952-841-2345
 

Call Us Today: 952-841-2345

Call Us Today: 952-841-2345

Imagine your life
with less pain

Visit the
pain management
experts at Twin Cities
Pain Clinic and let us
help you get back the
life you deserve.

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.

Your Rights

You have the right to:

  • Get a copy of your paper or electronic medical record
  • Correct your paper or electronic medical record
  • Request confidential communication
  • Ask us to limit the information we share
  • Ask us to limit/opt you out of how we communicate with you
  • Get a list of those with whom we’ve shared your information
  • Get a copy of this privacy notice
  • Choose someone to act for you
  • File a complaint if you believe your privacy rights have been violated

Your Choices

You have some choices in the way that we use and share information as we:

  • Tell family and friends about your condition
  • Provide disaster relief
  • Include you in a hospital directory
  • Provide mental health care
  • Market our services and sell your information
  • Raise funds

Our Uses and Disclosures

We may use and share your information as we:

  • Treat you
  • Run our organization
  • Bill for your services
  • Help with public health and safety issues
  • Do research
  • Comply with the law
  • Respond to organ and tissue donation requests
  • Work with a medical examiner or funeral director
  • Address workers’ compensation, law enforcement, and other government requests
  • Respond to lawsuits and legal actions
  • Send you communications regarding your care, including voicemails, texts and emails

Your Rights

When it comes to your health information, you have certain rights.

This section explains your rights and some of our responsibilities to help you.

Get a paper copy of your medical record

  • You can ask to see or get a paper copy of your medical record and other health information we have about you. Ask us how to do this.
  • We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Get an electronic copy of your medical record

  • You can ask to get an electronic copy of your medical record and other health information we have about you.
  • We have policies and procedures in place to encrypt your electronic records via encrypted email or encrypted USB flash drive.
  • If you request your records to be sent unencrypted, you must provide a written or verbal confirmation. You understand the risk of transmission and break with electronic records being sent via unsecure email or by other digital media.
  • We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your medical record

  • You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
  • We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications

  • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
  • We will say “yes” to all reasonable requests.

Ask us to limit what we use or share

  • You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
  • If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Ask us to limit/opt you out of how we communicate with you

  • You will have the option to opt-out of text messages and most email communications
  • We will say “yes” to all opt-out requests for text messages
  • We will say “yes” to most opt-out requests for email communications, though we reserve the right to send you emails as necessary in order to administer adequate care, carry out operational processes, and/or resolve any potential disputes

Get a list of those with whom we’ve shared information

  • You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
  • We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

  • You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

 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 and make choices about your health information.
  • If you are physically onsite at our facilities, you may verbally designate a non-legally appointed representative to act and make decisions on your behalf.
  • We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated

  • If you feel we have violated your rights, you may contact our practice administrator at (651) 208-9161.
  • 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 hhs.gov/ocr/privacy/hipaa/complaints/.
  • We 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 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

In the case of fundraising:

  • We may contact you for fundraising efforts, but you can tell us not to contact you again.

Our Uses and Disclosures

How do we typically use or share your health information?

We typically use or share your health information in the following ways.

To treat you

We can use your health information and share it with other professionals who are treating you.

Example: A doctor treating you for an injury asks another doctor about your overall health condition.

Dr. Andrew Will has ownership interest in Twin Cities Pain Clinic, Twin Cities Surgery Center, Burnsville Surgery Center, Twin Cities Anesthesia, and Twin Cities Pain Clinic Transportation, and we reserve the right to share your personal health information between these entities for the purpose of continuity of care.

To run our organization

We can use and share your health information for the purposes of running our practice, continuity of care, and contacting you when necessary.

Example: We use health information about you to manage your treatment and services.

Example: We may share the minimum amount of information necessary with a third-party mail vendor to send important organizational information to all patients via mail, OR, to ensure you are EXCLUDED from any marketing aimed at prospective new patients. Any shared information is protected with password encryption.

To bill for your services

We can use and share your health information to bill and get payment from health plans or other entities.

Example: We give information about you to your health insurance plan so it will pay for your services.

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 have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

To 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

To perform research

We can use or share your information for health research.

To 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.

To respond to organ and tissue donation requests

We can share health information about you with organ procurement organizations.

To work with a medical examiner or funeral director

We can share health information with a coroner, medical examiner, or funeral director if an individual dies.

To 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 health oversight agencies for activities authorized by law
  • For special government functions such as military, national security, and presidential protective services

To 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.

Send you communications regarding your care, including voicemails, texts and emails

We may contact you via digital means, such as phone, email, or text message, for purposes related to your care, such as appointment reminders, continuity of care, important announcements, and obtaining feedback. The quantity of communications you receive will vary depending on the frequency of your appointments and the circumstances of your care. We can share your health information with a third-party business associate for the purpose of creating and sending digital communications. The information we share will be limited to the minimum amount necessary to carry out these communications. You may opt out of digital communications at any time by replying STOP to a text message or clicking the “unsubscribe” link in an email.

Our Responsibilities

  • We are required by law to maintain the privacy and security of your protected health information.
  • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
  • We must follow the duties and privacy practices described in this notice and give you a copy of it.
  • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.

Privacy Officer:

Latifah Moss
(952) 204-3081
latifah.moss@tcpain.com

 

Formal complaints may be submitted to the following:
Twin Cities Pain Clinic
Attn. Practice Administrator
7235 Ohms Ln.
Edina, MN 55439
(651) 208-9161
compliance@tcpain.com

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