Privacy Notice

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

Wellspring Health Center PLLC ("the clinic") is required by law to maintain the privacy and confidentiality of your protected health information and to provide our patients with notice of our legal duties and privacy practices with respect to your protected health information.

Disclosure of your Health Information

Treatment: We may disclose your health care information to other healthcare professionals within our practice for the purpose of treatment, payment or healthcare operations. (example)

"It is our policy to provide a substitute health care provider, authorized by Wellspring Health Center PLLC to provide assessment and/or treatment to our patients, without advance notice, in the event of you primary health care provider's absence due to vacation, sickness, or other emergency situation."

"If indicated, it may be necessary to seek consultation regarding your health condition from other health care providers associated with Wellspring Health Center PLLC"

Payment: We may disclose your health information to your insurance provider for the purpose of payment or health care operations. (Example)

"As a courtesy to our patients, we will submit an itemized billing statement to your insurance carrier for the purpose of payment to Wellspring Health Center PLLC for health care services rendered. The billing statement contains medical information, including diagnosis, date of injury/condition, and codes which describe the health care services received."

Worker's Compensation: We may disclose your health information as necessary to comply with State Worker's Compensation Laws.

Emergencies: We may disclose your health information to notify or assist in notifying a family member, or another person responsible for your care about your medical condition or in the event of an emergency or of your death.

Public Health: As required by law, we may disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability, reporting child abuse or neglect, reporting domestic violence, reporting to the Food and Drug Administration problems with products and reactions to medications, and reporting disease or infection exposure.

Judicial and Administrative Proceedings: We may disclose your health information in the course of any administrative or judicial proceeding.

Law Enforcement: We may disclose your health information to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena, and other law enforcement purposes.

Deceased Persons: We may disclose your health information to coroners or medical examiners.

Organ Donation: We may disclose your health information to organizations involved in procuring, banking, or transplanting organs and tissues.

Research: We may disclose your health information to researchers conducting research that has been approved by an Institutional Review Board.

Public Safety: It may be necessary to disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or to the general public.

Specialized Government Agencies: We may disclose health information for military, national security, prisoner and government purposes.

Marketing: We may contact you for marketing purposes or fundraising purposes, as described below:

"As a courtesy to our new patients, it is our policy to call your home the day prior to your scheduled appointment to remind you of your appointment time. If you are not at home, we leave a reminder message on your answering machine or with the person answering the phone. No personal health information will be disclosed during this recording or message other than the date and time of your scheduled appointment along a request to call our office if you need to cancel or reschedule your appointment."

"It is our practice to participate in charitable events to raise awareness, food donations, gifts, money, etc. During these times, we may send you an email, letter, post card, invitation or call your home to invite you to participate in the charitable activity. We will provide you with information about the type of activity, the dates and times, and request your participation in such an event. It is not our policy to disclose any personal health information about your condition for the purposes of sponsored fund-raising events."

Your Health Information Rights:

  • You have the right to request restrictions on certain uses and disclosures of your health information. Please be advised, however, that our clinic is not required to agree to the restrictions that you requested.
  • You have the right to have your health information received or communicated through an alternative method or sent to an alternative location other than the usual method of communication or delivery, upon request.
  • You have the right to inspect and copy your health information.
  • You have a right to request that our clinic amend your protected health information. Please be advised, however, that our clinic is not required to agree to amend your protected health information. If your request to amend your health information has been denied, you will be provided with an explanation of our denial reason(s) and information about how you can disagree with the denial.
  • You have a right to receive an accounting of disclosures of your protected health information made by our clinic.
  • You have a right to a paper copy of this Notice of Privacy Practices at any time upon request.

Changes to this Notice of Privacy Practices: The clinic reserves the right to amend this Notice of Privacy Practices at any time in the future, and will make the new provisions effective for all information that it maintains. Until such amendment is made, the clinic is required by law to comply with this Notice.

The clinic is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. If you have questions about any part of this notice or if you want more information about your privacy rights, please contact our office at 952.933.1150 during business hours.

Complaints: Complaints about your Privacy rights, or how the clinic has handled your health information should be directed to the clinic and scheduling a phone conference or meeting with the clinic administrator.

If you are not satisfied with the manner in which the clinic handles your complaint, you may submit a formal complaint to:

DHHS, Office of Civil Rights
200 Independence Avenue SW
Room 509F HHH Building
Washington, DC 20201