NOTICE OF PRIVACY PRACTICES

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

Specialized Forensic Unit PC is committed to protecting the privacy of your personal and health information. At our clinic, we are committed to protecting the confidentiality of individuals’ test results and other patient Protected Health Information (PHI) that we collect or create as part of our services.

We urge you to read this Notice of Privacy Practices carefully so that you will understand both our commitment to the privacy of your PHI, and how you can participate in that commitment. Should you have any questions about this Notice or our privacy practices, please call us at 1-800-488-9790, send an email to privacy@sfunit.com, or write to us at the following address:

Specialized Forensic Unit PC
Attention: Privacy
555 S. Randall Rd., Ste. 204,
St. Charles, IL 60174

PRIVACY POLICY
Specialized Forensic Unit PC and its employees or independent contractors are committed to obtaining, maintaining, using, and disclosing patient’s protected health information (PHI) in a manner that protects patient’s privacy. We will only use or disclose the minimum amount of your PHI we consider necessary to perform a job or complete an activity. This Notice applies to all PHI that we maintain.

Specialized Forensic Unit PC is required by law to provide you with this Notice of Privacy Practices with respect to PHI, to maintain the privacy of PHI, to state the uses and disclosures of PHI that our clinic may make, and to list the rights of individuals and our legal duties with respect to their PHI. Your PHI at Specialized Forensic Unit PC includes personal and medical information (such as your name, address, date of birth, testing results, etc.) that we obtain from you, your physician, health plan, or other sources. Your PHI also includes the results of your psychological testing and interview notes.

Specialized Forensic Unit PC is required to abide by the terms of the Notice of Privacy Practices currently in effect. Our clinic reserves the right to change the terms of this Notice of Privacy Practices and to make the provisions of the new Notice of Privacy Practices effective for all PHI that we maintain. The current Notice will be displayed on our website and a paper copy is available upon request.

HOW SFU MAY USE AND DISCLOSE YOUR PHI
Your PHI will be used or disclosed for treatment, payment or healthcare operations purposes and for other purposes permitted or required by law. Not every use or disclosure is listed; however, all of the ways we use or disclose your PHI will fall into one of the categories listed below.

Use” applies only to activities within Specialized Forensic Unit PC, including independently contracted personnel bound by confidentiality contracts. “Use” includes sharing, employing, applying, utilizing, examining, and analyzing information that identifies you.

Disclosure applies to activities outside of Specialized Forensic Unit PC, such as releasing, transferring, or providing access to information about you to other parties.

Authorization is your written permission to disclose confidential mental health information.  All authorizations to disclose must be on a specific legally required form (e.g., Specialized Forensic Unit PC uses the Authorization to Release Records form). You have the right to revoke your authorization at any time, except if we have already made a disclosure based on that authorization.

Specialized Forensic Unit PC may use or disclose your PHI in the course of activities necessary to support our healthcare operations, such as performing quality checks on our testing, for teaching purposes or for developing normal reference ranges for tests that we perform.

Specialized Forensic Unit PC does not need your authorization or permission to use or disclose your PHI for the following purposes:

Treatment” is when Specialized Forensic Unit PC provides, coordinates, or manages your health care and other services related to your health care (i.e., when Specialized Forensic Unit PC consults with another health care provider, such as your family physician or another psychologist).

Payment is when Specialized Forensic Unit PC obtains reimbursement for your healthcare (i.e., when we disclose your PHI to your health insurer to obtain reimbursement for your health care or to determine eligibility or coverage).

Health Care Operations are activities that relate to the performance and operation of Specialized Forensic Unit PC (i.e., quality assessment and improvement activities, business-related matters of audits and administrative services, and case management and care coordination).

DISCLOSURES TO BUSINESS ASSOCIATES
Specialized Forensic Unit PC may disclose your PHI to other companies or individuals who need your PHI in order to provide specific services to us. These other entities, known as “business associates,” must comply with the terms of a contract designed to ensure that they will maintain the privacy and security of the PHI Specialized Forensic Unit PC provides to them or which they create on our clinic’s behalf. Specialized Forensic Unit PC’s business associates must only use your PHI for designated treatment, payment, or health care operations purposes that they perform on our behalf. For example, Specialized Forensic Unit PC may disclose your PHI to temporary employees or independent contractors (i.e., psychological associates, psychological technicians, editors, etc).

