This Notice describes how medical information about you may be used and disclosed and how you can access this information. Please review it carefully.
Our Pledge Regarding Medical Information
Pelvic Health Institute of Illinois ("we," "our," "us") understands that medical information about you and your health is personal. We are committed to protecting medical information about you. This Notice applies to all records of your care generated by PHII.
How We May Use and Disclose Medical Information About You
- For Treatment. We may use medical information about you to provide you with medical treatment or services.
- For Payment. We may use and disclose medical information about you so that the treatment and services you receive may be billed to and payment may be collected from you, an insurance company, or a third party.
- For Health Care Operations. We may use and disclose medical information about you for activities necessary to run our practice and ensure that all of our patients receive quality care.
Your Rights Regarding Medical Information About You
- Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your care.
- Right to Amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information.
- Right to an Accounting of Disclosures. You have the right to request an accounting of certain disclosures we have made of medical information about you.
- Right to Request Restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or health care operations.
- Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time.
Changes to This Notice
We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for medical information we already have about you, as well as any information we receive in the future.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint.
Contact
Pelvic Health Institute of Illinois, P.C.
Privacy Officer · info@pelvichealthil.com · (708) 499-9800
This page is a placeholder pending legal review. The final HIPAA Notice of Privacy Practices will reflect counsel-reviewed language meeting all federal and Illinois state requirements.
