PRESIDING JUSTICE HOPKINS delivered the opinion of the court:

The plaintiff, Suresh Chand, M.D., filed a complaint in the circuit court of MadisonCounty for judicial review of the administrative action of the Illinois Department of PublicAid (the Department) terminating his eligibility as a vendor of medical services. The circuitcourt reversed the Department's decision to terminate the plaintiff from eligibility toparticipate in the State's medical assistance program and ordered the Department to pay theplaintiff $42,650 in attorney fees.

On appeal, the Department asserts that the case is moot, that the circuit courtimproperly awarded attorney fees, and that the plaintiff's failure to answer a questionnaireor provide copies of his professional licenses was a sufficient, alternative basis upon whichto affirm the Department's determination. We affirm in part and reverse in part.

In a letter dated February 9, 1998, and again in a letter dated March 16, 1998, theDepartment, through the Bureau of Medical Quality Assurance (the Bureau), indicated thatthe plaintiff had "been selected for peer review *** to determine [the plaintiff's] compliancewith Department policies." The Bureau requested that the plaintiff produce the medicalcharts of 15 patients and attached a list of the 15 patients with their recipient identificationnumbers. The Bureau requested the patient records "in their entirety[,] including the initialvisit, all progress notes, operative reports, consultation reports, hospitalization records[,] ***and diagnostic services." The Bureau also enclosed a physician's information questionnaireand requested that the plaintiff return the questionnaire within two weeks, along with copiesof his current license, Illinois controlled substance license, Drug Enforcement Agencycertificate, and continuing education certificates for the previous three years.

On February 23 and March 30, 1998, the plaintiff's attorney responded to theDepartment's request, stating that because the Department had failed to comply with theMental Health and Developmental Disabilities Confidentiality Act (the Confidentiality Act)(740 ILCS 110/1 et seq. (West 2000)), the plaintiff would not honor the Department'srequest.

On May 22, 1998, the Department commenced an administrative proceeding seekingto terminate the plaintiff's eligibility to participate in the State's medical assistance program,which provides medical care to the State's public aid recipients. The administrative lawjudge (ALJ) heard evidence and argument on October 27 and 28, 1998; February 5 and 22,1999; and March 8 and March 22, 1999.

Marilyn Harvatin, a health facilities surveillance nurse with the Bureau's peer reviewunit, testified that she participated in the Bureau's request for the recipient records, thephysician questionnaire, and copies of professional licenses for the peer review committee. Harvatin asserted that the purpose of the peer review was to determine whether the plaintiffwas in compliance with the Department's policies and whether recipients of the medicalassistance program were receiving quality care. Harvatin testified that she did not contactor attempt to acquire authorizations from the 15 recipients whose medical records the Bureaurequested. Harvatin explained that when a recipient signs up with the program, the recipientunderstands that the recipient's records might be reviewed.

Harvatin stated that the physician's questionnaire was essential to the peer reviewprocess. The questionnaire requested information regarding the provider's age, education,certification, licensing, and practice, i.e., how many offices and employees the provider has;whether the provider has an interest in a pharmacy, transportation company, or long-termcare company; how many patients the provider treats; and whether the provider has alaboratory.

On April 23, 1999, the ALJ recommended that the plaintiff's eligibility to participatein the medical assistance program be terminated. The ALJ held that the plaintiff wrongfullyrefused to produce copies of the medical records. The ALJ determined that the plaintiff waspermitted under the Confidentiality Act to supply the records to the Department becausedoing so was pursuant to a peer review of his work, a specific exception to the disclosurerequirements under the Confidentiality Act (740 ILCS 110/9 (West 2000)). The ALJ furtherdetermined that the Confidentiality Act required the plaintiff, as the medical provider, toinform his patients that he was disclosing their records to the Bureau.

The ALJ held that the plaintiff also wrongfully refused to produce his professionaldocuments and the physician's information questionnaire. The ALJ held that the informationsought in the questionnaire was current and updated information to ensure an accurate basison which to conduct a peer review. The ALJ rejected the plaintiff's claims that no specificrules or handbook policies required him to provide such information, that the Departmentalready had the information, or that the plaintiff was being harassed by the Bureau. The ALJdetermined that the plaintiff violated sections 140.12(f) and 140.16(a)(1) and (a)(4) of theDepartment's regulations, as well as paragraph four of the plaintiff's provider agreement.

