EMPLOYEE RESOURCE SYSTEMS, INC.
Employee Resource Systems, Inc.
29 E. Madison, Suite 1600
Chicago, IL 60602
Ph: 800-292-2780 Fx: 312-780-6344
This notice is in effect as of April 14, 2003.
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.
1. Statement of Our Duties
We are required by law to maintain the privacy of your personal health information and to provide you
with this notice of our privacy practices and legal duties. We are required to follow the terms of this
notice. We reserve the right to change the terms of this notice based on the ERS’ needs and changes in
state and federal law. If we change this notice, we will provide you with a revised notice in writing.
2. Statement of Your Rights
You have the right to know how we may use or disclose your Protected Health Information (PHI). In
addition, you have the following rights:
• The right to request that we place additional restrictions on our uses and disclosures of your
PHI. However, we are not obligated to agree to impose any such additional restrictions.
• The right to access, inspect and to receive a copy of the protected health information that we
maintain in our files about you. Recipient will be charged a fee for copying and postage of
• The right to have us correct or amend any information that we create in error. Requests to
access or amend your health information should be sent to the contact person and address
provided in Section 4 of this notice.
• The right to receive an accounting of the disclosures of your PHI that we make for purposes
other than activities related to your treatment, our payment functions, or other health care
• The right to receive