Effective Date: 06/10/2025
This Notice describes how your medical information may be used and disclosed and how you can access this information. Please review it carefully.
We are required by law to maintain the privacy of your protected health information (PHI), provide you with this Notice of our legal duties and privacy practices, and follow the terms of the Notice currently in effect.
1. For Treatment: We may use or share your PHI to provide you with medical care and services.
2. For Payment: We may use or disclose your PHI to bill and collect payment for services provided to you.
3. For Healthcare Operations: We may use and disclose your PHI for internal administration, quality improvement, and other healthcare operations.
We may also disclose your PHI without your authorization in the following circumstances:
– As required by law
– For public health and safety
– For health oversight activities
– For legal proceedings and law enforcement
– To avert a serious threat to health or safety
– For workers’ compensation
We will not use or disclose your PHI for the following purposes without your written authorization:
– Marketing purposes
– Sale of your health information
– Most sharing of psychotherapy notes (if applicable)
– Right to Access: You may request a copy of your medical records.
– Right to Amend: You may ask us to correct your records.
– Right to Request Restrictions: You may request limitations on how we use or disclose your information.
– Right to Confidential Communications: You may request we contact you in a specific way.
– Right to an Accounting of Disclosures: You may request a list of disclosures we’ve made.
– Right to a Copy of this Notice: You may request a paper or electronic copy of this Notice at any time.
Kindly be informed that our office will require approximately 48-72 hours to process this information.
We reserve the right to change this Notice at any time. The new Notice will apply to all PHI we maintain and will be available upon request and posted on our website.
If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.
Meadows Place Associates, LLC
4020 Green Mount Crossing, Suite 394
O’Fallon, IL 62269
Email: meadowsplaceassociates@outlook.com
Phone: 601-769-4465 or 601-994-0646
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