Notice of Privacy Practices

This notice describes how health information about you may be used and disclosed and how you can obtain access to this information. Please review it carefully.

“Protected Health Information” refers to information about your past or present health status, condition, diagnosis, treatment, prognosis or payment for health care.

We collect personal health information from you through treatment, payment and healthcare related operations. Your personal health information that is protected by law includes any information oral, written or recorded that is created or received by certain health care entities, including health care providers and health insurance companies. The law specifically protects health information that includes data, such as your name, address, social security number and other individually identifiable information.

Uses or Disclosures of Personal Health Information

We may not use or disclose you personal health information without your written permission. Furthermore, once permission is obtained, we must use or disclose your personal health information specifically in accordance with the terms of that permission. If information is restricted to your insurer, you must explain how you intend to pay for products and/or services.

Without your consent, we may use or disclose your protected health information in order to provide you with services and the treatment you require or request, or to collect payment for those services, and to conduct other related health care operation otherwise permitted or required by law.

As Required By Law

We may use or disclose you personal health information to the extent that such use or disclosure is required by and complies with and is limited to relevant requirements of such law. Examples of which we are required to disclose your personal health information include the following:

  1. Public health activities including, preventing or controlling disease or other injury, public health surveillance or investigations, reporting adverse events with respect to food reactions and/or dietary supplements or product defects to the Food and Drug administration.
  2. Disclosures regarding victims of abuse, neglect, or domestic violence including reporting to social service or protective service agencies.
  3. Health oversight activities including, audits, civil or criminal proceedings or actions.
  4. Judicial or administrative proceedings in response to an order from the court or administrative tribunal, a warrant, subpoena, or other lawful process.
  5. Law enforcement purposes for the purpose of identifying or locating a suspect, fugitive, material witness, missing person or reporting crimes in emergencies, or reporting a death.
  6. To avoid serious threat to health or safety.
  7. national security and intelligence activities, protective services of the President and others.
  8. Medical suitability determinations by entities that are components of the Department of State.
  9. Correctional institutions and other law enforcement custodial situations.
  10. Covered entities that are government programs providing public benefits, and for workers’ compensation.

Right To Request Restrictions On Use Or Disclosure

You have the right to request restrictions on certain uses and disclosures of your personal health information about yourself. You may request restrictions on the following uses or disclosures: to carry out treatment, payment or healthcare operations; disclosures to family members, relatives, or close personal friends of personal health information directly relevant to your care or payment related to your health care, or your location, general condition or death; instances in which you are not physically present or your permission cannot practicably be obtained due to your incapacity or emergency situation; permitting others to act on your behalf to pick up prescriptions, medical supplies or other forms of personal health information.

While we are not required to agree to any requested restriction, if we agree we are not bound to use or disclose your personal health information in violation of such restriction, except in certain emergency situations. We will not accept a request to restrict uses or disclosures otherwise required by law.

Patient/Customer Access

You may request to view or obtain copies of you health information. Any request must be made in writing. If you ask for copies, we may charge photocopying fees, as well as the cost of postage if copies are mailed. If your request is denied, you will receive a written denial, which will include the reason and describe any rights you may have to a review of the denial.

Right To Amend Your Personal Information

You may request us to change certain health information. Such requests to amend must be in writing. You must explain why the information should be changed. If we accept your change, we will attempt to notify prior recipients of the change. We will include the changes in future releases of your health information. If your request is denied, we will send you a written denial, which will include the reason and describe any steps you may take in response.

Questions/Complaints

If you have any questions about our privacy practices, please contact our office at our office 651-462-3444. If you disagree with a decision about your privacy rights or feel that those rights have been violated, you may file a complaint with our office. You may also send a written complaint to the U.S. Department of Health and Human Services- Office of Civil Rights (OCR). You may obtain the address to file a complaint upon request.