HIPAA: Your Information, Your Rights, Our Responsibilities: 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.

YOUR RIGHTS: When it comes to your health information you have certain rights. This section explains your rights and some of our responsibilities to help you.

1. Get an electronic or paper copy of your records:


-We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable cost-based fee.

2. Ask us to correct your medical record:



3. Request confidential communications:


-We will say "yes" to all reasonable requests.

4. Ask us to limit what we use or share:


-If you pay for a service or a health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment of our operations with your health insurer. We will say "yes" unless a law requires us to share that information.

5. Get a list of those with whom we have shared information:



6. 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 this notice electronically. We will provide you with a paper copy promptly.

7. Choose someone to act for you:



8. File a complaint if you feel your rights are violated:

-You can complain if you feel we have violated your rights by contacting us by calling Cindy A. Stear at 815-389-0123 or sending her a letter at 5334 Williams Drive, Roscoe, IL 61073.


-We will not retaliate against you for filing a complaint.


For certain health information, you can tell us your choices about what we share:




-Share information in a disaster relief situation

-Include your information in a hospital directory

-Contact you for fundraising efforts.


In these cases we will never share your information unless you give us written permission:

-Marketing purposes, Sale of your information, Most sharing of psychotherapy notes.




1. Treat you: We can use your health information and share it with other professionals who are treating you. Example: A doctor treating you for an injury asks another doctor for your overall health condition.

2. Run our organization: We can use and share your health information to run our practice, improve your care, and contact you when necessary. Example: we use healthy information about you to manage your treatment and services.

3. Bill for your services: We can use and share your health information to bill and get payment for health plans and other entities. Example: We give information about you to your health insurance plan so it will pay for your services.


We require your written authorization to disclose information related to HIV/AIDS and/or substance abuse.