AS PERMITTED OR REQUIRED BY LAW
Specialized Forensic Unit PC may use or disclose your PHI for various public policy purposes that are authorized or required by federal or state law. For example, Specialized Forensic Unit PC is required to disclose your PHI to the Secretary of the U.S. Department of Health and Human Services (“HHS”) upon request. Our clinic must provide you with copies of your PHI at your request, except when restricted or prohibited by state law. We will provide the information regarding your specific state upon request.

OTHER USES AND DISCLOSURES REQUIRING AUTHORIZATION
Specialized Forensic Unit PC may use or disclose PHI for purposes outside of treatment, payment, or health care operations when your appropriate authorization is obtained. In those instances, when Specialized Forensic Unit PC is asked for information for purposes outside of treatment, payment, or health care operations, we will obtain an authorization from you before releasing this information. You may revoke all such authorizations at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that we have relied on that authorization; or if the authorization was obtained as a condition of obtaining insurance coverage.

OTHER USES AND DISCLOSURES WITHOUT AUTHORIZATION
Specialized Forensic Unit PC may use or disclose PHI without your consent or authorization in the following circumstances:

Child Abuse: If Specialized Forensic Unit PC knows or has cause to suspect that a child has been abused or neglected, we must report the matter to the appropriate authorities as required by law.

Adult and Domestic Abuse: If Specialized Forensic Unit PC suspects that an adult has been abused, neglected, or exploited and our clinic has cause to suspect that the adult is incapacitated or dependent, we must report the matter to the appropriate authorities as required by law.

Health Oversight Activities: Specialized Forensic Unit PC may disclose PHI to the state psychology board, or one of its representatives, pursuant to standards or regulations for regulation, accreditation, licensure, or certification.

Judicial and Administrative Proceedings: If you are involved in a court proceeding and a request is made for information about your diagnosis and treatment or the records thereof, such information is privileged under state law, and Specialized Forensic Unit PC will not release information without the written authorization of you or your legally appointed representative or a court order. The privilege does not apply when you are being evaluated for a third party or where the evaluation is court ordered. You will be informed in advance if this is the case.

Serious Threat to Health or Safety: If, in Specialized Forensic Unit PC’s professional judgment, you pose a direct threat of imminent harm to the health or safety of any individual, including yourself, Specialized Forensic Unit PC may disclose PHI to the appropriate persons.

Worker’s Compensation: Specialized Forensic Unit PC may disclose PHI as authorized by and to the extent necessary to comply with laws relating to worker’s compensation or other similar programs, established by law, that provide benefits for work-related injuries or illness without regard to fault.

PATIENT’S RIGHTS 
Right to Request Restrictions: You have the right to request restrictions on certain uses and disclosures of PHI. However, Specialized Forensic Unit PC is not required to agree to a restriction you request.

Right to Receive Confidential Communications by Alternative Means and at Alternative Locations: You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations. For example, you may not want a family member to know that you are seeing a professional at our agency. On your request, Specialized Forensic Unit PC may send your bills to another address.

Right to Inspect and Copy: You (or your authorized or designated personal representative) have the right to inspect and/or obtain a copy of your PHI in our mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record.  Specialized Forensic Unit PC may deny your access to PHI under certain circumstances, but in some cases, you may have this decision reviewed. Specialized Forensic Unit PC must permit you to request access to inspect and/or to obtain a copy of Psychotherapy Notes, unless Specialized Forensic Unit PC believes that such access would be detrimental to your health. If you are denied access to Psychotherapy Notes, it is possible, upon presentation of a written authorization signed by you, that such notes or a “narrative” of the notes may be made available to your “authorized representative.” Specialized Forensic Unit PC can discuss the details of the request and denial process.

Right to Amend: You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. Specialized Forensic Unit PC may deny your request. On your request, Specialized Forensic Unit PC will discuss with you the details of the amendment process.

Right to an Accounting: You have the right to receive an accounting of disclosures of your PHI that were made by Specialized Forensic Unit PC for a period of up to six years prior to the date of your written request. Under the law, this accounting does not include disclosures made for purposes of treatment, payment, health care operations, or certain other excluded purposes, but includes other types of disclosures, including disclosures for public health reporting or in response to a court order.

Right to a Paper Copy: You have the right to obtain a paper copy of the notice from Specialized Forensic Unit PC upon request, even if you have agreed to receive the notice electronically.

