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Privacy Policy


Protected Health Information

While receiving care from our clinic, information regarding your medical history, treatment, and payment for your health care may be originated and/or received by us. Information which can be used to identify you, and which relates to your past, present or future medical condition, receipt of health care or payment for health care (“Protected Health Information”).

Our Responsibilities

Federal and state law imposes certain obligations and duties upon us as a covered healthcare provider with respect to your protected health information.  We are required to:

  • Provide you with a copy of the clinic’s privacy practices regarding the use and disclosure of your protected health information
  • Maintain the privacy and security of your Protected Health Information
  • Honor your requested restrictions regarding the use and disclosure of your Protected Health Information unless under the law we are authorized or required to release your Protected Health Information without your authorization, in which case you will be notified within a reasonable period of time as allowed by law
  • Allow you to inspect and get a copy of your Protected Health Information and medical record
  • Act on your request to amend or correct your Protected Health Information you think is incorrect or not complete
  • Accommodate reasonable requests to communicate protected health information by alternative means or methods
  • Abide by the terms of this notice

How Your Information Is Maintained

Information may be maintained by the clinic in a variety of ways. This may include paper documents, electronic documents, a HIPPA compliant electronic medical record (EMR), surgical or clnical images, email, secure messaging systems, electronic systems, the internet, cloud providers and participation in third-party information networks.

How Your Protected Health Information May be Used and Disclosed

Your Protected Health Information may be used and disclosed by us only with your express written authorization.  However, there are some exceptions to this general rule.

Treatment, Payment, or Health Care Operations

General Use

As part of our treatment, payment, and operations we may also release information to business associates who may perform various treatment, payment, or operation functions.  If information is provided to another person or entity, clinic or provider whom you seek treatment, that clinic or provider may treat the information received as part of its protected information.

Treatment Purposes

We may use or disclose your protected health information for treatment purposes. It may be necessary for various personnel involved in your care to have access to your protected health information to provide you with quality care.

Situations may also arise when it is necessary to disclose your protected health care Information to health care providers outside our clinic who may also be involved in your care or to facilitate referral to another provider.   We may inform your physician of your treatment regimen for continuity of care.

Payment Purposes

Your protected health information may be used or disclosed for payment purposes so that treatment and services provided by us may be billed and collected from you, your insurance company, or other third-party payor. We may disclose your information to your health insurance carrier to obtain prior approval for a service, or to your health insurance carrier upon its request for additional information necessary for it to determine whether a service is covered. We may also release your protected health information to another healthcare provider or individual or entity covered by the HIPAA regulations who has a relationship with you for their payment activities.

Health Care Operations

Your protected health information may also be used for healthcare operations, quality assurance, or risk management purposes, or disclosed to our accountant for audit purposes which are necessary to allow us to provide the highest quality of care. We may remove information to de-identify you from your record to prevent others from identifying specific patients. We may release your Protected Health Information to another individual, business associate, or entity covered by the HIPAA privacy regulations that has a relationship with you for their fraud and abuse detection or compliance purposes, quality assessment and improvement activities, or review, evaluation, or training.

Notification & Communications to Individuals Involved in Your Care

Your Protected Health Information may be used or disclosed by us to notify or assist in notifying a family member, close friend, or other individual you have authorized as responsible for your care. This is typically limited to your name, location, and condition.  It may be to the extent necessary to release your Protected Health Information to allow individuals you have authorized to participate in your care. Please notify us if you prefer certain individuals, uses, or disclosures to be limited.

Fundraising & Marketing Activities

Your Protected Health Information may be used to contact you for these purposes. The clinic or an affiliated organization, foundation, or business associate may contact you. We never share or sell your information for marketing or fundraising activities unless you give us written permission. Please notify us If you wish not to be contacted for marketing or fundraising activities.

Disaster Relief

Your Protected Health Information may be shared with public or private entities in this scenario as necessary to facilitate treatment, locate family members or caregivers, or assist with public health needs.

Psychotherapy Notes

If psychotherapy notes are part of your Protected Health Information record, we never share or disclose psychotherapy notes without your authorization, except in limited circumstances as allowed or required by law.


Research projects that use protected health information must meet stringent laws and requirements through special approval processes. Your protected health information may be used or disclosed for research purposes. Patient identifying information is often removed in these situations.

Compliance with Law

We may share your protected health information without your authorization as required or permitted by state or federal laws that may include but not limited to public health activities, legal proceedings or court order, law enforcement, organ donation, suspected abuse, neglect, or domestic violence, medical examiner/coroners, funeral director, special government functions, and workers compensation claims.

Some protected health information may be subject to different, often more stringent laws or regulation. Some of those conditions including but are not limited to HIV/AIDS, substance abuse, mental health, and genetic information. Our practice will comply with all applicable laws.

Public Health & Safety Issues

We may share your protected health information for certain public health or safety purposes including preventing disease, product recalls, reporting adverse reactions, or to prevent or reduce a serious threat to any person’s health or safety.

Your Rights

Under federal law you have certain rights and responsibilities regarding your protected health information.

You have the right to:

  • Request a copy of our privacy practices and policies.
  • Request restrictions on how your information is shared or used. We are not required to agree to you request and may refuse if it would affect your care.
  • Restrict disclosure of information for services or health care items for which you have paid the full out-of-pocket expense. This would not apply to information for care paid for or submitted to an insurer or required by law.
  • Obtain a paper or electronic copy of your medical record and protected health information. We will provide a copy or summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
  • Request us to correct your health information you think is incorrect or incomplete. We reserve the right to deny this request but will notify you why in writing within 60 days.
  • Obtain an accounting of disclosures of your protected health information for the 6 years prior to your request.
  • Revoke any prior authorizations or consents for use or disclosure of your protected health information, except to the extent that action has already been taken
  • Request confidential or alternative communications in a specific way such as an alternative locations or means. We will agree to all reasonable requests.
  • Notification and actions you can take in the event any breach occurs that may compromise the privacy or security of your protected health information.
  • Choose a medical power of attorney or legal guardian so that person can exercise your rights and make choices on your behalf. We will verify to ensure that person has authority before we take any action.
  • File a complaint if you feel your privacy rights have been violated. Please contact us at 701-707-0200 or on our website at You may also file a complaint with the US Department of Health and Human Services by visiting We will not retaliate for filing a complaint.

Effective Date

This notice is effective on March 3, 2022.

Changes to the Terms of this Notice

We reserve the right to change the terms of this notice and will apply to all information we have about you. A current notice of our privacy practices will be available upon request, in our office, or our website at