On June 9, 1999, the director adopted the ALJ's recommended decision andterminated the plaintiff's eligibility to participate in the medical assistance program.

On June 17, 1999, the plaintiff sought administrative review in the circuit court. Healleged that the Department's decision was incorrect because the files that he refused toprovide the Department were protected under the Confidentiality Act and that theDepartment failed to follow the procedures outlined in the Confidentiality Act.

On April 7, 2000, the circuit court continued the proceedings for three months, notingthat a separate appeal was pending in the appellate court between the Department and theplaintiff, and that it concerned issues raised in the present case. In the separate appeal, thiscourt, on April 26, 2000, affirmed the Department's termination of the plaintiff's eligibilityto participate as a vendor in the medical assistance program because the plaintiff hadprovided medical goods and services to public aid patients that placed them at risk of harmand that were of a grossly inferior quality. Chand v. Wright, No. 5-98-0691 (2000)(unpublished order under Supreme Court Rule 23 (166 Ill. 2d R. 23)). On October 4, 2000,the Illinois Supreme Court denied the plaintiff's petition for leave to appeal. Chand v.Wright, 191 Ill. 2d 527 (2000).

In its November 20, 2000, order, the circuit court held that, despite the separate appealterminating the plaintiff's eligibility, the present cause was not moot and that theDepartment's decision was not against the manifest weight of the evidence but that theDepartment's regulatory requirement to provide psychiatric records of patients without theirconsent violates the Confidentiality Act. The circuit court also held that the plaintiff's failureto complete the questionnaire did not constitute a sufficient basis for termination because theplaintiff did not refuse to supply the questionnaire and supporting documents.

On December 27, 2000, the plaintiff filed a motion for costs and attorney fees,pursuant to the Illinois Administrative Procedure Act (5 ILCS 100/10-55(c) (West 2000)) andpursuant to the Confidentiality Act (740 ILCS 110/15 (West 2000)), seeking a total fee of$42,650. On December 23, 2001, the circuit court awarded the plaintiff his attorney fees andcosts. The Department filed its timely appeal.

The Department argues that because the plaintiff's eligibility to participate in theprogram had already been terminated, this case was moot prior to the circuit court's order,and therefore, the Department requests that we vacate the circuit court's order. We declineto do so.

It is well-settled that the existence of an actual controversy is an essential requisiteto appellate jurisdiction. Meyer v. Marshall, 62 Ill. 2d 435 (1976); La Salle National Bankv. City of Chicago, 3 Ill. 2d 375 (1954). In Meyer, the Illinois Supreme Court held that theappellate court had erred in reviewing the merits of the case to determine whether theplaintiffs were entitled to costs or attorney fees, because the substantive questions hadbecome moot. Meyer, 62 Ill. 2d at 442. The Illinois Supreme Court stated:

"We have repeatedly held that where it is no longer possible to render effectiverelief on the ultimate merits of a controversy, a reviewing court should not undertakea review of the controversy simply because liability for costs may be at stake." Meyer, 62 Ill. 2d at 441.

See also La Salle National Bank, 3 Ill. 2d at 378-79 (where issues involved in the trial courtno longer exist, the appellate court will not review a case merely to decide moot or abstractquestions, to establish a precedent, to determine the right to or the liability for costs, or ineffect, to render a judgment to guide potential future litigation).

The record reveals that on April 26, 2000, this court affirmed the Department'sseparate and previous termination of the plaintiff's eligibility to participate as a vendor in itsmedical assistance program (Chand v. Wright, No. 5-98-0691 (2000) (unpublished orderunder Supreme Court Rule 23)), and on October 4, 2000, the Illinois Supreme Court deniedthe plaintiff's petition for leave to appeal) (Chand v. Wright, 191 Ill. 2d 527 (2000)). Because the plaintiff has been previously terminated, on alternative grounds, from eligibilityto participate as a vendor in the medical assistance program, it is no longer possible to renderthe plaintiff effective relief on the ultimate merits of the instant controversy.