PSYCHOLOGIST’S DUTIES
Specialized Forensic Unit PC is required by law to maintain the privacy of PHI and to provide you with a notice of our legal duties and privacy practices with respect to PHI. Specialized Forensic Unit PC reserves the right to change the privacy policies and practices described in this notice. Unless Specialized Forensic Unit PC notifies you of such changes, however, Specialized Forensic Unit PC is required to abide by the terms currently in effect.

NOTE REGARDING STATE LAW 
For all of the above purposes, in cases where state law is more restrictive than federal law, Specialized Forensic Unit PC is required to follow the more restrictive state law.

HOW TO CONTACT US
If you have questions or concerns regarding the privacy or confidentiality of your PHI, or you wish to register a complaint, please contact Specialized Forensic Unit PC by writing to the address located at the beginning of this notice, by calling at 1-800-488-9790, or by sending an email to privacy@sfunit.com. Specialized Forensic Unit PC reserves the right to amend this Notice of Privacy Practices, at any time, to reflect changes in our privacy practices, and these changes will apply retroactively. Any such changes will be applicable to and effective for all PHI that we maintain including PHI we created or received prior to the effective date of the Notice revision.

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Model Part 2 Patient Notice

Your Information. Your Rights. Our Responsibilities.

Notice of Privacy Practices of Specialized Forensic Unit PC

This notice describes:

  • HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
  • YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION
  • HOW TO FILE A COMPLAINT CONCERNING A VIOLATION OF THE PRIVACY OR SECURITY OF YOUR HEALTH INFORMATION, OR OF YOUR RIGHTS CONCERNING YOUR INFORMATION
  • YOU HAVE A RIGHT TO A COPY OF THIS NOTICE (IN PAPER OR ELECTRONIC FORM) AND TO DISCUSS IT WITH DR. KOSTYSHYNA AT 800-488-9790 EXT. 702, DRK@SFUNIT.COM IF YOU HAVE ANY QUESTIONS.

In this notice, your health information means your substance use disorder patient record.

Your Rights

You have the right to:

  • Consent to most uses and disclosures of your health information
  • Ask us to limit the information we share
  • Get a copy of this privacy notice
  • Discuss this notice with someone in our program
  • Get a list of those with whom we’ve shared your electronic records*
  • Get a list of health care providers who have received your information through certain third parties
  • Choose in advance whether to receive fundraising communications
  • File a complaint if you believe your privacy rights have been violated

Your Choices

With your consent, we can use and share your information as we:

  • Treat you
  • Run our organization
  • Bill for our services
  • Fulfill your requests to share information with your consent
  • Prevent multiple program enrollments
  • Report about court-referred treatment
  • Report to prescription drug monitoring programs

Our Uses and Disclosures

We may use and share your information without your consent as we:

  • Communicate within our program and with our contractors
  • Help with medical emergencies
  • Help with public health
  • Report crimes (and threats of crimes) on our premises and suspected child abuse and neglect
  • Aid scientific research
  • Respond to audits and evaluations of our program
  • Assist cause of death inquiries
  • Respond to court orders

In all these circumstances, we must protect your information and limit how we use and share it.

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Provide consent when we use or share your information for most purposes

  • You may provide a single consent for all future uses or disclosures for treatment, payment, and health care operations purposes.
  • You may provide consent for more limited purposes (for example, to only disclose information to another health care provider for your treatment); however, doing so may affect the services we can provide you or how you pay for services.
  • You may provide a general consent to share your information through certain third parties, such as a health information network or a research institution, where your treating health care providers can access it.

Ask us to limit what we use or share

  • You can ask us not to use or share certain health information for treatment, payment, or our health care operations after you have provided consent for all those purposes. We are not required to agree to your request, and we may say “no” if, for example, it could affect your care. If we agree to your request, we may still share this information in the event that you need emergency treatment.
  • If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our health care operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Get a copy of this privacy notice

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Discuss this notice with someone in our program

You can ask questions or obtain more information about this notice and our privacy practices by calling or emailing the contact person at the top of this notice.

Choose in advance about fundraising

You have the right to a clear and obvious notice in advance of, and a choice about whether to receive, fundraising communications for our program.

File a complaint if you feel your rights are violated

  • You can complain if you feel we have violated your rights by contacting us using the information on page 1.
  • You can file a complaint with the U.S. Department of Health and Human Services’ Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting https://www.hhs.gov/hipaa/filing-a-complaint/index.html.
  • We will not retaliate against you for filing a complaint.

Your Choices

How do we typically use or share your health information?

