Notice of Privacy Practices

Effective Date (Last Edited On): October 26, 2023

THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Introduction
This Notice of Privacy Practices is being provided to you on behalf of Fertility Centers of Illinois, PLCC, with respect to medical services provided at Fertility Centers of Illinois facilities (collectively referred to herein as “We” or “Our”). We understand that your medical information is private and confidential. Further, we are required by law to maintain the privacy of “Protected Health Information” (PHI). PHI includes any individually identifiable information that we obtain from you or others that relates to your past, present or future physical or mental health, the health care you have received or payment for your health care.

Your Rights

Although your health record is the physical property of Fertility Centers of Illinois, you have the right to:

• Request a restriction on certain uses and disclosures of your information as provided by applicable law
• Obtain a paper copy of this Notice of Privacy Practices upon request
• Inspect and copy your health record as provided for by applicable law
• Request an electronic copy of your electronic health record
• Request to amend your health record as provided by applicable law
• Obtain an accounting of disclosures of your health information as provided by applicable law
• Request communications of your health information by alternative means or at alternative locations
• Revoke your authorization to use or disclose health information, except to the extent that action has already been taken
• Request a restriction of disclosure of your health information to your health insurer for services for which you pay “out-of-pocket” in full
• Transmit copies of your health information to third parties when requested by you, in writing

Our Responsibilities

We are required to:

• Maintain the privacy of your health information
• Provide you with notice as to our legal duties and privacy practices with respect to information we collect and maintain about you
• Abide by the terms of this notice
• Notify you if we are unable to agree to a requested restriction
• Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations
• Where required by law, notify you in the event that there has been a breach of your unsecured health information

We will not use or disclose your health information without your authorization, except as described in this notice. We will not sell your health information (unless permitted by law) or use or disclose such information for paid marketing (for which we receive payment from a third party) without your authorization. If we obtain your authorization, you may revoke it at any time, and this revocation will take effect except where we have already relied upon your authorization.

We reserve the right to change our practices and to make the new provisions effective for all PHI we maintain. Should our information practices change, we will post the revised Notice of Privacy Practices on our website at fcionline.com as well as at our offices and provide you with a hard copy upon request.

We will not use or disclose your health information without your authorization, except as described in this notice.

Permitted Uses and Disclosures

We will use and disclose your health information for treatment. For example: Information obtained by a nurse, physician or other member of your health care team will be recorded in your record and used to determine the course of treatment that should work best for you. Your physician will document in your record their expectations of the members of your healthcare team. Members of your healthcare team will then record the actions they took and their observations. In that way the physician will know how you are responding to treatment.

We will also provide your physician or a subsequent health care provider with copies of various reports that should assist him/her in treating you once you’re discharged from this practice.

We will use your health information for payment. For example: A bill may be sent to you or a third-party payer, such as an insurance company or health plan, for the purposes of receiving payment for treatment and services that you receive. The information on the bill may contain information that identifies you, your diagnosis and treatment or supplies used in the course of treatment. If you indicate your interest in participating in the Fertility Access Program, we will provide relevant information concerning your medical condition to the FCI team for determination of your qualifications for this financing program.

We will use and disclose your health information for our health care operations. For example: Members of the clinical staff, the risk or quality improvement manager or members of the quality improvement team may use information in your health record to assess the care and

outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the health care and the reproductive medicine service we provide.We will collect health information on you and your spouse/significant other. For example: Although health information in your medical record belongs to you, it will contain some information pertaining to your spouse/significant other. This is because the treatment of infertility may focus on the couple, rather than the individual.

Other Uses or Disclosures of Protected Health Information

Business Associates: There are some services provided at Fertility Centers of Illinois through contracts with business associates. For example: The management services of US Fertility and certain laboratories for testing. When these services are contracted, we may disclose your health information to our business associate, so they can perform the job we have asked them to do and bill you or your third-party payer for services rendered.

Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative or another person responsible for your care, your location and general condition. We will give you an opportunity to object to these disclosures, and we will not make these disclosures if you object.

Communication with Spouse/Family: Upon receiving your permission, healthcare providers may share information that is directly relevant to the involvement of a spouse, family member, or other person identified by you, in your care or payment related to your care.

Research: We may disclose information to researchers when their research has been approved by an Institutional Review Board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.

Marketing: Where permitted by law, we may contact you to tell you about or recommend possible treatment alternatives or other medical technology and services. We may also seek your authorization to contact you with other marketing communications.

Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects or post-marketing surveillance information to enable product recalls, repairs or replacement.

Public Health: As required by law, 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, disability or for other health oversight activities.

Law Enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena. Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney provided that a workforce member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.

NOTE: HIV-related information, genetic information, mental health records and other specially protected health information may be subject to certain special confidentiality protections under applicable state and federal laws. Any disclosures of these types of records will be subject to these special protections.

For More Information or to Report a Problem/Complaint

If you believe your privacy rights have been violated, immediately contact Fertility Centers of Illinois Privacy Officer at 847.729.2188.

We will not take action against you for filing a complaint. You may also file a complaint with the Secretary of Health and Human Services. If you have any questions or would like further information about this notice, contact Fertility Centers of Illinois Privacy Officer at 847.729.2188 or visit fcionline.com.