Notice of Privacy Practices

1. Overview & Scope

Local MD Urgent Care, operated by Illinois Urgent Care Professionals, PLLC (“Local MD,” “we,” “us,” or “our”), is committed to protecting the privacy of your health information. We are required by law to maintain the privacy of your protected health information (“PHI”), to provide you with this Notice of our legal duties and privacy practices, to notify you following a breach of unsecured PHI, and to follow the terms of the Notice currently in effect.

This Notice applies to all Local MD Urgent Care clinic locations, our providers, employees, staff, and volunteers, and to the members of our workforce and business associates who may receive, use, or share your health information on our behalf. Our clinics may share health information with one another as needed for treatment, payment, and health care operations as described in this Notice.

2. Permitted Uses & Disclosures of PHI

We may use and disclose your PHI without your written authorization for the following purposes:

3. Other Permitted Uses and Disclosures Without Your Authorization

Federal and state law permit or require us to use or disclose your health information without your authorization in certain circumstances, including:

• As required by law — when disclosure is required by federal, state, or local law.
• Public health activities — to prevent or control disease, injury, or disability; to report births, deaths, and reportable conditions; to report adverse events related to products or medications; and to notify persons who may have been exposed to a communicable disease.
• Victims of abuse, neglect, or domestic violence — to appropriate government authorities as authorized or required by law.
• Health oversight activities — to agencies that oversee the health care system, such as for audits, investigations, inspections, and licensure.
• Judicial and administrative proceedings — in response to a court or administrative order, subpoena, discovery request, or other lawful process.
• Law enforcement — for limited law enforcement purposes as permitted by law, such as in response to a warrant or to identify or locate a suspect, witness, or missing person.
• Coroners, medical examiners, and funeral directors — to carry out their duties consistent with applicable law.
• Organ and tissue donation — to organizations that handle organ, eye, or tissue procurement or transplantation, where applicable.
• Research — under conditions that protect the privacy of your health information and as approved by an institutional review board or privacy board.
• To avert a serious threat to health or safety — when necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
• Specialized government functions — for military and veterans’ activities, national security and intelligence, protective services, and correctional institutions, as permitted by law.
• Workers’ compensation — to comply with workers’ compensation laws and similar programs that provide benefits for work-related injuries or illnesses.
• Business associates — to vendors who perform services on our behalf (such as billing, laboratory, or IT services). We require our business associates to protect your health information by written agreement.
• Persons involved in your care — to a family member, relative, friend, or other person you identify who is involved in your care or payment for your care, unless you object. In an emergency or when you are not present, we will use our professional judgment to disclose only information directly relevant to that person’s involvement.
• Disaster relief — to authorized public or private organizations assisting in disaster relief efforts, so your family can be notified of your condition and location.
• Appointment reminders and health-related information — to remind you of appointments or to tell you about treatment alternatives or other health-related benefits and services that may be of interest to you.

4. Uses and Disclosures That Require Your Written Authorization

Other uses and disclosures of your health information not described in this Notice will be made only with your written authorization. In particular, the following generally require your authorization:

• Marketing — most uses and disclosures of PHI for marketing purposes.
• Sale of PHI — any disclosure that constitutes a sale of your health information.
• Psychotherapy notes — if we maintain any such notes, most uses and disclosures require your authorization.

If you provide us with an authorization, you may revoke it in writing at any time. Your revocation will apply going forward and will not affect any uses or disclosures we already made in reliance on your authorization.

5. Special Protections for Certain Information

Certain categories of health information receive additional protection under federal and Illinois or Indiana law, and we will handle such information in accordance with those laws. These may include information relating to mental health, developmental disabilities, HIV/AIDS and other sexually transmitted infections, genetic information, and substance use disorder treatment. In some cases, these laws require your specific written consent before we may disclose this information, even for treatment, payment, or health care operations. Where state law is more protective of your privacy than federal law, we will follow the more protective law.

6. Your Rights Regarding Your Health Information

You have the following rights with respect to your health information. To exercise any of these rights, please submit your request in writing to our Privacy Officer at the address below.

• Right to inspect and copy — you may inspect and obtain a copy of the health information we maintain about you in a designated record set, in the form and format you request if readily producible. We may charge a reasonable, cost-based fee.
• Right to request an amendment — if you believe information we have about you is incorrect or incomplete, you may ask us to amend it. We may deny your request under certain circumstances and will explain our reasons in writing.
• Right to an accounting of disclosures — you may request a list of certain disclosures we made of your health information, other than those made for treatment, payment, health care operations, or certain other excepted purposes.
• Right to request restrictions — you may ask us to limit how we use or disclose your health information for treatment, payment, or health care operations. We are not required to agree except as noted below.
• Right to restrict disclosure to your health plan — if you pay for a service or item in full, out of pocket, you may ask us not to disclose information about that service to your health plan for payment or operations, and we will honor that request unless the disclosure is otherwise required by law.
• Right to confidential communications — you may ask us to contact you at a specific address or by a specific means. We will accommodate reasonable requests.
• Right to a paper copy of this Notice — you may request a paper copy at any time, even if you agreed to receive it electronically.
• Right to be notified of a breach — you have the right to be notified if there is a breach of your unsecured health information.
• Right to revoke an authorization — where you have given a written authorization, you may revoke it in writing at any time, as described above.

7. Our 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 may in writing. If you tell us we may, you may change your mind at any time by letting us know in writing.

8. Changes to This Notice

We reserve the right to change this Notice and to make the revised Notice effective for health information we already have about you as well as any information we receive in the future. We will post the current Notice in our clinics and on our website, and the effective date will appear at the top. You may request a copy of the current Notice at any time.

9. How to File a Complaint

If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.

To file a complaint with the federal government:

10. For More Information

If you have questions about this Notice or would like more information about our privacy practices, please contact our Privacy Officer at 7444 W Wilson Ave, Harwood Heights, IL 60706, or by email at [email protected].