Notice of Privacy Practices – Brief Version




Our commitment to your privacy:

Our practice is dedicated to maintaining the privacy of your personal health information as part of providing professional care. We also are required by law to keep your information private. These laws are complicated, but we must give you this important information. This pamphlet is a shorter of the version of the full, legally required NPP and you may have a copy of this to read and refer to it for more information; however, we can’t cover all possible situations so please talk either Dr. Paul or Dr. Kerri about any questions or concerns.

We will use the information about your health, which we get from you or from others, mainly to provide you with treatment, to arrange payment for our services, and for some other business activities that are called, in the law, health care operations. After you have read this NPP we will ask you to sign a Consent Form to let us use and share your information. If you do not consent and sign this form, we cannot treat you.

If we, or you, want to use or disclose (send, share, release) your information for any other purpose we will discuss this with you and ask you to sign an Authorization Form to allow this.

Of course we will keep your health information private, but there are some times when the laws require us to use or share it. For example:

1-When there is a serious threat to your health and safety or the health and safety of another individual or the public. We will only share this information with a person or organization that is able to help prevent or reduce the threat.

2-Some lawsuits and legal or court proceedings.

3-If a law enforcement official requires us to do so.

4-For Worker’s Compensation and similar benefit programs.

There are some other situations like these but which don’t happen very often.

They are described in the longer version of the NPP.

Your Rights Regarding Your Health Information

  1. You can ask your provider to communicate with you about your health
  2. and related issues in a particular way or at a certain place which is
  3. more private for you. For example, you can ask your provider to call you
  4. at home and not at work to schedule or cancel an appointment. Your
  5. provider will try their best to do as you ask.
  6. You have the right to ask your provider to limit what they tell
  7. certain individuals involved in your care or the payment for your care,
  8. such as family members and friends. While your provider does not have to
  9. agree with your request, if they do agree, they will keep the agreement
  10. unless it is against the law or an emergency, or when the information
  11. is necessary to treat you.
  12. You have the right to look at the health information your provider
  13. has about you, such as your medical and billing records. You can even
  14. get a copy of these records, but you may be charged for this. Contact
  15. Dr. Paul or Dr. Kerri to arrange to see your records. See below.
  16. If you believe the information in your records is incorrect or
  17. incomplete, you can ask your provider to make changes (called amending)
  18. to your health information. Requests must be in written form and sent to
  19. Dr. Paul or Dr. Kerri. You must state your rationale for the proposed
  20. changes.
  21. You have the right to a copy of this notice. If the NPP is changed,
  22. it will be posted in the waiting area and you can obtain a copy from
  23. your provider.
  24. You have the right to file a complaint if you believe your privacy
  25. rights have been violated. You can file a complaint with Dr. Paul or Dr.
  26. Kerri and with the secretary of the Department of Health and Human
  27. Services. All complains must be in writing. Filing a complaint will not
  28. change the health care we provide to you in any way.

If you have any questions regarding this notice or the health information privacy policies at Heart Light, please contact your

provider by calling Heart Light at (847) 374-1234. You can also speak with Dr. Paul or Dr. Kerri about your other rights that are granted to you by the laws of our state, which may be the same or different from the rights described above, now or as they arise. The effective date of this notice is March 31, 2023.