Although we would therefore be precluded from reviewing the controversy simplybecause liability for attorney fees is at stake, an exception to the mootness doctrine existswhere collateral legal consequences survive the expiration of the order under review. In reJessie B., 327 Ill. App. 3d 1084, 1088 (2002). In In re Jessie B., 327 Ill. App. 3d at 1088,the court held that collateral legal consequences survived an order of delinquency becausein the future a history of prior delinquency might be considered in aggravation against adefendant convicted of a crime as an adult. Similarly, in the present case, collateral legalconsequences survive the expiration of the order terminating the plaintiff from eligibility toparticipate in the medical assistance program, because the order may be used against theplaintiff in the future when he applies for reinstatement to the program after one year,pursuant to the Illinois Public Aid Code (305 ILCS 5/12-4.25(D) (West 2000)). Thus,because collateral legal consequences survive the expiration of the order under review, weagree with the trial court that the case sub judice is not moot, and we address the merits.

The Department asserts that the Bureau's request for medical records was madepursuant to a peer review and was consistent with the Confidentiality Act (740 ILCS 110/9(West 2000)). The Department asserts that the plaintiff must disclose to the recipients thathe might release their medical records and that the Department therefore did not actimproperly. Although we agree that the Bureau's request was made pursuant to the peerreview exception to the disclosure requirements under the Confidentiality Act, we disagreewith the Department's contention that the plaintiff must disclose to the recipients that hemight release their psychiatric medical records.

Section 10-55(c) of the Illinois Administrative Procedure Act provides, in pertinentpart:

"In any case in which a party has any administrative rule invalidated by a courtfor any reason, including but not limited to the agency's exceeding its statutoryauthority or the agency's failure to follow statutory procedures in the adoption of therule, the court shall award the party bringing the action the reasonable expenses of thelitigation, including reasonable attorney's fees." 5 ILCS 100/10-55(c) (West 2000).

"A rule is defined as a principle, procedure[,] or regulation governing conduct or action. (See The Random House Dictionary (unabr. ed. 1966).)" Ackerman v. Department of PublicAid, 128 Ill. App. 3d 982, 983 (1984).

The Confidentiality Act provides that "any record kept by a therapist or by an agencyin the course of providing mental health or developmental disabilities service to a recipient"and "any communication made by a recipient or other person to a therapist or to or in thepresence of other persons during or in connection with providing mental health ordevelopmental disability services to a recipient" *** "shall be confidential and shall not bedisclosed except as provided in this Act." 740 ILCS 110/2, 3(a) (West 2000).

Section 9 of the Confidentiality Act provides:

"In the course of providing services and after the conclusion of the provision ofservices, a therapist may disclose a record or communications without consent to:

***

(2) persons conducting a peer review of the services being provided;

Information may be disclosed under this Section only to the extent thatknowledge of the record or communications is essential to the purpose for whichdisclosure is made and only after the recipient [the person receiving mental health ordevelopmental disabilities services (740 ILCS 110/2 (West 2000))] is informed thatsuch disclosure may be made." 740 ILCS 110/9 (West 2000).

"[A]nyone seeking the nonconsensual release of mental health information faces aformidable challenge and must show that disclosure is authorized by the Act." Norskog v.Pfiel, 197 Ill. 2d 60, 72 (2001). As the United States Supreme Court has noted:

"Effective psychotherapy *** depends upon an atmosphere of confidence and trustin which the patient is willing to make a frank and complete disclosure of facts,emotions, memories, and fears. Because of the sensitive nature of the problems forwhich individuals consult psychotherapists, disclosure of confidentialcommunications made during counseling sessions may cause embarrassment ordisgrace. For this reason, the mere possibility of disclosure may impede developmentof the confidential relationship necessary for successful treatment." Jaffee v.Redmond, 518 U.S. 1, 10, 135 L. Ed. 2d 337, 345, 116 S. Ct. 1923, 1928 (1996).

