Notice of Privacy Practices

ProActive Chiropractic & Rehab
1521 West Walnut Street, Ste D, Jacksonville, IL 62650
pacjacksonville.com

Effective date: October 22, 2026

Your Information. Your Rights. Our Responsibilities.

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.

If you have questions about this notice, or want a copy of it, please contact our Privacy Official:

• Privacy Official: Annette Smith
• Phone: (217) 243-4333
• Email: staff@pacjacksonville.com
• Mail: ProActive Chiropractic & Rehab, Attn: Privacy Official, 1521 West Walnut Street, Ste D, Jacksonville, IL 62650

This notice applies to ProActive Chiropractic & Rehab and to the chiropractors and staff who work in our office, including Dr. Paul Lyell, DC, and Dr. Matt Link, DC.

At a Glance

Your Rights

You have the right to:

• Get a copy of your paper or electronic health record
• Correct your paper or electronic health 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

See "Your Rights" below for more information.

Your Choices

You have some choices in the way that we use and share information as we:

• Tell family and friends about your condition
• Provide disaster relief
• Provide mental health care
• Market our services and sell your information
• Raise funds

See "Your Choices" below for more information.

Our Uses and Disclosures

We may use and share your information as we:

• Treat you
• Run our practice
• Bill for your services
• Help with public health and safety issues
• Do research
• Comply with the law
• Respond to organ and tissue donation requests
• Work with a medical examiner or funeral director
• Address workers' compensation, law enforcement, and other government requests
• Respond to lawsuits and legal actions

To the extent that we have your substance use disorder patient records, subject to 42 CFR part 2, we will not share that information for investigations or legal proceedings against you without (1) your written consent or (2) a court order and a subpoena.

See "Our Uses and Disclosures" below for more information.

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.

Get an electronic or paper copy of your health record

• You can ask to see or get an electronic or paper copy of your health record and other health information we have about you, such as your chiropractic exam notes, X-ray or imaging reports, treatment and rehab records, and billing records. Ask us how to do this.
• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your health record

• You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
• We may say "no" to your request, but we'll tell you why in writing within 60 days.

Request confidential communications

• You can ask us to contact you in a specific way (for example, home phone, cell phone, text message, or email) or to send mail to a different address.
• We will say "yes" to all reasonable requests.

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 operations. We are not required to agree to your request, and we may say "no," for example, if it could affect your care. If we agree to your request, we may still share this information if 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 with your health insurer for the purpose of payment or our operations. We will say "yes" unless a law requires us to share that information.

Get a list of those with whom we've shared information

• You can ask for a list (accounting) of the times we've shared your health information for six years prior to the date you ask, who we shared it with, and why.
• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We'll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

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.

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 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.

File a complaint if you feel your rights are violated

• You can complain if you feel we have violated your rights by contacting our Privacy Official using the contact information at the top of this notice.
• 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 www.hhs.gov/hipaa/filing-a-complaint.
• We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

• Share information with your family, close friends, or others involved in your care or payment for your care (for example, a spouse who drives you to appointments or helps with your bill)
• Share information in a disaster relief situation

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases we never share your information unless you give us written permission:

• Marketing purposes
• Sale of your information
• Most sharing of psychotherapy notes

In the case of fundraising:

• We may contact you for fundraising efforts, but you can tell us not to contact you again.
• If we have your substance use disorder patient records, subject to 42 CFR part 2, we will give you clear and obvious notice in advance and a choice about whether to receive fundraising communications that use your Part 2 information.

Our Uses and Disclosures

How do we typically use or share your health information?

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: We send a progress report to the physician who referred you to us, or we coordinate your care with your primary care doctor, a physical therapist, or an imaging center.

Run our practice
We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Example: We use your health information to manage your treatment plan and to train and supervise our staff. We may contact you with appointment reminders by phone, text message, or email using the contact information you give us. If you would like us to contact you a different way, let us know.

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, Medicare, or an auto or workers' compensation insurer so it will pay for your chiropractic and rehab services.

How else can we use or share your health information?

We are allowed or required to share your information in other ways – 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. For more information see: www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers.

Substance use disorder (Part 2) records. In all cases, including those listed below, if we have substance use disorder patient records about you, subject to 42 CFR part 2, we cannot use or share information in those records in civil, criminal, administrative, or legislative investigations or proceedings against you without (1) your consent or (2) a court order and a subpoena. A court order may be issued only after you, or the holder of the record, are given notice and an opportunity to be heard, and the order must be accompanied by a subpoena or other legal requirement compelling disclosure before the record is used or shared.

Help with public health and safety issues
We can share health information about you for certain situations such as:

• Preventing disease
• Helping with product recalls
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone's health or safety

Do research
We can use or share your information for health research.

Comply with the law
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we're complying with federal privacy law.

Respond to organ and tissue donation requests
We can share health information about you with organ procurement organizations.

Work with a medical examiner or funeral director
We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers' compensation, law enforcement, and other government requests
We can use or share health information about you:

• For workers' compensation claims
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law
• For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions
We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Illinois law may give you extra protection

Illinois law may give certain kinds of health information more protection than federal law. When Illinois law is stricter than federal law, we follow the stricter law. For example:

• Mental health and developmental disabilities records (Illinois Mental Health and Developmental Disabilities Confidentiality Act, 740 ILCS 110): We will not share these records without your written consent unless it is for a purpose that Illinois law specifically allows or another law requires us to share the information.
• HIV/AIDS information (Illinois AIDS Confidentiality Act, 410 ILCS 305): We will not share HIV test results or the fact that you were tested without your written permission, except as Illinois law allows or requires.
• Genetic testing information (Illinois Genetic Information Privacy Act, 410 ILCS 513): We will not share genetic test results or genetic information without your written permission, except as Illinois law allows or requires.

If you have questions about how these laws apply to you, please contact our Privacy Official.

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will 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.

For more information see: www.hhs.gov/hipaa/for-individuals/notice-privacy-practices.

Changes to the Terms of this Notice

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 website at pacjacksonville.com.

Effective Date

This notice is effective as of October 22, 2026.

Contact Us

Privacy Official: Annette Smith
ProActive Chiropractic & Rehab
1521 West Walnut Street, Ste D, Jacksonville, IL 62650
Phone: (217) 243-4333 · Email: staff@pacjacksonville.com