Your rights
You can ask us to exercise any of these rights using the contact details on this page.
Get a copy of your record
Ask for an electronic or paper copy of your medical record and other health information we have. We usually respond within 30 days and may charge a reasonable, cost-based fee.
Ask us to correct your record
Ask us to correct information you believe is incomplete or incorrect. If we deny your request, we will explain why in writing within 60 days.
Request confidential communications
Ask us to contact you in a certain way or send mail to a different address. We will agree to reasonable requests.
Ask us to limit sharing
Ask us not to use or share information for treatment, payment, or operations. We may deny a request that could affect your care. If you pay in full out of pocket, we will honor a request not to share that item or service with your health insurer unless the law requires disclosure.
Get an accounting of disclosures
Ask for a list of disclosures made during the six years before your request. The list excludes treatment, payment, health care operations, and certain other disclosures. One accounting each year is free.
Get this notice
Ask for a paper copy at any time, even if you agreed to receive it electronically.
Choose a representative
A person with medical power of attorney, legal guardianship, or other legal authority may exercise your rights after we verify that authority.
File a complaint
Contact us or the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.
How we may use and share information
Treatment
We may use and share your health information with professionals involved in your care.
Run our practice
We may use and share information to run our practice, improve your care, and contact you when needed.
Billing and payment
We may share information with health plans or other entities so services can be billed and paid.
Public health and safety
We may share information to prevent disease, report adverse medication reactions, report suspected abuse, neglect, or domestic violence, help with product recalls, or reduce a serious threat to health or safety.
Research and legal duties
We may use or share information for health research and when federal or state law requires it, including with the Department of Health and Human Services to confirm our compliance with federal privacy law.
Other authorized purposes
We may share information with organ procurement organizations, coroners, medical examiners, funeral directors, workers' compensation programs, law enforcement, health oversight agencies, and government officials when the law permits or requires it.
Legal actions
We may share information in response to a court or administrative order, or in response to a subpoena when the law permits it.
Your choices
Tell us your preference in these situations. We will follow it when the law requires. If you cannot tell us your preference, we may share information when it is in your best interest or needed to reduce a serious and imminent threat.
- Tell us whether we may share information with family, close friends, or others involved in your care or payment for care.
- Tell us whether we may share information for disaster relief.
- Marketing, sale of your information, and most uses or disclosures of psychotherapy notes require your written authorization.
Our responsibilities
We are required by law to maintain the privacy and security of your protected health information, follow the duties described in this notice, and notify you promptly if a breach may have compromised your information.
We will not use or share your information other than as described here unless you authorize us in writing. You may revoke that authorization in writing at any time.
Mental health and substance use information
We follow applicable federal and Illinois law for mental health information. If we have substance use disorder patient records subject to 42 CFR Part 2, we will not use or disclose them in civil, criminal, administrative, or legislative investigations or proceedings against you without your written consent or a court order and subpoena.
Complaints and changes to this notice
If you believe we violated your privacy rights, contact our Privacy Officer using the information above. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights: 200 Independence Avenue, S.W., Washington, D.C. 20201; 1-877-696-6775; or submit a complaint online. We will not retaliate against you for filing a complaint.
We may change the terms of this notice, and the changes will apply to all information we maintain about you. The current notice will be available on this website and upon request.