Your Access to and Control Over Information
You may opt out of any future contacts from us at any time. You can do the following at any time by contacting us via the e-mail address or phone number given on our website:
- See what data we have about you, if any
- Change/correct any data we have about you
- Have us delete any data we have about you
- Express any concern you have about our use of your data
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT OUR CLIENTS MAY BE USED AND DISCLOSED AND HOW OUR CLIENTS CAN GET ACCESS TO THE INFORMATION. PLEASE REVIEW IT CAREFULLY.
obligation to maintain all medical information in the strictest of confidence. Our practice cannot release information without
your written consent, including conversations, reminder calls, test results, and other confidential issues. Patient information
about health care is identified as “PHI” or protected health information. This new policy requires that you, the patient, identify
at the time of registration with us specific direction about release of information. You can change this information at any time
with either written notification or verbal notification, followed up in writing.
II. Your protected health information (PHI) is a part of your medical care, and can be used or disclosed as follows:
•For your treatment in this practice and other locations under the immediate care needs. This may include information related
to medical clearances, office services, lab/ diagnostic test results, or services related to hospital care.
•For obtaining payment for treatment with your identified health care program. This would include any documentation related
to this care including history forms, progress notes or operative notes, and financing.
•For operation of this practice, accounting and compliance with federal and state laws and regulations.
•Appointment reminders in the form of emails, phone calls, or text messages to the information you have provided on your
•Disclosure to your family and friends concerning any related health care information with your approval on the registration
form which can be modified at any time orally, followed by written consent.
•Consent is not required for emergency care and treatment. An emergency is identified as a medical condition that in the
judgment of the physician requires information for care on your behalf.
Certain disclosures can be made without your consent, and they are as follows:
•Disclosure required by the government or law enforcement agencies.
•Information used for health care oversight, such as a site review by OSHA, DEA, or a government audit.
III. Your rights for your health information include: The right to request limits on the uses and disclosure at registration or anytime
during your care. The right to choose how we send this information to you, including an alternate address. The right to see and
obtain copies of your PHI (there may be copy and postage fees). The right to get a listing of who we have made disclosure to
about your PHI. The right to correct your file through an amendment process if appropriate.
IV. This practice reserves the right to modify or change this Privacy Statement and process at any time. Revision to the Notice will be
available upon request by contacting the office. The changes will be effective retroactively to the initial date of the Privacy
Notice. An updated Privacy Notice will be posted in the office within 60 days of the revision.
V. If you have a concern or complaint about how your protected health information is being used, from this time forward you should
first contact our Practice Administrator at our Business office to resolve your concern.
Office of Civil Rights – Regional Manager
Department of Health & Human Services
233 N. Michigan Ave, Suite 240
Chicago, IL 60601
Office of Civil Rights – Regional Manager Department of Health & Human Services 233 N. Michigan Ave, Suite 240 Chicago, IL 60601