Notice of Privacy Practices

Fleming Family Wellness · 142 Maple Street, Springfield, IL 62701

Effective Date: April 1, 2026

Fleming Family Wellness ("we," "us," or "our") is required by law to maintain the privacy of your protected health information (PHI), to provide you with this Notice of Privacy Practices, and to follow the terms of this Notice currently in effect.

Our Pledge Regarding Your Health Information

We understand that health information about you and your health is personal. We are committed to protecting your health information. We create records about the care and services you receive at our practice. We need these records to provide you with quality care and to comply with certain legal requirements.

How We May Use and Disclose Your Health Information

The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures, we explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed.

For Treatment. We may use your health information to provide, coordinate, or manage your healthcare and any related services. For example, we may disclose health information about you to doctors, nurses, or other health care providers who are involved in taking care of you. We may also share your information with another provider to whom you have been referred for additional care.

For Payment. We may use and disclose your health information so that the treatment and services you receive may be billed to and payment collected from you, an insurance company, or a third party. For example, we may need to give your health plan information about your condition and services we provided so your health plan will pay your provider for the service.

For Health Care Operations. We may use and disclose your health information for normal health care operations of our practice. These uses and disclosures are necessary to run our practice and make sure you and all our patients receive quality care. For example, we may use health information to review our treatment and services and to evaluate the performance of our staff.

Appointment Reminders. We may contact you as a reminder that you have an appointment for treatment or medical care at our office.

Treatment Alternatives. We may tell you about or recommend possible treatment options or alternatives that may be of interest to you.

Business Associates. We may share information with third parties ("business associates") who perform services on our behalf, such as billing, cloud data storage, or patient portal services. Our business associates are required by contract and HIPAA to safeguard your information.

As Required by Law. We will disclose health information about you when required to do so by federal, state, or local law.

Public Health Activities. We may disclose your health information for public health activities, such as mandatory reporting of certain communicable diseases to public health authorities.

Abuse, Neglect, or Domestic Violence. We may disclose your health information to report suspected abuse, neglect, or domestic violence as required or authorized by law.

Oversight Activities. We may disclose your health information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, or licensure.

Lawsuits and Disputes. If you are involved in a lawsuit or dispute, we may disclose health information about you in response to a court or administrative order, or in response to a subpoena, as permitted or required by applicable law.

Law Enforcement. We may release health information if asked to do so by a law enforcement official for specific law enforcement purposes permitted under HIPAA.

Coroners, Medical Examiners, and Funeral Directors. We may release health information to a coroner, medical examiner, or funeral director as necessary for them to carry out their duties.

Organ and Tissue Donation. If you are an organ donor, we may release health information to organizations that handle organ procurement or organ, eye, or tissue transplantation, or to an organ donation bank.

Research. Under certain circumstances, we may use and disclose health information about you for research purposes with appropriate safeguards and, where required, your authorization.

To Avert a Serious Threat to Health or Safety. We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.

Military and Veterans. If you are a member of the armed forces, we may release health information about you as required by military command authorities.

Workers' Compensation. We may release health information about you for workers' compensation or similar programs.

Uses and Disclosures That Require Your Authorization

Other uses and disclosures of medical information not covered by this Notice or the laws that apply to us will be made only with your written permission (authorization). This includes, but is not limited to:

• Most uses and disclosures of psychotherapy notes
• Uses and disclosures for marketing purposes
• Sale of your health information
• Disclosures not otherwise permitted by this Notice

If you provide us authorization to use or disclose health information about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose health information about you for the reasons covered by your written authorization, except to the extent that we have already taken action in reliance on your authorization.

Your Rights Regarding Your Health Information

You have the following rights regarding health information we maintain about you:

Right to Inspect and Copy. You have the right to inspect and receive a copy of health information that may be used to make decisions about your care, including medical and billing records. To inspect and copy your health information, you must submit your request in writing to our office. If you request a copy of the information, we may charge a reasonable fee for copying, mailing, or other costs associated with your request. We may deny your request in certain limited circumstances.

Right to Amend. If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for our practice. To request an amendment, your request must be made in writing and submitted to our Privacy Officer. It must explain why the information should be amended.

Right to an Accounting of Disclosures. You have the right to request an accounting of certain disclosures we have made of your health information during the six years prior to your request. This right does not apply to disclosures for treatment, payment, or healthcare operations, or to disclosures made with your authorization.

Right to Request Restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care, such as a family member or friend. We are not required to agree to your request unless the request is to restrict disclosure to a health plan for a service you paid for in full out of pocket.

Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail only.

Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time, even if you have agreed to receive this Notice electronically. To obtain a paper copy of this Notice, contact our office.

Changes to This Notice

We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice in our office and on our website. The Notice will contain on the first page, in the top right-hand corner, the effective date.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. To file a complaint with our practice, contact our Privacy Officer at the address below. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights:

• 200 Independence Avenue, S.W., Washington, D.C. 20201
• Phone: 1-877-696-6775
• Website: www.hhs.gov/ocr/privacy

Contact Our Privacy Officer

• Privacy Officer — Fleming Family Wellness
• 142 Maple Street, Springfield, IL 62701
• Phone: (555) 867-5309
• Fax: (555) 867-5310
• Email: flemingfamilywellness@hotmail.com