Notice of Privacy Practices

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. To use any of these rights, contact our Privacy Official using the information at the top of this notice. Because many requests require a signed authorization, we handle them by phone, mail or in person, not through our website.

Get a Copy of Your Medical Record

• You can ask to see or get an electronic or 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.
• If you ask to see or receive a copy of your record for the purpose of reviewing your current medical care, we may not charge you a fee. [Minn. Stat. § 144.292, subd. 6]
• If you request copies of records of past medical care, or for certain appeals, we may charge the fees allowed by law. [Minn. Stat. § 144.292, subd. 6]

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 with your health insurer for the purpose of payment or our operations. We will say “yes” unless a law requires us to share that information.
• Minnesota law requires your consent before we disclose information for treatment, payment or operations, with limited exceptions described below. [Minn. Stat. § 144.293, subd. 2]

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 disclosures except 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 it 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. 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

• You can complain if you feel we have violated your rights by contacting our Privacy Official using the information at the top of this notice.
• 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 1-800-368-1019, or visiting www.hhs.gov/ocr/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 NOT to:

• Share information with your family, close friends or others involved in your care
• Share information in a disaster relief situation

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 your consent for most other sharing purposes.

Fundraising: We do not use your health information for fundraising. If that ever changes, you can tell us not to contact you, and we will honor that request.

Our Uses and Disclosures

How Do We Typically Use or Share Your Health Information?

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 emergency. [Minn. Stat. § 144.293, subds. 2 and 5]

Treat you. We can use your health information and share it with other professionals who are treating you only if we have your consent. We can release your health records to providers outside our practice without your consent only in an emergency when you are unable to consent. Example: With your consent, we send your exam findings to an orthopedic specialist or physical therapist we refer you to.

Run our practice. We can use your health information to run our practice, improve your care and contact you when necessary, such as appointment reminders by phone, text or email through our scheduling system. We must obtain your consent before we release your health records to other providers for their own health care operations. Example: We use health information about you to manage your treatment and services.

Bill for your services. We can use and share your health information to bill and get payment from health plans or other payers only if we obtain your consent. Example: We give information about you to your health insurance plan, auto (no-fault) insurer, workers’ compensation carrier or the VA Community Care Network 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/hipaa/for-individuals.

• Help with public health and safety issues, such as preventing disease, helping with product recalls, reporting adverse reactions to medications, reporting suspected abuse, neglect or domestic violence, and preventing or reducing a serious threat to anyone’s health or safety.
• Do research. We can use or share your information for health research if you do not object. [Minn. Stat. § 144.295, subd. 1]
• 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. [Minn. Stat. § 144.293, subd. 2]
• Respond to organ and tissue donation requests. We can share health information about you with organ procurement organizations only with your consent. [Minn. Stat. § 525A.14]
• Work with a medical examiner or coroner. We can share health information with a coroner or medical examiner when an individual dies. We need consent to share information with a funeral director. [Minn. Stat. § 390.11, subd. 7(a)]
• 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; and for special government functions such as military, national security and presidential protective services with your consent, unless required by law. [Minn. Stat. § 144.293, subd. 2]
• 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 as permitted by Minnesota law. [Minn. Stat. § 144.293, subd. 2]

Other State and Federal Law

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. [Minn. Stat. §§ 13.386, 254A.09]

Substance use disorder records. We do not provide substance use disorder treatment. If we receive records that are protected by federal confidentiality rules for substance use disorder treatment (42 C.F.R. Part 2), we will not use or share them, or testimony about their contents, in any civil, criminal, administrative or legislative proceeding against you without your written consent or a court order, and we will follow all other limits those rules require.

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 HHS: Notice of Privacy Practices for Protected Health Information.

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 website.

Effective Date and Privacy Official

This notice is effective October 16, 2026.

Privacy Official: Dr. Heather Flatgard O’Sullivan, DC
Excelsior & Grand Chiropractic, LLC, 5605 W. 36th St., Suite 100C, St. Louis Park, MN 55416
Phone: (952) 920-9247 · Email: contactus@eandgchiro.com

Adapted from the Minnesota Department of Health Minnesota Model Notice of Privacy Practices and the U.S. Department of Health and Human Services Model Notice of Privacy Practices. See also our Website Privacy Policy.