With your consent, we typically use or share your health information in the following ways.

Treat you

We can use your health information and share it with other professionals who are treating you.

Example: A doctor treating you for a chronic condition asks a doctor at our program about your health condition and medications you are taking, for example, to avoid complications.

Run our organization

We can use and share your health information to run our program, improve your care, and contact you when necessary.

Example: We use health information about you to manage your treatment and services. 

Bill for your services

We can use and share your health information to bill and get payment from health plans or other entities.

Example: We give information about you to your health insurance plan so it will pay for your services.

With your consent, we may also use and share your information in the following ways:

  • To whomever you name in a consent to share your information
  • To prevent multiple enrollments in withdrawal management or maintenance treatment programs
  • To report participation in treatment required by the criminal justice system
  • To report prescribed substance use disorder treatment medications to a state prescription drug monitoring program when required by law

You can choose someone to act for you.

  • If someone has authority to act as your personal representative, such as if someone has your medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
  • We will make sure the person has this authority and can act for you before we take any action.

Our Uses and Disclosures

How else can we use or share your health information?

We are allowed or required to share your information in certain ways without your consent – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.

To communicate within our program and with contractors

We can share your information within our program, with an organization that has administrative control over our program, and with contractors who help us run our program.

For medical emergencies

We can share your information during a bona fide medical emergency with the personnel and health care providers responding to your emergency, even when you are unable to consent because of the emergency.

We can also share your identifying information to assist the federal Food and Drug Administration in notifying you or your doctor about unsafe products you may be using.

Help with public health

We can share health information that does not identify you for certain situations such as:

  • Preventing disease
  • Reporting adverse reactions to medications

Aid scientific research

We can use or share your information to conduct or help with health research. Researchers cannot include any patient identifying information in their reports about the research.

Respond to management and financial audits and program evaluations

We can use or share your information to improve the quality of our services, obtain needed credentials, and cooperate with oversight agencies for activities authorized by law, as long as those who view or receive the information agree to destroy or return the information when they are finished and agree not to use it against you.

Assist with cause of death inquiries

We can share patient identifying information about a deceased patient as required or allowed by laws that collect information relating to cause of death.

Report suspected child abuse and neglect

We will only report the information required by law.

Prevent or reduce crime in our program

We may report to law enforcement when a patient commits or threatens to commit a crime within our program or against our staff.

Redisclosure According to HIPAA

When you consent to uses and disclosures for all future treatment and payment purposes and to run our business, we may share your information with other substance use disorder treatment programs, doctors’ offices, and health care businesses for those activities. If the person who receives it is subject to HIPAA, then they are allowed to use and share your information again without your consent for the purposes that HIPAA allows. Your information still cannot be used in legal proceedings against you unless (1) you consent or (2) based on a Part 2 court order and a subpoena (or similar legal requirement).

Legal Proceedings and Court Orders

We must follow certain procedures before using or sharing your information for investigations and legal proceedings.

  • We will not use or share your information or provide testimony about your information in any civil, administrative, criminal, or legislative proceedings against you without your written consent or a court order.
  • We will only respond to a court order to use or share your health information if it is accompanied by a subpoena or other similar legal mandate requiring us to comply.
  • We will only use or share your information in proceedings against you based on a court order after we have received notice and an opportunity to be heard or you tell us that you have received notice.
  • We may use or share your information to respond to legal proceedings against our program based on a court order and you may not be notified in advance. You have the right to seek to overturn or change the court order after you learn about it.

Our Responsibilities

  • We are required to obtain your consent for most uses and sharing of your information.
  • We are required by law to maintain the privacy and security of your information.
  • We must let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
  • We must follow the duties and privacy practices described in this notice and give you a copy of it.
  • We will not use or share your information other than as described in this notice unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

Changes to the Terms of this Notice

We are required to follow the terms of this notice that are currently in effect.  We can change the terms of this notice, and the changes will apply to all information we have about you.  The new notice will be available upon request in our office and on our web site.

Effective Date

This notice is effective as of February 15, 2026.

Other Instructions for Notice

  • Name and title of the privacy contact and his/her email address and phone number: Dr. Kostyshyna, DrK@sfunit.com, 800-488-9790 ext. 702.
  • We will provide you with a summary of your treatment history upon request.

Endnotes

The compliance date for this requirement will be set when the same right is revised in the HIPAA Privacy Rule.

Content created by Office for Civil Rights (OCR)
Content last reviewed February 13, 2026