Notice of Privacy Practices

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 medical record

• Request correction of your medical record if you believe it is incorrect or incomplete

• Request confidential communications, such as being contacted in a specific way or location

• Ask us to limit the information we share, although we may not always be able to agree

• Receive a list of certain disclosures of your health information

• Get a copy of this Notice of Privacy Practices at any time

• Choose someone to act for you, such as a legal guardian or healthcare agent

• File a complaint if you believe your privacy rights have been violated

 

Minnesota law may provide additional protections for certain mental health, substance use, and psychotherapy records.

 

Our Uses and Disclosures

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

 

For Treatment

We use your health information to provide, coordinate, or manage your care.

Example: Consulting with another healthcare provider involved in your treatment.

For Payment

We use and share your information to bill for services and obtain payment.

Example: Submitting claims to your insurance company.

For Healthcare Operations

We use your information to operate our practice, improve care, and manage administrative functions.

Example: Reviewing the quality of services provided.

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Other Uses and Disclosures Permitted by Law

We may disclose your health information without your written authorization when required or permitted by law, including:

• Public health reporting

• Reporting abuse, neglect, or domestic violence

• Health oversight activities such as audits or investigations

• Responding to court orders, subpoenas, or lawful processes

• Workers’ compensation claims

• Law enforcement requests when legally required

• Coroners, medical examiners, or funeral directors

• Organ and tissue donation coordination

 

We do not use or disclose your health information for purposes not described in this Notice without your written authorization, unless required by law.

 

Serious Threats to Health or Safety

If there is a serious and imminent threat to your health or the safety of others, we may disclose limited information to individuals or authorities who are able to help prevent or lessen the threat, as permitted by law.

 

Our Responsibilities

We are required by law to:

• Maintain the privacy and security of your protected health information

• Notify you if a breach occurs that may have compromised the privacy or security of your information

• Follow the privacy practices described in this Notice

• Provide you with a copy of this Notice

 

We will not use or share your information other than as described here unless you authorize us to do so in writing. You may revoke your authorization at any time.

 

Changes to This Notice

We may change the terms of this Notice at any time. The updated Notice will apply to all health information we maintain. The most current version will be available on our website and upon request.

 

Questions or Complaints

If you have questions about this Notice or believe your privacy rights have been violated, contact:

 

Lynn Gevik

Privacy Officer

Hope Psychiatry, LLC

7201 Metro Blvd, Suite 550

Edina, MN 55439

Phone: 952-520-3649

Email: welcome@hopeinmn.com

 

You may also file a complaint with the U.S. Department of Health and Human Services. You will not be retaliated against for filing a complaint.

 

Office for Civil Rights

www.hhs.gov/ocr/privacy/hipaa/complaints

 

Policy Effective Date: 12/15/2025