Privacy Notice

This information describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. If you have any questions, please contact our privacy office at the address or phone number listed at the end of this notice.

Who will follow this notice?

Clinical Radiologists (CR) provides health care to our patients. We provide these services together with other physicians, professionals and organizations. The information about privacy practices in this notice will be followed by:

  1. All employees of our organization, including our staff at our affiliate sites with whom we may share medical information.
  2. All business associates of CR with whom we share medical information.

Our pledge to you

We understand that medical information about you is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive to provide quality care and to comply with legal requirements. This notice applies to all of the records of your care that we maintain, whether created by CR physicians and staff, other physicians or other health care professionals. These other physicians and health care professionals may have different policies or notices regarding their use and disclosure of medical information. We are required by law to:

  1. Keep medical information about you private.
  2. Give you this notice of our legal duties and privacy practices with respect to medical information about you.
  3. Follow the terms of the notice that are currently in effect.

Changes to this notice

We may change our policies at any time. Changes will apply to medical information we already hold, as well as medical information obtained after the change. If we make a significant change in our policies, we will change our notice and post the new notice on our Web site ( You may request a copy of the current notice at any time. The effective date of this notice is September 23, 2013.

How we may use and disclose medical information about you

We may use and disclose your medical information without your prior authorization for the following purposes:

  1. For treatment such as sending medical information about you to a health care facility or to another physician involved in your care.
  2. To obtain payment for treatment such as sending billing information to your insurance company or Medicare.
  3. To support our health care operations such as comparing patient data to improve treatment methods.

We may contact you for appointment reminders or to tell you about or recommend possible treatment options, alternatives, health-related benefits or services that may be of interest to you. We may use or disclose your medical information, subject to certain requirements, without your prior authorization for other reasons:

  1. When required by law, such as where we disclose medical information to comply with a federal, state or local law.
  2. For public health purposes such as reporting an adverse event to a governmental agency.
  3. For health oversight activities such as to a government agency as part of an audit or inspection.
  4. Reporting suspected abuse, neglect or domestic violence.
  5. Disclosures for judicial or administrative proceedings such as responding to a valid court order or subpoena.
  6. For law enforcement purposes such as to respond to law enforcement officials.
  7. Disclosures about a person who has died or is near death, such as to a funeral director for funeral arrangements or a coroner or medical examiner to identify a person who has died.
  8. Organ and tissue donation such as assisting an organ procurement organization or organ bank in facilitating organ or tissue donation and transplantation.
  9. Research in compliance with federal requirements.
  10. To avert a serious threat to your health or safety or the health or safety of another person or the public.
  11. Workers’ compensation purposes, such as to comply with the Illinois Workers’ Compensation law or similar programs.
  12. For specialized government functions such as military and veteran activities, national security and intelligence activities and protective services for the President and other officials and to correctional institutions.
  13. Incidental uses and disclosures such as the use and disclosure of information incident to another use or disclosure of your medical information as permitted or required by law.
  14. Use and disclosure of limited data sets in which certain identifying information has been removed from your medical information which we use or disclose for purposes such as research, public health or health care operations as permitted or required by law.
  15. For disaster relief purposes such as to an organization helping with disaster relief in order to assist in disaster relief efforts or to notify or assist in notifying a family member, personal representative or other person responsible for your care of your location or general condition.
  16. Unless you object, use or disclose medical information to a family member, close personal friend or any other person you identify relevant to the person’s involvement in your care or payment related to your care. If you are unable to object, we may exercise our professional judgment to determine if a disclosure is in your best interest and disclose only information that is relevant to the person’s involvement with your care.
  17. Notwithstanding the above, we will comply with the requirements of more stringent laws that limit the use and disclosure of certain medical information. For example, we will not use or disclose any information regarding mental illness or developmental disability, genetic testing, alcohol and drug abuse treatment or HIV status without your express authorization, except as otherwise permitted by those laws regulating the use and disclosure of such information.

Other uses and disclosures of medical information

For any category of use or disclosure that is not described above or authorized by law, we must obtain your written authorization. If you give us your written authorization, you may revoke (cancel) it at any time by submitting a written revocation to our Privacy Office at the address listed below. Your revocation will be effective except to the extent that we have already acted upon it. We will obtain your written authorization for the following categories of use and disclosure:

  1. Psychotherapy Notes. We will not use or disclose psychotherapy notes without your express authorization, except as otherwise permitted or required by the laws regulating the use and disclosure of such information.
  2. Marketing. We will obtain your written authorization before using or disclosing patient information about you for marketing purposes.
  3. Sale of Patient Information. We will obtain your written authorization for uses and disclosures that constitute sale of medical information about you.

Your rights regarding medical information about you

In most cases, you have the right to look at or get a copy of medical information that we use to make decisions about your care when you submit a written request. If you request copies, we may charge a fee for the cost of copying, mailing or other related supplies. If we deny your request to review or obtain a copy, you may submit a written request for a review of that decision.

If you believe that information in your record is incorrect or if important information is missing, you have the right to request that we amend the records by submitting a request in writing that provides your reason for requesting the amendment. We may deny your request to amend a record if the information was not created by us; if it is not part of the medical information maintained by us; or if we determine that your record is accurate. You may appeal in writing a decision by us not to amend a record.

You have the right to an accounting of those instances where we have disclosed medical information about you, other than for treatment, payment, health care operations or where you specifically authorized disclosure, for the purposes of national security, to comply with the authorized requests of law enforcement or correctional institutions, to inform you of the content of your medical records or any disclosures that you authorized. In order to obtain an accounting of disclosures, you must submit a written request to our Privacy Office at the address listed below. Your request must state a time period, which may not be longer than 6 years prior to the date on which the accounting is requested. The first disclosure list request in a 12 month period is free; other requests may be subject to a fee. We will inform you of the cost before you incur any costs.

You have the right to be notified of a breach of your unsecured medical information.

If this notice was sent to you electronically, you have the right to a paper copy of this notice.

You have the right to request that medical information about you be communicated to you in a confidential manner, such as sending mail to an address other than your home, by notifying us in writing of the specific way or location for us to use to communicate with you. We will accommodate all reasonable requests, however, if the request may result in our not being paid for your care, then we may require you to provide additional information about how payment will be handled.

You may request in writing a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations or to persons involved in your care except when specifically authorized by you, when required by law, or in an emergency. We will consider your request but we are not legally required to accept it. We will inform you of our decision on your request.

If you request in writing a restriction of the disclosure of your medical information to a health plan, we must agree to restrict disclosure of your medical information to the health care plan if the disclosure is for purpose of carrying out payment or health care operations and is not otherwise required by law and the medical information pertains solely to a health care item or service for which you, or person other than the health plan on your behalf, has paid CR in full.

If we conduct fundraising, you have the right to opt-out of receiving fundraising communications from us.

All written requests or appeals should be submitted to our Privacy Office at the address listed below.


If you are concerned that your privacy rights may have been violated, or you disagree with a decision we made about access to your records, you may contact our Privacy Office.

Finally, you may send a written complaint to the U.S. Department of Health and Human Services Office of Civil Rights. Our Privacy Office can provide you the address.

You will not be penalized or retaliated against for filing a complaint.

Clinical Radiologists
Privacy Office
3050 Montvale, Suite A
Springfield, IL 62704

Thank you for the opportunity to provide for your health care needs.

Follow Us