Effective Date: March 20, 2026

YOUR RIGHTS

You have the right to:

• Inspect or receive an electronic or paper copy of your medical record and other health information we maintain about you. We generally respond within 30 days and may charge only a reasonable, cost-based fee when allowed by law.

• Ask us to correct information you believe is inaccurate or incomplete. We may deny the request in certain circumstances, but we will explain the reason in writing, generally within 60 days.

• Ask us to contact you in a specific way, such as by phone, text, email, or mail, or at an alternative address. We will accommodate reasonable requests.

• Ask us to limit certain uses or disclosures of your information. We are not always required to agree. However, if you pay for a service in full and ask us not to disclose that information to a health plan for payment or health care operations, we will honor the request unless disclosure is required by law.

• Request an accounting of certain disclosures made during the six years before your request. One accounting during any 12-month period will be provided without charge.

• Receive a paper copy of this Notice at any time, even if you previously agreed to receive it electronically.

• Designate a legally authorized representative to exercise your privacy rights. We will verify that person’s authority before taking action.

• File a complaint if you believe your privacy rights have been violated. You will not be penalized or retaliated against for filing a complaint.

YOUR CHOICES

You may tell us whether and how to:

• Share relevant information with family members, close friends, caregivers, or others involved in your care or payment for your care.

• Share information during disaster-relief efforts.

If you cannot communicate your preference, we may share information when we reasonably believe it is in your best interest or when necessary to prevent or lessen a serious and imminent threat to health or safety.

We will obtain your written authorization before using or disclosing your information for marketing, selling your information, or most uses and disclosures of psychotherapy notes. True North Medical Care does not sell patient information.

Uses or disclosures not described in this Notice will be made only with your written authorization. You may revoke an authorization in writing at any time, except to the extent that we have already acted in reliance on it.

OUR USES AND DISCLOSURES

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

• To treat you and coordinate your care with other healthcare professionals, pharmacies, laboratories, or specialists.

• To operate our practice, improve the quality of care, manage services, contact you, and conduct necessary administrative activities.

• To obtain payment from you or another responsible party, process payments, collect amounts due, and prepare superbills at your request. True North Medical Care does not routinely submit claims to insurance companies.

We may also use or share your information when permitted or required by law:

• For public health and safety activities, including preventing disease, reporting adverse medication reactions, assisting with product recalls, reporting suspected abuse or neglect, and preventing a serious threat to health or safety.

• For health research when all legal requirements have been satisfied.

• To comply with federal or state law, including providing information to the U.S. Department of Health and Human Services to demonstrate compliance with federal privacy law.

• To respond to organ and tissue donation requests.

• To assist a coroner, medical examiner, or funeral director when an individual dies.

• For workers’ compensation claims, lawful law-enforcement requests, authorized health-oversight activities, and certain government functions.

• In response to a valid court or administrative order, subpoena, discovery request, or other lawful legal process.

If we maintain substance-use-disorder patient records protected by 42 CFR Part 2, we will not use or disclose those records in civil, criminal, administrative, or legislative investigations or proceedings against you without your written consent or a qualifying court order and subpoena.

OUR RESPONSIBILITIES

• We are required by law to maintain the privacy and security of your protected health information.

• We will notify you 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 provide you with a copy upon request.

• We will not use or share your information other than as described in this Notice unless you authorize us in writing. You may revoke that authorization in writing at any time, except to the extent we have already acted in reliance on it.

COMPLAINTS AND QUESTIONS

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

Privacy Officer

Chad L. Stencel, APRN, CNP, FNP-C

True North Medical Care LLC

7250 Metro Blvd

Edina, MN 55439

Phone: 612-990-5849

Fax: 612-435-4947

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by writing to 200 Independence Avenue SW, Washington, DC 20201; calling 1-877-696-6775; or visiting hhs.gov/hipaa/filing-a-complaint.

We will not retaliate against you for filing a complaint.

MINNESOTA PRIVACY REQUIREMENTS

Minnesota law may provide additional protections for certain health records. We will follow whichever applicable federal or Minnesota requirement provides greater protection for your information.

notice of privacy practices

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