Effective Date: August 07, 2025
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.
This Notice of Privacy Practices (“Notice”) describes how Lilac Health PLLC, and its licensed medical providers in Illinois, Oregon, and Wisconsin (“Lilac Health,” “we,” “our,” or “us”), may use and disclose your protected health information (“PHI”) to carry out treatment, payment, or health care operations, and for other legally permissible purposes. It also describes your rights to access and control your PHI.
PHI includes information about you that may identify you and that relates to your past, present, or future physical or mental health or condition and related health care services.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION:
TREATMENT: We may use and disclose your PHI to provide, coordinate, or manage your health care and related services. For example, your PHI may be disclosed to another health care provider for consultation or referral.
PAYMENT:
We may use and disclose your PHI to bill and collect payment for the services we provide to you. This may include activities like determining insurance eligibility, obtaining prior authorization, and reviewing services for medical necessity.
HEALTH CARE OPERATIONS:
We may use or disclose your PHI to support business operations, such as quality assessment, provider performance evaluations, auditing, and legal services. These activities help ensure you receive high-quality care.
USES AND DISCLOSURES THAT DO NOT REQUIRE YOUR AUTHORIZATION:
We may use or
disclose your PHI without your authorization in the following situations: as required by law; for public health reporting; for oversight by health agencies; to report abuse or neglect; in legal proceedings; to law enforcement; to coroners, medical examiners, and funeral directors; for organ and tissue donation; for research approved by an IRB; to avert a serious health threat; for specialized government functions; for workers’ compensation claims; and other disclosures permitted by HIPAA and applicable state law.
USES AND DISCLOSURES THAT REQUIRE YOUR AUTHORIZATION:
We will not use or disclose your PHI for marketing, the sale of information, or fundraising without your express written authorization. We will also obtain your authorization before releasing psychotherapy notes, except as allowed by law. You may revoke your authorization at any time in writing.
YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION:
– You have the right to inspect and request a copy of your PHI. – You may request an amendment of your PHI. – You may request restrictions on certain uses or disclosures. – You may request confidential communications by alternative means or location. – You have the right to receive an accounting of certain disclosures. – You have the right to obtain a paper copy of this Notice at any time.
STATE LAW REQUIREMENTS:
Lilac Health complies with HIPAA as well as applicable privacy laws in Illinois, Oregon, and Wisconsin. These states may provide additional protections for mental health, substance use, or HIV-related information.
REVISIONS TO THIS NOTICE:
We reserve the right to revise this Notice at any time. Revised notices will apply to existing PHI and future information. The current version of the Notice will always be available on our website at www.lilachealth.org.
BREACH NOTIFICATION:
We will notify you in writing if a reportable breach of your unsecured PHI occurs. Notice will be sent within 60 days of discovery and will include relevant information about the breach.
COMPLAINTS:
If you believe your privacy rights have been violated, you may contact us or file a complaint with the U.S. Department of Health and Human Services.
Privacy Officer – Lilac Health PLLC Email: privacy@lilachealth.org Phone: (815) 656-3153
You may also contact: Office for Civil Rights, U.S. Department of Health and Human Services 200 Independence Avenue, S.W., Washington, D.C. 20201 Phone: 1-877-696-6775 | www.hhs.gov/ocr/privacy/hipaa/complaints/
We will not retaliate against you for filing a complaint.
This Notice complies with the HIPAA Privacy Rule as set forth in 45 CFR 164.520(b).