Patient Information

Notice of Privacy Practices

Keep for your records

Rise Up Health Clinics

This notice describes how health information about you may be used and disclosed and how you can get access to this information. Please read it carefully.

Your Health Information

Each time you visit the Rise Up Health Clinics, a record of your visit is made. Usually, this record has your symptoms, exam, test results, diagnosis, treatment, and a plan for future care or treatment. This information is often called your health or medical record. It serves as a:

• basis to plan your care and treatment.

• way the health professionals who care for you communicate with each other.

• legal document describing the care you received.

• source of data for facility and service planning.

• source of information to improve the care and services we give to our patients.

• source of information for public health officials who have the goal of improving the health of the city, state, or nation.

Understanding what is in your record and how your health information is used helps you to be sure your health information is correct, know who, what, when, where, and why others may have your health information, and make better decisions when allowing disclosure to others.

Privacy Rights of Minors

Most of the time, parents or guardians of minors have the privacy rights described in this Notice. However, there are times when minor patients may make decisions about their own care and have the rights described in this Notice. When minor patients are allowed by law to make decisions about their own medical care, they can usually control the release of their medical information even to their parents/guardians. If you have questions or concerns about whether your parents/guardians will have access to your medical information, you should talk to your health care provider.

Your Rights Regarding Your Health Information

Although your health record belongs to the Clinic, the information in it belongs to you. You have the right to:

look at and/or ask for a copy of your health record. An appointment is required to view the record with your health care provider. We may deny your request to inspect and copy in certain very limited circumstances. You may request that the denial be reviewed in most circumstances.

• ask to restrict certain uses and disclosures of your record. If we deny your request, we will tell you in writing why we do not agree.

• ask for a correction or change to your health record. We do not have to make the change you request. If we deny your request you can write a statement of disagreement with the denial that we will keep with your medical record.

• get a list of when and to whom your health information has been sent in the last six (6) years for reasons other than disclosures made with your consent, treatment, payment or health questions.

• ask us to communicate your health information to you by other means or to another location. For example, you can ask that we only contact you through use of a certain telephone number.

Our Responsibilities

Rise Up Health Clinics has a duty to:

• keep your health information private.

• give you this Notice of Privacy Practices and seek your written acknowledgment of your receipt of this notice.

• abide by our current Notice of Privacy Practices. We will not use or give out your health information without your permission, except as described in this notice.

• tell you if we are unable to agree to your request to change or correct your health record or to restrict certain disclosures of your record.

How We Use Health Information

Treatment, Payment, and Health Operations

Treatment. For example, the laboratories conducting your lab tests will receive your health information necessary to conduct the test. Also, the information the health care provider gets about you will be put in your record in either paper form or electronic form. Your health record is used to decide the best course of treatment for you and to provide continuity of care should you get a different health care provider. We have policies and procedures in place to protect the confidentiality of your health information contained in either the paper or electronic record.

Regular Health Care Operations. For example, members of our clinical staff, a quality improvement, or an auditing team may use information in your health record to assess the care and outcome in your case and others like it. This information will then be used to improve the quality and effectiveness of the health care and service we provide.

Patient Communications. We may contact you to remind you of appointments, and we may contact you about health-related services that may be of interest to you. Normally we contact you at the telephone number, email address, or home address you give us. You may ask us to communicate with you in other ways or at another location. We will agree to your request if it is reasonable.

Other Disclosures Not Requiring Your Permission

Required by Other Law. We may disclose health information when required by other federal, state, or local laws. For example, other laws require us to report minor neglect, physical or sexual abuse, and health information necessary to follow laws relating to workers’ compensation or other similar programs established by law.

Legal Process. We may disclose health information in response to court orders, subpoenas, or other legal documents.

Public Health. We may disclose your health information for public health purposes such as birth reporting, to prevent or control disease, injury, or disability, to let a person know if they were exposed to a disease or may be at risk for getting or spreading a disease or condition, or to report problems with medicines or other products.

Organ and Tissue Donation. If you are an organ donor, we may release health information to organizations that handle organ procurement, transplantation, or to an organ donation bank. We may also release health information to a coroner, medical examiner, or a funeral director.

Health Oversight Activities. We may disclose health information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, and licensing. These activities are needed for the government to oversee the health care system.

Specialized Government Functions. If you are a member of the armed forces or a foreign military or become an individual at a correctional institution, we may share health information as required by law. We may also disclose your health information to authorized federal officials for activities authorized by law related to national security.

Law Enforcement. If we believe you have been the victim of abuse, neglect, or domestic violence, we must report it to law enforcement. If you are emancipated, we will get your permission first. Other situations are when a crime occurs at the clinic or when it is necessary to prevent a serious health and safety threat to you, another person, or the public.

Research. We may use or share your health information for research purposes as allowed by law or if you have given permission.

Disclosures Requiring Your Permission

Other uses and disclosures will be made only with your written permission. You may cancel that permission in writing at any time. If you cancel your permission, we will no longer use or share your health information for the reasons of your written permission. Of course, we are unable to take back any disclosures we have already made with your permission.

Questions or Complaints

If you have questions, please contact the clinic manager (651-653-2923). If you believe your privacy rights have been violated, let the clinic manager know. You may also file a complaint with the Secretary of the Department of Health and Human Services. You will not be treated differently by the Rise Up Health Clinics staff if you make a complaint.

Changes to this Notice

We must follow the terms of the Notice of Privacy Practices. We can change this Notice of Privacy Practices, however, and reserve the right to make the new notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in this clinic. The effective date of this notice is listed on this page.

Effective Date: August 2020; updated July 2023

Patients' Rights and Responsibilities

Keep for your records

Rise Up Health Clinics

The patient has the right to 

• Reasonable access to considerate, safe, secure, and respectful care that includes consideration of cultural and spiritual beliefs.

• Make informed decisions regarding personal health care and include family or significant others in decision-making to the degree possible. 

• Be actively involved in the plan of care.

• Know the names of providers participating in their care, including the provider who is coordinating care.  

• Receive understandable information in their language of choice about diagnosis, treatment, prognosis, and continuing care requirements. 

• Decline treatment and be informed of the consequences of declination.

• Access information contained in the medical record 

• Expect confidentiality in regards to personal and health care information.

• Privacy in discussion and performance of health care.

• Voice complaints regarding care received and information on how to do so.

• Be informed of the reasons for any procedure or treatment before giving consent. This includes a description of the procedure or treatment, the significant risks involved, reasonable medical alternatives, and the probable length of time for recuperation. 

• An explanation of the health care bill and an opportunity to discuss the charges and methods of payment, regardless of the sources of payment.

The patient has the responsibility to

• Actively participate in decisions regarding personal health care.

• Accurately relate information regarding medical history.

• Inform the provider if treatment plans are not understood or will not be followed.

• Notify the provider of any unexpected changes to personal health habits.

• Accept responsibility for and understand possible consequences if the choice is not to follow provider instructions, recommendations, or orders for treatment.

• Be considerate and respectful of the rights of other patients of the Clinic and Clinic personnel.

• Make payments toward charges as agreed upon.

• Be aware of their health plan requirements regarding availability, location, and appropriate use of emergency and other medical services.