HIPAA Notice of Privacy Practices

Effective Date: June 30, 2025

This Notice describes how your medical information may be used and disclosed and how you can get access to this information. Please review it carefully.

Your Rights

You have the right to:

  • Get a copy of your medical record.

  • Correct your medical record.

  • Request confidential communication.

  • Ask us to limit the information we share.

  • Get a list of those with whom we’ve shared your information.

  • Get a copy of this privacy notice.

  • Choose someone to act for you.

  • File a complaint if you believe your privacy rights have been violated.

Your Choices

You can ask us to:

  • Share information with your family, close friends, or others involved in your care.

  • Share information in a disaster relief situation.

  • Include your information in a facility directory.

  • Contact you for fundraising efforts (we would always ask your permission first).

You can choose not to share information in certain cases, unless we are required by law.

Our Uses and Disclosures

We typically use or share your information to:

  • Treat you: Share information with other healthcare providers involved in your care.

  • Run our organization: Use your health information to manage your treatment and services.

  • Bill for your services: Send information to your health insurance plan for payment.

We may also share your information to:

  • Help with public health and safety issues.

  • Comply with laws, including reporting abuse or responding to legal requests.

  • Work with medical examiners or funeral directors.

  • Address workers’ compensation, law enforcement, and other government requests.

  • Respond to lawsuits or legal actions.

Our Responsibilities

  • We are required by law to protect your health information.

  • We will let you know if a breach occurs that may have compromised your information.

  • We must follow the duties and privacy practices described in this notice.

  • We will not use or share your information other than as described here unless you give us written permission.

Changes to This Notice

We reserve the right to change this notice and apply the new terms to all information we have about you. A current version of the notice will always be posted on our website.

Contact Information

If you have questions or complaints, contact:

Katherine Jackson Occupational Therapy, PLLC
2906 Central St, #294 Evanston, IL 60201
847.238.2008


You can also file a complaint with the U.S. Department of Health and Human Services at www.hhs.gov/ocr/privacy/hipaa/complaints/.

We will not retaliate against you for filing a complaint.