Patient’s rights and responsibilities

Please see the page in New Patient Forms

Office Rules

Please see the page in New Patient Forms

Financial Policy

Please see the page in New Patient Forms

Privacy policies

Patient portal/electronic records we encourage you to provide your e-mail so we can register you in the patient portal. This is a secure medium through which you can make your appointments, communicate with us for non-urgent needs see your lab work , manage medications etc.

HIPAA Notice of Privacy Practices


If you have any questions about this notice, please contact our Privacy Officer at 8472818902


North suburban healthcare NSHC is required by law to:

  • Maintain the privacy of protected health information (PHI).
  • Give you this notice of our legal duties and privacy practices regarding health information about you.
  • Follow the terms of our notice that are currently in effect. NSHC reserves the right to change the terms of this notice. Revisions will be effective for all health information NSHC has created or maintained in the past, and for any records NSHC may create or maintain in the future.
  • Notify you following a breach of your unsecured health information.


The following describes the ways NSHC may use and disclose (“Health Information”) that identifies you. Except for the purposes described below NSHC will use and disclose Health Information only with your written permission. You may revoke such permission at any time by writing to our practice privacy officer

For Payment. NSHC may use and disclose Health Information so thatNSHC or others may bill and receive payment from you, an insurance company or a third party for the treatment and services you received. For example, NSHC may give your health plan information about you so that they will pay for your treatment.

For Health Care Operations. We may use and disclose Health Information for health care operations purposes. These uses and disclosures are necessary to make sure that all of our patients receive quality care and to operate and manage our office. For example, NSHC may use and disclose information to make sure the care you receive is of the highest quality NSHC also may share information with other entities that have a relationship with you (for example, your health plan) for its health care operation activities.

Appointment Reminders, Treatment Alternatives and Health Related Benefits and Services. We may use and disclose Health Information to contact you to remind you that you have an appointment with us. We also may use and disclose Health Information to tell you about treatment alternativesor health-related benefits and services that may be of interest to you.

Individuals Involved in Your Care or Payment for Your Care. When appropriate, NSHC may share Health Information with a person who is involved in your medical care or payment for yourcare, such as your family or a close friend, according to your signed Protected Health Information (PHI) form on file withNSHC. NSHC also may notify your family about your location or general condition or disclose such information to an entity assisting in a disaster relief effort. Research. Under certain circumstances, NSHC may use and disclose Health Information for research. For example, a research project may involve comparing the health of patients who received one treatment to those who received another, for the same condition. Before NSHC uses or discloses Health Information for research, the project will go through a special approval process. Even without special approval, NSHC may permit researchers to look at records to help them identify patients who may be included in their research project or for other similar purposes, as long as they do not remove or take a copy of any Health Information.


As Required by Law. NSHC will disclose Health Information when required to do so by international, federal, state or local law.

To Avert a Serious Threat to Health or Safety. NSHC may use and disclose Health Information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Disclosures, however, will be made only to someone who may be able to help prevent the threat.

Business Associates. NSHC may disclose Health Information to our business associates that perform functions on our behalf or provide us with servicesif the information is necessary for such functions or services. For example, NSHC may use another company to perform billing services on our behalf. All of our business associates are obligated to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.

Organ and Tissue Donation. If you are an organ donor, NSHC may use or release Health Information to organizations that handle organ procurement or other entities engaged in procurement, banking or transportation of organs, eyes or tissues to facilitate organ, eye or tissue donation and transplantation

Military and Veterans
If you are a member of the armed forces, NSHC may release Health Information as required by military command authorities. NSHC also may release Health Information to the appropriate foreign military authority if you are a member of a foreign military. Workers’ Compensation. NSHC may release Health Information for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.

Public Health Risks.

NSHC may disclose Health Information for public health activities.These activities generally include

(1) disclosures to prevent or control disease, injury or disability;

(2) report births and deaths;

(3) report child abuse or neglect; (4) report reactions to medications or problems with products;

(5) notifypeople of recalls of products they may be using; a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and the appropriate government authority if NSHC believes a patient has been the victim of abuse, neglect or domestic violence. NSHC will only make this disclosure if you agree or when required or authorized by law.

Health Oversight Activities.
NSHC may disclose Health Information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

Data Breach Notification Purposes.
We may use or disclose your Protected Health Information to provide legally required notices of unauthorized access to or disclosure of your health information

Lawsuits and Disputes.
If you are involved in a lawsuit or a dispute, NSHC may disclose Health Information in response to a court or administrative order. We also may disclose Health Information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

Law Enforcement
NSHC may release Health Information if asked by a law enforcement official if the information is: (1) in response to a court order, subpoena, warrant, summons or similar process; (2) limited information to identify or locate a suspect, fugitive, material witness, or missing person; (3) about the victim of a crime even if, under certain very limited circumstances, NSHC is unable to obtain the person’s agreement; (4) about a death we believe may be the result of criminal conduct; (5) about criminal conduct on our premises; and (6) in an emergency to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime

Coroners, Medical Examiners and Funeral Directors.
NSHC may release Health Information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. NSHC also may release Health Information.

Protective Services for the President and Others. NSHC may disclose Health Information to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or to conduct special investigations.

Inmates or Individuals in Custody. If you are an inmate of a correctional institution or under the custody of a law enforcement official, NSHC may release Health Information to the correctional institution or law enforcement official. This release would be if necessary: (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) the safety and security of the correctional institution.