We reject the plaintiff's contention that because Harvatin was a nurse who had neverworked in the mental health field, she was not a peer and that, therefore, the Bureau's requestwas not made pursuant to a peer review. Considering Harvatin's testimony that the Bureau'srequest for information was contemplated for a peer review, along with the letters notifyingthe plaintiff of the peer review, the Department's determination that the Bureau's request wasmade pursuant to a peer review and pursuant to section 9 of the Confidentiality Act (740ILCS 110/9 (West 2000)) was not clearly erroneous. See City of Belvidere v. Illinois StateLabor Relations Board, 181 Ill. 2d 191, 205 (1998).

However, we disagree that section 9 requires the plaintiff, as the medical provider,to disclose to the recipients that he might release their medical records. Recognizing that thepossibility of disclosure impedes the development of the confidential relationship betweenthe medical provider and the psychiatric recipient (see Jaffee, 518 U.S. at 10, 135 L. Ed. 2dat 345, 116 S. Ct. at 1928), we hold that, when conducting a peer review of the servicesbeing provided, the Department, who is seeking the nonconsensual release of mental healthinformation, is required to limit its request to records or communications essential for thepurpose for which the disclosure is made and to inform the recipient that such disclosuremight be made. See 740 ILCS 110/9 (West 2000).

We next consider whether the Department informed the recipients that such adisclosure might be made. See 740 ILCS 110/9 (West 2000). Harvatin testified thatrecipients understand that their records might be reviewed, but Harvatin admitted that shedid not contact any of the 15 recipients before requesting their mental health medical recordsfrom the plaintiff. In the circuit court's November 20, 2000, order, the court directed theDepartment to provide consent forms or a showing of notice to the 15 recipients whosemedical records the Department requested. However, the Department, in its brief, assertsthat because the plaintiff was terminated for independent reasons, the Department "did notpursue the question of whether the fifteen patients had received sufficient disclosures"because "the question was entirely academic."

Under Supreme Court Rule 323 (166 Ill. 2d R. 323), the appellant must provide anadequate record on appeal sufficient to establish reversible error, and any doubt arising fromthe incompleteness of the record will be resolved against the appellant. Reed v. Hoffman,48 Ill. App. 3d 815, 819 (1977). The Department failed to supplement the record withevidence that the recipients had previously been informed that a disclosure of their mentalhealth information might be made. As a result, we resolve the issue-whether the Departmentinformed the recipients that a disclosure of their mental health information might bemade-against the Department.

Thus, the Department's procedures for acquiring the recipients' mental healthinformation, for the purposes of peer review, without first notifying the recipients that sucha disclosure might be made, did not comply with the Confidentiality Act (see 740 ILCS110/9 (West 2000)), and had the effect, force, and impact of a rule (see Ackerman, 128 Ill.App. 3d at 984). The plaintiff had the Department's rule invalidated, and the trial courtcorrectly awarded attorney fees to the plaintiff pursuant to the Illinois AdministrativeProcedure Act (5 ILCS 100/10-55 (West 2000)). See Ackerman, 128 Ill. App. 3d at 984 (theargument that an attorney fee award was barred by sovereign immunity was devoid of merit). We therefore affirm that part of the circuit court's judgment relating to the requested medicalrecords.

The Department asserts that the plaintiff's termination based on his failure to answerthe questionnaire or provide copies of his professional documents was not clearly erroneousbecause the information concerned the plaintiff and his practice and should have beenpromptly provided as required by state regulations. The plaintiff counters that because hemay have completed and updated similar informational requests, he should not be requiredto do so on the whim of the Department, that no regulation required the disclosure of suchinformation, and that as a result the plaintiff was improperly terminated on this basis. Wedisagree with the plaintiff.

Section 140.12(f) of the Illinois Administrative Code requires that the provider shallagree to "[f]urnish to the Department, in the form and manner requested by it, anyinformation it requests regarding payments for providing goods or services[] or in connectionwith the rendering of goods or services or supplies to recipients by the provider [or] hisagent, employer[,] or employee." 89 Ill. Adm. Code