How did the Doctors of Prairie help you?

Share Your Story.

Stories inspire us, help us feel a sense of connection with others, and are a part of something bigger than ourselves. At their heart, stories help us heal.

Cardiovascular conditions affect more Americans than any other disease in the United States.   It takes bravery to fight heart disease, and having a community of support makes a world of difference.

Do you have an extraordinary story?  If you’ve been affected by heart disease, tell us how the doctors of Prairie have helped you.  Please share your story!

Tell Us About You

Where Are You From?
How Can We Contact You?

Your Story

What were you dealing with and how did it affect your life?
Had you previously gone elsewhere? What did you expect when choosing us?
Tell us about your treatment and the doctors who work with you. Is there anything special that stood out?
Describe what has changed after you received the help you needed.
Please tell us the names of any physicians involved in your treatment.

Photos and Videos

Consent to Publish

User Agreement


1. I, the undersigned, a participant in the publishing of “Share Your Story” with Prairie Cardiovascular, Prairie Heart Institute at HSHS St. John’s Hospital or any other Prairie Heart Institute of Illinois facility (“Prairie”), or the parent, legal guardian, or person otherwise authorized to consent to such participation, hereby consent to the use of any and all still photographs, motion pictures, television and/or video tapes, voice recording, and/or other recordings of my/his/her person at Prairie and agree to the use of my property as follows: For any educational, training, contribution solicitation, marketing, promotional or other purpose, in any medium whatsoever, by Prairie and/or by any person or persons Prairie may name, and/or for any broadcast or other public viewing. Such publication may be used as described above, in full or edited form, and may be incorporated into other formats and may be copied for multiple distributions and/or broadcast.


2. I agree that I will receive no compensation or other remuneration for the taking, production, use, broadcast, and/or distribution of such publication or for my participation in any manner, and I specifically release Prairie and all others from any liability or other obligation arising from the taking, production, use, broadcast, and/or distribution of such publication.


3. I understand that my consent herein implies that I have obtained permission and consent of any other individual who may appear in any and all still photographs, motion pictures, television and/or video tapes, voice recording and/or other recordings that I have submitted as my own.


4. I understand that I have the right to withdraw from participating in “Share Your Story” at any time, by giving notice in writing to Prairie, and that I have the right to revoke this consent at any time to the extent that Prairie and/or its designee have not relied upon it, or has not submitted the publication for use in external media.

Terms & Conditions


INDIVIDUAL AUTHORIZATION FOR RELEASE OF INFORMATION


We understand that information about you and your health is personal and we are committed to protecting the privacy of that information. Because of this commitment, we must obtain your written authorization before we may use or disclose your protected health information for the purposes described below. This form provides that authorization and helps us make sure that you are properly informed of how this information will be used or disclosed. Please read the information below carefully before agreeing to the terms of this authorization.


USE AND DISCLOSURE COVERED BY THIS AUTHORIZATION


Who will use and disclose my information? Prairie Cardiovascular, Prairie Heart Institute at HSHS St. John’s Hospital or any other Prairie Heart Institute of Illinois facility (“Prairie”) will disclose the information you submit about your experience by electronically posting it to www.prairieheart.org and/or any other Prairie social media channels. Prairie will send you messages regarding the status of your submission through the email service provider of Prairie’s choosing. Prairie may use the information you submit to contact you to request permission to use the information you submit about your experience for other purposes. Prairie may also use the information you submit about your experience for: (i) educational, training, and/or promotional purposes at Prairie and/or at any other location(s); (ii) publicity, advertising (print, digital, and/or television), publications, and/or solicitation of contributions; and/or (iii) broadcast and/or other public display or viewing.


Who will see my information? Anyone visiting www.prairieheart.org and/or any Prairie social media channels may see or use the information you submit. Administrators of the email service provider Prairie uses to send you status messages will also have access to limited information, primarily your email address. In addition, in the event Prairie uses your information as described above members of the general public will see the information.


What information will be used or disclosed? The information used and disclosed will be limited to the information you submit through this website.


The information posted/disclosed on www.thedoctorsofprairie.com, and/or Prairie’s social media channels, or otherwise used and/or disclosed as described above, may include:

  • your name
  • the city/town, state/province/territory, and country where you live;
  • the story of your care at Prairie with information on your condition/injury, diagnosis, and treatment (including surgery if applicable);
  • the name of your Prairie physician(s), therapist(s) and other caregivers; and your photo and/or video.

The information disclosed to Prairie’s email Service provider, and used by Prairie to contact you, will include your:

  • Name and Email address.

If you submit sensitive information, that information may be deleted from your submission prior to your story being posted to www.thedoctorsofprairie.com and/or Prairie's social media channels, or if the sensitive information cannot be deleted from your submission without compromising the integrity of your story, we may decline to post your submission altogether. The following types of information are considered sensitive and will not be posted/disclosed:

  • HIV-related information (which is any information indicating that you have had an HIV-related test, or have HIV infection, HIV-related illness or AIDS, or any information that could indication you have been potentially exposed to HIV);
  • Substance abuse information;
  • Psychiatric/psychotherapy care information;
  • Sexually transmitted disease information;
  • Tuberculosis information; and
  • Genetic information.

What is the purpose of the use or disclosure? The purpose of the use or disclosure is to share your experience.


When will this authorization expire? This authorization will expire 15 years from the date you submit it to Prairie. After the expiration of this authorization, Prairie will not use or disclose your health information for the purposes described herein, unless you authorize such additional use or disclosure by submitting another authorization.


SPECIFIC UNDERSTANDINGS


By agreeing to the terms of this authorization, you authorize the use or disclosure of your protected health information, as described above. This information may be re-disclosed if the recipient(s) described in this authorization is not required by law to protect the privacy of the information, and such information is no longer protected by federal health information privacy regulations.


You have a right to refuse to agree to the terms of this authorization. Your health care, the payment for your health care, and your health care benefits will not be affected if you do not agree to the terms of this authorization, but we will not be permitted to disclose your information as described on this authorization without your agreement.


You have a right to receive a copy of this authorization after you have agreed to its terms. If you would like a copy of this authorization, please send your request to:  Prairie Heart Institute of Illinois, 619 E. Mason St., Suite 3P10, Springfield, IL 62701.


If you agree to the terms of this authorization, you will have the right to revoke it at any time, except to the extent that Prairie has already taken action based upon your authorization. To revoke this authorization, please write to Prairie Heart Institute of Illinois, 619 E. Mason St., Suite 3P10, Springfield, IL  62701.


Unless you represent below that you are the personal representative of an adult or minor patient, Prairie will only post information about you. If you submit information about another patient or individual that could be considered protected health information, that information will be deleted from you submission prior to your story being posted to www.thedoctorsofprairie.com and/or Prairie’s social media channels, or if the information cannot be deleted from your submission without compromising the integrity of your story, Prairie may decline to post your submission altogether.

You must agree to have read the User Agreement and the Terms & Conditions to send your story.