not always required to agree, but if we do, we will honor your request.
- Right to Confidential Communications: You may request that we communicate with you in a certain way (e.g., by mail instead of phone).
- Right to a Paper Copy of This Notice: You may request a copy of this Notice at any time.
SECURITY OF YOUR INFORMATION
Champions Benchmark requires its employees to follow strict security policies. We use physical, administrative, and technical safeguards to protect your PHI from unauthorized access, use, or disclosure.
CHANGES TO THIS NOTICE
We reserve the right to change this Notice and to make new provisions effective for all PHI we maintain. A current copy will always be available upon request.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with:
DeVashia Champion, Privacy Officer
Champions Benchmark
Phone: (815) 265-6124
Email: info@championsbenchmark.com
You may also file a complaint with the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.