Effective date: June 9, 2026

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.

Keith Schmidt, MD (“the Practice,” “we,” “us,” or “our”) is committed to protecting the privacy of your protected health information (“PHI”). This Notice describes how we may use and disclose your PHI and your rights regarding it. We are required by law to maintain the privacy of your PHI, to give you this Notice of our legal duties and privacy practices, to notify you following a breach of unsecured PHI, and to abide by the terms of the Notice currently in effect.

How we may use and disclose your health information

For treatment. We use and disclose your PHI to provide, coordinate, and manage your care, such as sharing information with physicians, nurses, technicians, or other providers involved in your treatment, including referrals and consultations.

For payment. We use and disclose your PHI to obtain payment for the services we provide, such as verifying insurance coverage, obtaining prior authorization, and billing your health plan.

For health care operations. We use and disclose your PHI for our operations, such as quality assessment, staff review and training, scheduling, and general administration of the practice.

Other uses and disclosures permitted or required by law (without your authorization)

We may use or disclose your PHI without your authorization in the following circumstances, subject to legal limits: as required by law; for public health activities; to report abuse, neglect, or domestic violence; for health oversight activities; in judicial and administrative proceedings; for law enforcement purposes; to avert a serious threat to health or safety; for workers’ compensation; to coroners, medical examiners, and funeral directors; for organ and tissue donation; for approved research with privacy safeguards; for specialized government functions such as military and national security; and to our business associates who perform services for us under written agreements requiring them to protect your information.

We may also contact you for appointment reminders, to tell you about treatment alternatives, or about health-related benefits and services. With your agreement, we may share information with family members or others involved in your care.

Special protections for certain information

Substance use disorder (SUD) records. Certain records relating to the diagnosis or treatment of a substance use disorder may be subject to additional federal confidentiality protections under 42 CFR Part 2. Where those protections apply, we will use and disclose such records only as permitted by Part 2 and applicable law.

Re-disclosure. Information disclosed to a recipient under an authorization or as otherwise permitted may be re-disclosed by that recipient and may no longer be protected by the HIPAA Privacy Rule, subject to other applicable laws.

Other specially protected information. Certain information, such as HIV/AIDS, mental health, and genetic information, may have additional protections under federal or Illinois law, and we will handle it accordingly.

Uses and disclosures that require your written authorization

The following require your written authorization: most uses and disclosures of psychotherapy notes; uses and disclosures for marketing; disclosures that constitute a sale of PHI; and any other use or disclosure not described in this Notice. You may revoke an authorization in writing at any time, except to the extent we have already acted in reliance on it.

Your rights regarding your health information

  • Inspect and copy your PHI in our designated record set, and receive an electronic copy where applicable.
  • Request an amendment of PHI you believe is incorrect or incomplete.
  • Request an accounting of certain disclosures we have made.
  • Request restrictions on certain uses and disclosures. You also have the right to restrict disclosure of PHI to your health plan for an item or service you paid for in full, out of pocket.
  • Request confidential communications, for example that we contact you at a specific phone number or address.
  • Receive a paper copy of this Notice, even if you agreed to receive it electronically.
  • Be notified of a breach of your unsecured PHI.

To exercise any of these rights, contact our Privacy Officer below.

Our duties

We are required by law to maintain the privacy of your PHI, provide this Notice of our duties and privacy practices, abide by the terms of the Notice currently in effect, and notify you if a breach affects your unsecured PHI. We reserve the right to change this Notice and to make the revised Notice effective for PHI we already have as well as information we receive in the future. The current Notice will be posted in our office and on our website with its effective date.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with our Practice or with the U.S. Department of Health and Human Services, Office for Civil Rights. You will not be penalized or retaliated against for filing a complaint.

  • Our Practice: Keith Schmidt, MD, Privacy Officer — (847) 981-3630
  • HHS Office for Civil Rights: 200 Independence Avenue SW, Washington, D.C. 20201; 1-877-696-6775; www.hhs.gov/ocr

Contact

Keith Schmidt, MD, Privacy Officer
1555 Barrington Road, DOB 3, Suite 2400, Hoffman Estates, IL 60169
Phone: (847) 981-3630