Notice of Privacy Practices
FavorGrace Wellness Clinic
Effective as of: December 2025
6160 Summit Drive. Suite 231, Brooklyn Center, MN 55430
This Notice describes how your medical and mental-health information may be used and disclosed, and how you can access this information.
Please review it carefully.
Your privacy is essential to us. FavorGrace Wellness Clinic is required by law to maintain the confidentiality of your Protected Health Information (PHI) and to provide you with this Notice of our legal duties and privacy practices.
1. Your Rights Regarding Your Health Information
You have the right to:
A. Access Your Records
You may request to view or receive a copy of your health and billing records.
We will provide a copy or summary within 30 days.
B. Request Corrections
If you believe information is incomplete or incorrect, you may request a correction.
We may deny your request if the information is already accurate, but we will always explain our reasoning in writing.
C. Request Confidential Communications
You may ask us to contact you in a specific way (e.g., only by email or phone) or at a specific location.
We will accommodate reasonable requests.
D. Request Restrictions
You may ask us not to disclose certain information for treatment, payment, or healthcare operations.
While we will consider the request, we are not required to agree unless the disclosure would be to your health insurer and you have paid in full out of pocket.
E. Obtain a List of Disclosures
You may request an accounting of when we shared your PHI for reasons other than treatment, payment, or operations.
F. Receive a Copy of This Notice
You can request a paper or digital copy of this Notice at any time.
G. Choose a Representative
If someone is legally authorized to act on your behalf (e.g., legal guardian), we will treat them as your personal representative.
H. File a Complaint
If you believe your privacy rights have been violated, you may file a complaint with:
- Our clinic (contact information below)
- The U.S. Department of Health and Human Services (HHS Office for Civil Rights)
You will not be penalized for filing a complaint.
2. How We Use and Disclose Your Information
We are allowed to use and disclose your PHI in the following ways:
A. For Treatment
We may use your health information to:
- Provide, manage, or coordinate your care
- Communicate with other healthcare professionals involved in your treatment
Example: Discussing your care with a referring psychiatrist or primary care physician, when authorized.
B. For Payment
We may use your PHI to:
- Bill for services
- Confirm insurance coverage
- Process claims
C. For Healthcare Operations
We may use your PHI to:
- Evaluate clinic performance
- Improve quality of care
- Conduct internal audits and training
These uses help us operate safely and effectively.
3. Other Permitted Uses and Disclosures
We may also share your information in the following circumstances:
A. When Required by Law
We must disclose PHI when required by federal, state, or local laws.
B. Public Health & Safety
We may share information to help prevent or report:
- Abuse or neglect
- Serious threats to health or safety
- Public health emergencies
C. Legal Proceedings
We may share information when required by:
- Court orders
- Subpoenas
- Government investigations
D. Law Enforcement
Certain disclosures may be made for law enforcement purposes when allowed by law.
E. Specialized Government Functions
This includes:
- Military and national security
- Protective services
Workers’ compensation claims
F. Deceased Individuals
We may share information with medical examiners, coroners, or funeral directors if necessary.
4. Uses and Disclosures Requiring Your Written Authorization
We will not use or disclose your PHI for the following unless you give written permission:
- Marketing purposes
- Release of psychotherapy notes
- Sale of your health information
- Any disclosure not covered in this Notice
You may revoke your authorization at any time.
5. Our Responsibilities
FavorGrace Wellness Clinic is legally required to:
- Keep your PHI private and secure
- Provide you this Notice of our privacy practices
- Notify you if a breach occurs that may have compromised your information
- Follow the terms stated in this Notice
We may update this Notice as laws or practices change. Updates will be posted on our website and available upon request.
6. Contact Us
If you have questions, privacy concerns, or want to exercise your rights, please contact:
FavorGrace Wellness Clinic
6160 Summit Drive. Suite 231
Brooklyn Center, MN 55430
Email: favorgracewellness@gmail.com
Phone: (612) 364 – 2297
7. How to File a HIPAA Complaint
You may 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
Online: https://www.hhs.gov/ocr/privacy/hipaa/complaints/
We will never retaliate against you for filing a complaint.
