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Notice of Privacy Practices

This Notice is made pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), and this version is effective as of March 6, 2023. It describes how each Forum Health provider uses and discloses your protected health information (PHI) for treatment, payment, healthcare operations, and other purposes permitted or required by law. It also describes your rights to access and control your PHI.  

PHI is information about you, including demographic information, that might identify you and that relates to your past, present, or future physical or mental health or to your health condition and related healthcare services.   

We are required by law to:  

  • Maintain the privacy of your PHI.  
  • Provide you with a Notice describing our legal duties and privacy practices related to PHI.  
  • Abide by the terms of our Notice.  


Uses & Disclosures of PHI 

Your PHI may be used and disclosed by your physician, our organization, our office staff, and others outside our office who are involved in your care and treatment for the purpose of providing healthcare services to you, obtaining payment your healthcare bills, supporting the operation of our organization, and any other use required by law.   


  • Treatment: We will use and disclose your PHI to provide, coordinate, or manage your healthcare and any related services. This includes the coordination or management of your healthcare with a third party. For example, we would disclose your PHI, as necessary, to a healthcare agency that provides care to you, or to a physician to whom you have been referred to ensure that the physician has the information necessary to diagnose or treat you.   


  • Payment: Your PHI will be used, as needed, to obtain payment for your healthcare services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the healthcare services, we recommend for you.   


  • Healthcare operations: We may use and disclose health information about you in connection with healthcare operations necessary to run our practice, including review of our treatment and services, training, evaluating the performance of our staff and healthcare professionals, quality assurance, financial or billing audits, legal matters, and business planning and development. In addition, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician.    


  • We may also call you by name in the waiting room when your physician is ready to see you. We may use or disclose your PHI, as necessary, to contact you to remind you of your appointment.   


  • Additional uses: We may use or disclose your PHI in the following situations without your authorization: as required by law; public health activities; lawsuits and legal actions; law enforcement purposes; coroners, medical examiners, and funeral directors; organ, eye and tissue donation; research; serious threat to health or safety; military activity and national security; and workers’ compensation.   


  • Business associates: We may share your information with third-party business associates that perform various activities such as billing or transcription services. Whenever an arrangement between our office and business associate involves the use or disclosure of your PHI, we will have a written contract with the business associate that contains the terms that will protect the privacy of your PHI.   


Your Rights with Respect to Your Health Information 

You have the following rights with respect to certain health information that we have about you (information in a Designated Record Set as defined by HIPAA). To exercise any of these rights, you must submit a written request to our privacy officer.   


  • Right to access and review: You may request to access and review a copy of your health information. We may deny your request under certain circumstances. You will receive written notice of a denial and can appeal it. We will provide a copy of your health information in a format you request if it is readily producible. If not readily producible, we will provide it in a hard-copy format or other format that is mutually agreeable. If your health information is included in an electronic format and to direct us to send it to the person or entity you designate in an electronic format. We may charge a reasonable fee to cover our cost to provide you with copies of your health information.   


  • Right to amend: If you believe that your health information is incorrect or incomplete, you may request that we amend it. We may deny your request under certain circumstances. You will receive written notice of a denial and can file a statement of disagreement that will be included with your health information that you believe is incorrect or incomplete.   


  • Right to restrict use and disclosure: You may request that we restrict uses of your health information to carry out treatment, payment, or healthcare operation or to your family member or friend involved in your care or the payment for your care. We may not (and are not required to) agree to your requested restrictions, with one exception: if you pay out of your pocket in full for a service you receive from us and you requested that we not submit the claim for this service to your health insurer or health plan for reimbursement, we must honor that request.   


We are required to abide by the terms of this Notice. We may change the terms of this Notice at any time. The revised Notice will be effective for all PHI we maintain at this time.  Forum Health reserves the following rights:  


  • Protected health information may be disclosed or used for treatment, payment, or healthcare operations.   
  • The practice reserves the right to change the privacy policy as allowed by law.   
  • The practice has the right to restrict the use of the information, but the practice does not have to agree to those restrictions.   
  • The patient has the right to revoke this consent in writing at any time and all full disclosures will then cease.   
  • The practice may condition receipt of treatment upon execution of this consent.   
  • The practice may contact you by phone, email, or text to you to confirm appointments. 
  • The practice may discuss your medical condition with friends or family members who are involved in your care or the payment of your care.   
  • The practice may leave a message on your answering machine at home or your cell phone. 


You can reach the Privacy Officer at 2300 Cabot Drive, Ste. 125, Lisle, IL 60532.