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HIPAA Notice of Privacy Practices

Northern Lights Psychiatry LLC
Effective Date: 09/05/2025


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.


1. Our Responsibilities

We are required by law to:

  • Maintain the privacy and security of your protected health information (PHI).

  • Give you this Notice describing our legal duties and privacy practices.

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

  • Follow the terms of this Notice.


2. Your Rights

You have the right to:

  • Get a copy of your medical record: You can request to see or get an electronic or paper copy of your record.

  • Ask us to correct your record: If you believe there is an error, you may request an amendment.

  • Request confidential communications: You may ask us to contact you in a specific way (e.g., at home, by cell phone, or at an alternate address).

  • Ask us to limit what we use or share: You can request restrictions on disclosures of your PHI. We will consider your request, but we are not always able to agree.

  • Get a list of disclosures: You can ask for a list of times we have shared your PHI, who we shared it with, and why (excluding certain routine disclosures like those for treatment, payment, and operations).

  • Get a copy of this Notice: You can request a paper or electronic copy of this Notice at any time.

  • Choose a representative: If you have given someone medical power of attorney or they are your legal guardian, they can exercise your rights on your behalf.

  • File a complaint: If you believe your privacy rights have been violated, you can file a complaint with us (see contact info below) or with the U.S. Department of Health and Human Services (HHS). Filing a complaint will not affect your care.


3. How We May Use and Share Information

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

  • For Treatment: To provide, coordinate, or manage your health care. Example: Sharing information with your primary care provider.

  • For Payment: To bill and receive payment from insurance companies or other payers. Example: Giving your insurance company information so it will pay for your services.

  • For Health Care Operations: To run our practice and improve your care. Example: Reviewing treatment outcomes to improve services.


4. Other Ways We May Use or Share Your Information

We may also use and share your information in other ways, as permitted or required by law, such as:

  • Public health and safety issues: Reporting to public health authorities, preventing disease, reporting adverse medication reactions.

  • Research: For research purposes when approved by an oversight board.

  • Legal and compliance: To respond to lawsuits, law enforcement requests, or regulatory agencies.

  • Workers’ compensation, law enforcement, or other government requests: When required by applicable laws.

  • To prevent or reduce a serious threat to health or safety: If necessary to protect you or the public.

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We will not use or share your information for marketing or fundraising without your written permission. We will never sell your personal information.

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5. Our Duties Regarding Your Information

 

  • We are required to maintain the privacy of your PHI.

  • We will notify you promptly if a breach occurs that may have compromised your information.

  • We will not use or share your information other than as described in this Notice unless you give us written authorization. You may revoke that authorization at any time in writing.

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6. Changes to This Notice


We may change the terms of this Notice at any time. The new Notice will apply to all PHI we maintain. We will post the current Notice in our office and on our website, and you may request a copy at any time.


7. Questions or Complaints


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


Northern Lights Psychiatry LLC
201 1st Street East, Suite 220
Park Rapids, MN 56470
Phone: 218-203-9215
Email: amanda@nlpsych.org


You may also file a complaint with:
U.S. Department of Health & Human Services – Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 1-877-696-6775
Website: www.hhs.gov/ocr/privacy/hipaa/complaints


We will not retaliate against you for filing a complaint.

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