Please note: By submitting this form, you are scheduling a consultation. In the dropdown menu above, select Consultation only. “Follow-up” and “New Patient” options do not apply.
Please note: By submitting this form, you are scheduling a consultation. In the dropdown menu above, select Consultation only. “Follow-up” and “New Patient” options do not apply.
NOTICE OF PRIVACY PRACTICES
EvolveMD Concierge Medicine – Chicago, Illinois
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED IN OUR CONCIERGE MEDICINE PRACTICE AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
EvolveMD operates under the Illinois Medical Practice Act (225 ILCS 60/) as a concierge medicine practice providing:
◉ 24/7 direct physician access
◉ Same-day and next-day appointments
◉ Comprehensive preventive care
◉ Acute care services
◉ Coordinated specialty referrals
◉ Telemedicine consultations
We understand that medical information about you is personal and we are committed to protecting it. We create a record of the care and services you receive at EvolveMD. This notice applies to all records of your care generated by this practice.
Treatment Examples in Concierge Medicine:
◉ 24/7 phone consultations for acute medical concerns
◉ Video telemedicine appointments for follow-up care
◉ Coordinating with specialists for comprehensive care
◉ Sharing information with hospitals during emergencies
◉ Prescription management and medication consultations
Payment Examples:
◉ Annual membership fee processing
◉ Insurance billing for services beyond membership
◉ Laboratory and imaging service coordination
◉ Specialty care referral processing
Healthcare Operations Examples:
◉ Quality improvement for concierge services
◉ Medical staff training and education
◉ Patient satisfaction surveys
◉ Compliance with medical practice standards
Mandatory Reporting Under Illinois Law:
◉ Child abuse reporting (DCFS – 1-800-25-ABUSE)
◉ Elder abuse reporting (1-866-800-1409)
◉ Communicable diseases to Illinois Department of Public Health
◉ Gunshot wounds to law enforcement
◉ Controlled substance monitoring program
Illinois Patient Rights:
◉ Access to medical records within 60 days
◉ Right to receive care regardless of ability to pay emergency services
◉ Right to file complaints with Illinois Department of Public Health
◉ Protection under Illinois Genetic Information Privacy Act
◉ Mental health information additional protections
Illinois Enhanced Protections:
◉ Mental health and substance abuse treatment records
◉ Genetic testing information and results
◉ HIV/AIDS testing and treatment information
◉ Marketing communications
◉ Sale of health information
◉ Psychotherapy notes
Given our concierge model’s 24/7 availability:
◉ Emergency disclosures to first responders
◉ After-hours consultation with specialists
◉ Hospital communication during emergencies
◉ Family notification in emergency situations (unless you object)
Access Rights:
◉ Right to inspect and copy your health information
◉ Electronic access through our patient portal
◉ Direct transmission to third parties upon request
◉ Reasonable fees as permitted under Illinois law
Amendment Rights:
◉ Right to request amendments to your health information
◉ 60-day response timeframe
◉ Appeal process for denied requests
Restriction Rights:
◉ Right to request restrictions on uses and disclosures
◉ Right to restrict information shared with family/friends
◉ Right to request alternative communication methods
Accounting Rights:
◉ Right to receive an accounting of disclosures
◉ Covers 6 years prior to your request
◉ Free annual accounting, fees for additional requests
Breach Notification Rights:
◉ Right to be notified of any breach of your health information
◉ Notification within 60 days of discovery
◉ Information about the breach and protective actions taken
For our digital health services:
◉ Right to choose communication methods (phone, video, secure messaging)
◉ Right to opt-out of digital communications
◉ Right to technical support for patient portal access
◉ Right to security information about our digital platforms
This practice is regulated by: Illinois Department of Public Health
Office of Health Care Regulation
525 W. Jefferson St., 5th Floor
Springfield, IL 62761
We reserve the right to change this notice and make it effective for health information we already have as well as any information we receive in the future. A current copy will always be available in our office and on our website.
You may file a complaint about our privacy practices with:
Practice Privacy Officer:
Dr. Brian Donahue, MD
EvolveMD Concierge Medicine
Email: support@evolvemdchicago.com
Illinois Department of Public Health:
Office of Health Care Regulation
You will not be retaliated against for filing a complaint.
Effective Date: 15 November 2025