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.
01Your rights
When it comes to your health information, you have certain rights.
Get a copy of your health and claims records
- You can ask to see or get a copy of your health and claims records and other health information we have about you. Ask us how to do this.
- We will provide a copy or a summary, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct your records
- You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
- We may say no to your request, but we will tell you why in writing within 60 days.
Request confidential communications
- You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
- We will say yes to all reasonable requests.
Ask us to limit what we use or share
- You can ask us not to use or share certain health information for treatment, payment or our operations. We are not required to agree, and we may say no if it would affect your care.
- If you pay for a service or item out of pocket in full, you can ask us not to share that information with your health insurer for payment or our operations. We will say yes unless a law requires us to share it.
Get a list of those with whom we have shared information
- You can ask for a list (accounting) of the times we have shared your health information for six years prior to the date you ask, who we shared it with and why.
- We will include all disclosures except those about treatment, payment and operations, and certain others, such as any you asked us to make. We will provide one accounting a year for free but may charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice
- You can ask for a paper copy of this notice at any time, even if you have agreed to receive it electronically. We will give you a paper copy promptly.
Choose someone to act for you
- If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
- We will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated
- You can complain if you feel we have violated your rights by contacting us using the information at the end of this notice.
- You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue SW, Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
- We will not retaliate against you for filing a complaint.
02Your choices
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations below, talk to us. Tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to:
- Share information with your family, close friends or others involved in your care.
- Share information in a disaster relief situation.
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases, we never share your information unless you give us written permission:
- Marketing purposes.
- Sale of your information.
Appointment reminders
We may contact you by phone, text or email to remind you of appointments or tell you about treatment options. Tell us if you would rather not be contacted this way.
03Our uses and disclosures
We typically use or share your health information in the following ways.
Treat you
We can use your health information and share it with other professionals who are treating you. Example: we send x-rays to an oral surgeon or specialist we refer you to.
Run our practice
We can use and share your health information to run our practice, improve your care and contact you when necessary. Example: we use health information about you to manage your treatment and services.
Bill for your services
We can use and share your health information to bill and get payment from health plans or other entities. Example: we give information about you to your dental insurance plan so it will pay for your services.
04Other ways we may share
We are allowed or required to share your information in other ways, usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.
Help with public health and safety issues
- Preventing disease.
- Helping with product recalls.
- Reporting adverse reactions to medications.
- Reporting suspected abuse, neglect or domestic violence.
- Preventing or reducing a serious threat to anyone's health or safety.
Do research
We can use or share your information for health research.
Comply with the law
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law.
Respond to organ and tissue donation requests
We can share health information about you with organ procurement organizations.
Work with a medical examiner or funeral director
We can share health information with a coroner, medical examiner or funeral director when an individual dies.
Address workers' compensation, law enforcement and other government requests
- For workers' compensation claims.
- For law enforcement purposes or with a law enforcement official.
- With health oversight agencies for activities authorized by law.
- For special government functions such as military, national security and presidential protective services.
Respond to lawsuits and legal actions
We can share health information about you in response to a court or administrative order, or in response to a subpoena.
05Illinois law
Some kinds of information have extra protection under Illinois law, such as mental health records, HIV and AIDS test results, genetic testing results and substance use treatment records. When Illinois law gives you more protection than federal law, we follow the stricter rule.
06Our responsibilities
- We are required by law to maintain the privacy and security of your protected health information.
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
- We must follow the duties and privacy practices described in this notice and give you a copy of it.
- We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
07Changes to this notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available on request, in our office and on this website.