Notice of Privacy Practices

Effective date March 7, 2025

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.

Headwaters of Healing Therapy, PLLC (the “Practice”) is committed to protecting your privacy. The Practice is required by federal law to maintain the privacy of Protected Health Information (“PHI”), which is information that identifies or could be used to identify you. The Practice is required to provide you with this Notice of Privacy Practices (this “Notice”), which explains the Practice's legal duties and privacy practices and your rights regarding PHI that we collect and maintain. 

YOUR RIGHTS

Your rights regarding PHI are explained below. To exercise these rights, please submit a written request to the Practice at the address noted below.

To inspect, copy and receive an electronic or paper copy of your medical record.

You can ask for an electronic or paper copy of PHI. Ask us how to do this. We will provide a copy or a summary of your health information within a reasonable time. 

If you ask to see or receive a copy of your record for purposes of reviewing current medical care, we may not charge you a fee.

If you request copies of your patient records of past medical care, or for certain appeals, we may charge you specified fees. 

The Practice may deny your request if it believes the disclosure will endanger your life or another person's life. You may have a right to have this decision reviewed.

To amend PHI. 

You can ask to correct PHI you believe is incorrect or incomplete. The Practice may require you to make your request in writing and provide a reason for the request.

The Practice may deny your request. The Practice will send a written explanation for the denial within 60 days and allow you to submit a written statement of disagreement.

To request confidential communications. 

You can ask the Practice to contact you in a specific way. The Practice will say “yes” to all reasonable requests.

To limit what is used or shared.

You can ask the Practice not to use or share PHI for treatment, payment, or business operations. The Practice is not required to agree if it would affect your care. 

If you pay for a service or health care item out-of-pocket in full, you can ask the Practice not to share PHI with your health insurer.

You can ask for the Practice not to share your PHI with family members or friends by stating the specific restriction requested and to whom you want the restriction to apply.

Minnesota Law requires consent for disclosure of treatment, payment, or operations information.

To obtain a list of those with whom your PHI has been shared.

You can ask for a list, called an accounting, of the times your health information has been shared. You can receive one accounting every 12 months at no charge, but you may be charged a reasonable fee if you ask for one more frequently.

To receive a copy of this Notice.

You can ask for a paper copy of this Notice, even if you agreed to receive the Notice electronically. We will provide you with a paper copy promptly.

To choose someone to act for you.

If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights.

To file a complaint if you feel your rights are violated.

You can file a complaint by contacting the Practice using the following information:

Headwaters of Healing Therapy, PLLC
7525 Village Drive, Suite 160
Lino Lakes, MN 55014
Julie Krogstad
612-305-8236

You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.

The Practice will not retaliate against you for filing a complaint.

YOUR CHOICES

For certain health information, you can tell us your choices about what we share.

If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions. In these cases, you have both the right and choice to tell us NOT to:

  • Share information with your family, close friends, or others involved in your care

  • Share information in a disaster relief situation

  • Include your information in a hospital directory.

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we never share your information unless you give us written permission:

  • Marketing purposes

  • Sale of your information

  • Most sharing of psychotherapy notes 

Minnesota Law also requires consent for most other sharing purposes.

ROUTINE USES AND DISCLOSURES OF PHI

How do we typically use or share your health information?

The Practice is permitted under federal law to use and disclose PHI, without your written authorization, for certain routine uses and disclosures, such as those made for treatment, payment, and the operation of our business.

The Practice typically uses or shares your health information in the following ways.

We need your consent before we disclose protected health information for treatment, payment, and operations purposes, unless the disclosure is to a related entity, or the disclosure is for a medical emergency and we are unable to obtain your consent due to your condition or the nature of the medical emergency.

Patient treatment. We can use your health information and share it with other professionals who are treating you only if we have your consent. We can only release your health records to healthcare facilities and providers outside our network without your consent if it is an emergency and you are unable to provide consent due to the nature of the emergency.

Business operations. We can use and share your health information to run our practice, improve your care, and contact you when necessary. We are required to obtain your consent before we release your health records to other providers for their own healthcare operations.

Example: We use health information about you to manage your treatment and services and to send you appointment reminders if you choose.

Billing. We can use and share your health information to bill and get payment from health plans or other entities only if we obtain your consent.

Example: We give information about you to your health insurance plan via your superbill, or to Mentaya if you have selected that service to submit your superbill for reimbursement.

How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We must meet many conditions in the law before we can share your information for these purposes. For more information see: https://www.hhs.gov/hipaa/for-individuals/index.html

Help with public health and safety issues. We can share health information about you for certain situations such as:

  • Preventing disease

  • Helping with product recalls

  • Reporting adverse reactions to medications

  • Reporting suspected abuse, neglect, or domestic violence

  • Preventing or reducing a serious threat to anyone’s health or safety

  • Health oversight: For audits, investigations, and inspections by government agencies that oversee the health care system, government benefit programs, other government regulatory programs, and civil rights laws.

Do research. We can use or share your information for health research if you do not object.

Comply with the law. We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

Work with a medical examiner or coroner. We can share health information with a coroner and medical examiner when an individual dies. We need consent to share information with a funeral director.

Address workers’ compensation, law enforcement, and other government requests. We can use or share health information about you:

  • For workers’ compensation claims.

  • For law enforcement purposes or with a law enforcement official with your consent, unless required by law.

  • With health oversight agencies for activities authorized by law.

  • For special government functions such as military, national security, and presidential protective services with your consent, unless required by law.

Respond to lawsuits and legal actions. We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Other State Law. We will never share any substance abuse treatment records without your written permission.

In Minnesota, we need your consent before we disclose protected health information for treatment, payment, and operations purposes, unless the disclosure is to a related entity, or the disclosure is for a medical emergency and we are unable to obtain your consent.

You may revoke your authorization, at any time, by contacting the Practice in writing, using the information above. The Practice will not use or share PHI other than as described in this Notice unless you give your permission in writing.

OUR RESPONSIBILITIES

The Practice is required by law to maintain the privacy and security of PHI.

The Practice is required to abide by the terms of this Notice currently in effect. Where more stringent state or federal law governs PHI, the Practice will abide by the more stringent law.

The Practice reserves the right to amend this Notice. All changes are applicable to PHI collected and maintained by the Practice. Should the Practice make changes, you may obtain a revised Notice by requesting a copy from the Practice, using the information above, or by viewing a copy on the website https://www.headwatersofhealingtherapy.com.

The Practice will inform you if PHI is compromised in a breach.

This Notice is effective as of March 7, 2025.

 

Julie Krogstad, LMFT, Privacy Official
Headwaters of Healing Therapy, PLLC
julie@headwatersofhealingtherapy.com
612-305-8236