FOX VALLEY MEDICINE, LTD.
30 N Lincoln Ave
Batavia, IL 60510

Notice of Privacy Practices

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.

Fox Valley Medicine, Ltd. uses health information about you to obtain payment for treatment, for administrative purposes and to evaluate the quality of care that you receive. Your health information is contained in individual (patient) records that are the physical property of Fox Valley Medicine, Ltd.

How Fox Valley Medicine, Ltd. May Use or Disclose Your Health Information

For Payment - Fox Valley Medicine, Ltd. may use or disclose your health information to others for purposes of determining eligibility for benefits, and receiving payment for treatment and services that you receive. For example, a bill may be sent to you or a third party payer, such as an insurance company or health plan. The health information on the bill may contain information that identifies you, your diagnosis and treatment or supplies used in the course of treatment.

For Health Care Operations - Fox Valley Medicine, Ltd. may use or disclose health information about you for operational purposes for example; your health information may be disclosed to members of the medical staff, risk or quality improvement personnel, and others to:
Assess the quality of care and outcomes in your case and in similar cases,
Determine how to continue to improve the quality effectiveness of health care provided to you, and
Learn how to improve facilities and services.

Required by Law - Fox Valley Medicine, Ltd. may use and disclose information about you as required by law. For example, we may disclose information for the following purposes:
For judicial and administrative proceedings pursuant to legal authority,
To report information related to victims of abuse, neglect or domestic violence; and
To assist law-enforcement officials in their law enforcement duties.

Public Health - Your health information may be used or disclosed for public health activities such as assisting public health authorities or other legal authorities to prevent or control disease, injury, or disability, or for other health oversight activities.

Other Uses - Other uses and disclosures will be made only with your written authorization and you may revoke the authorization except to the extent Fox Valley Medicine, Ltd. has taken action in reliance on your written authorization.

Your Information Rights
You have the right to:
Request a restriction on certain uses and disclosures of your information, however, Fox Valley Medicine, Ltd. is not required to agree to any requested restrictions,
Obtain a paper copy of the notice of information practices upon request,
Inspect and obtain a copy of your record
Request to amend your health care record
Request communications of your health information by alternative means or alternate locations,
Revoke your authorization to use or disclose health information except to the extent that action has already been taken, and
Receive an accounting of disclosures made of your health information.

Complaints
You may complain to Fox Valley Medicine, Ltd. and to the Department of Health and Human Services if you believe your privacy rights have been violated. This complaint should be in writing. There will be no repercussions to you for filing a complaint.

Obligations of Fox Valley Medicine, Ltd.
Fox Valley Medicine is required by law to:
Maintain the privacy of protected health information,
Provide you with this notice of its legal duties and privacy practices with respect to your health information,
Abide by the terms of this notice,
Notify you if we are unable to agree upon a requested restriction on how your information is used or disclosed,
Accommodate reasonable requests you may make to communicate health information by alternative means or at alternative locations; and
Obtain your written authorization to use or disclose your health information for reasons other than those listed above and permitted by law.

Fox Valley Medicine, Ltd. reserves the right to change its information practices and to make new provisions effective for all protected health information it maintains. Notice of any material revisions will be made available to you by mail.

Contact Information
If you have any questions or complaints, please contact:
Privacy Officer
30 N Lincoln Ave
Batavia, IL 60510
(630) 482-9701