USES AND DISCLOSURES THAT REQUIRE US TO GIVE YOU AN OPPORTUNITY TO OBJECT AND OPT OUT Individuals Involved in Your Care or Payment for Your Care. Unless you object, NSHC may disclose to a member of your family, a relative, a close friend or any other person you identify, your Protected Health Information that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure,NSHC may disclose such information as necessary ifwe determine that it is in your best interest based on our professional judgment.

Disaster Relief.NSHC may disclose your Protected Health Information to disaster relief organizations that seek your Protected Health Information to coordinate your care, or notify family and friends of your location or condition in a disaster. NSHC will provide you with an opportunity to agree or object to such a disclosure whenever we practically can do so.


The following uses and disclosures of your Protected Health Information will be made only with your written authorization

  1. Uses and disclosures of Protected Health Information for marketing purposes; and
  2. Disclosures that constitute a sale of your Protected Health Information Other uses and disclosures of Protected Health Information not covered by this Notice or the laws that apply to us will be made only with your written authorization. If you do giveNSHC an authorization, you may revoke it at any time by submitting a written revocation to our Privacy Officer and we will no longer disclose Protected Health Information under the authorization. But disclosure that NSHC made in reliance on your authorization before you revoked it will not be affected by the revocation.

You have the following rights regarding Health Information that NSHC has about you: Right to Inspect and Copy. You have a right to inspect and copy Health Information that may be used to make decisions about your care or payment for your care. This includes medical and billing records, other than psychotherapy notes. All requests to inspect and copy records must be in writing using the appropriate NSHC form. This form can be requested by contacting NSHC Medical Records at 847.2818902.. We have up to 30 days to make your Protected Health Information available to you and we may charge you a reasonable fee for the costs of copying, mailing or other supplies associated with your request. We may not charge you a fee if you need the information for a claim for benefits under the Social Security Act or any other state of federal needs-based benefit program.NSHC may deny your request in certain limited circumstances. If we do deny your request, you have the right to have the denial reviewed by a licensed healthcare professional who was not directly involved in the denial of your request, and we will comply with the outcome of the review

Right to an Electronic Copy of Electronic Medical Records.
If your Protected Health Information is maintained in an electronic format (known as an electronic medical record or an electronic health record), you have the right to request that an electronic copy of your record be given to you or transmitted to another individual or entity. NSHC will make every effort to provide access to your Protected Health Information in the form or format you request, if it is readily producible in such form or format. If the Protected Health Information is not readily producible in the form or format you request your record will be provided in either our standard electronic format or if you do not want this form or format, a readable hard copy form. NSHC may charge you a reasonable, cost-based fee for the labor associated with transmitting the electronic medical record.

Right to Get Notice of a Breach. You have the right to be notified upon a breach of any of your unsecured Protected Health Information.

Right to Amend. If you feel that Health Information we have is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for our office. To request an amendment, you must make your request, in writing, to Privacy Officer.. You have the right to request a list of certain disclosures NSHC made of Health Information for purposes other than treatment, payment and health care operations or for which you provided written authorization. To request an accounting of disclosures, you must make your request, in writing, to the Privacy Officer.

Right to Request Restrictions. You have the right to request a restriction or limitation on the Health Information NSHC uses or discloses for treatment, payment, or health care operations. Youalso have the right to request a limit on the Health Information we disclose to someone involved in your care or the payment for your care, like a family member or friend. For example, you could ask that NSHC not share information about a particular diagnosis or treatment with your spouse. To request a restriction, you must make your request, in writing, to Privacy Officer. We are not required to agree to your request unless you are asking us to restrict the use and disclosure of your Protected Health Information to a health plan for payment or health care operation purposes and such information you wish to restrict pertains solely to a health care item or service for which you have paid us “out-of-pocket” in full. If we agree, we will comply with your request unless the information is needed to provide you with emergency treatment

Out-of-Pocket-Payments. If you paid out-of-pocket (or in other words, you have requested that we not bill your health plan) in full for a specific item or service, you have theright to ask that your Protected Health Information with respect to that item or service not be disclosed to a health plan for purposes of payment or health care operations, and we will honor that request.

Right to Request Confidential Communications. You have the right to request that NSHC communicate with you about medical matters in a certain way or at a certain location. For example, you can ask thatNSHC only contact you by mail or at work. To request confidential communications, you must make your request, in writing, to Privacy Officer. Your request must specify how or where you wish to be contacted. We will accommodate reasonable requests.

Right to a Copy of This Notice. You have the right to receive a separate paper copy of this notice, even ifyou have agreed to receive this notice previously. A copy also may be obtained from our web site: .

CHANGES TO THIS NOTICE: NSHC reserves the right to change the terms of our notice and make the new notice apply to HealthInformation we already have as well as any information we receive in the future. NSHC will post a copy of our current notice in our office

QUESTIONS OR CONCERNS: If you want more information about our privacy practices, wish to exercise any of your rights or have any questions about the information in the Notice, please call the Privacy Officer at (8472818902 or write to: Privacy Officer 1870 W. Winchester Rd., Suite 248 Libertyville, IL 60048

COMPLAINTS: If you believe we may have violated your rights or if you disagree with a decision that we made in connection with your Health Information, you may file a complaint with NSHC using the contact information above. You may also submit a writtencomplaint to: Office for Civil Rights, Region V, U.S. Dept. of Health and Human Services, 233 North Michigan Ave., Ste. 240, Chicago, IL 60601. You will not be penalized for filing a complaint.

EFFECTIVE DATE: The effective date of this Notice is Sept. 23, 2013