Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Our Commitment To You

Cardinal Psychotherapy is committed to maintaining the privacy of your health information. During your treatment with us, clinicians, administrative staff, and other personnel may collect information about your health history and your current health status. This Notice explains how that information, called “Protected Health Information” may be used and disclosed to others. The terms of this Notice apply to health information produced or obtained by Cardinal Psychotherapy.

Our Legal Duties

The HIPAA Privacy Law requires us to provide this Notice to you regarding our privacy practices, our legal duties to protect your private information and your rights concerning health information about you. We are required to follow the privacy practices described in this Notice whenever we use or disclose your protected health information (PHI). Other companies or persons that perform services on our behalf, called Business Associates, must also protect the privacy of your information. Business Associates are not allowed to release your information to anyone else unless specifically permitted by law. There may be other state and federal laws, which provide additional protections related to communicable disease, mental health, substance or alcohol abuse, or other health conditions.

Your Health Information May Be Used And Disclosed 

The HIPAA Privacy Law permits Cardinal Psychotherapy to make uses and disclosures of your health information for purposes of treatment, payment and health care operations.

  • Treatment: We will use and may share health information about you for your health care and treatments.  For example, a clinician or Intake Coordinator will obtain treatment information about you and record it in a medical record. Alternatively, one of our clinicians may use information about you for a consultation with, or a referral to, another provider to diagnose your condition and determine which treatment option will best address your health needs. Except in emergency circumstances, we will make a “good faith effort” to get your permission prior to making disclosures outside Cardinal Psychotherapy for treatment purposes. 

  • Payment: We may use and disclose health information about you to obtain payment for the care and services that we have provided to you.  For example, we may need to provide your health plan provider with information about you, your diagnosis, and the treatment provided to you at Cardinal Psychotherapy so that your health insurer will pay us, or reimburse you, for the treatment. We may also contact your health insurance to obtain prior approval about coverage for treatment.  

  • Health Care Operations: We may use and share health information about you for Cardinal Psychotherapy’s health care operations, which include planning, management, quality assessment, and improvement activities for the treatments that we deliver.  For example, we may use your health information to evaluate the skills of our clinicians and other health care providers in caring for you. We also may use your information to review quality and health outcomes. We will obtain your written permission before making disclosures to others outside Cardinal Psychotherapy for health care operations purposes.

  • Appointment Reminders: We may use and disclose PHI to contact you for appointment reminders and to communicate necessary information about your appointment.

  • Practice Updates and Communications: We may use and disclose PHI to contact you with practice updates and news. You are able to opt out of practice communications by unsubscribing to any email communications you receive from our practice. 

  • People Assisting in Your Care: In certain limited situations, Cardinal Psychotherapy may disclose essential health information to people such as family members, relatives, or close friends who are helping care for you or helping you pay your health care bills. For example, we may provide limited information to a family member so that they may schedule appointments for you. Generally, we will ask you prior to making disclosures if you agree to such disclosures. If you are unable to make health-related decisions or it is an emergency, Cardinal Psychotherapy will determine if it would be in your best interest to disclose pertinent health information about you to the people assisting in your care.

  • As Required by Law: We must disclose health information about you if federal, state, or local law requires us. 

  • Serious Threat to Health or Safety: Consistent with applicable laws, we may disclose your PHI if disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public or yourself. We also may disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.

  • Public Health Risks: As authorized by law, we may disclose health information about you to public health or legal authorities whose official responsibilities generally include the following:

  • To prevent or control disease, injury or disability;

  • To report child or elder abuse or neglect, or the abuse or neglect of a dependent adult;

  • To notify the appropriate government authority if we believe a client has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree OR when required or authorized by law.

  • Workers Compensation: If you are seeking compensation due to a work-related injury, we may release health information about you to the extent necessary to comply with laws relating to Workers Compensation claims.

  • Lawsuits and Disputes: If you are involved in a lawsuit, dispute, or other judicial proceeding, we may disclose health information about you in response to a court order or subpoena, other lawful process, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

  • Law Enforcement:  We may disclose your health information to a law enforcement official if required or allowed by law or for reporting crimes occurring on our premises. In emergency situations if we need to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.

  • Required by HIPAA Law: The Secretary of the Department of Health and Human Services (HHS) may investigate privacy violations. If your health information is requested as part of an investigation, we must share your information with HHS.   

    Situations In Which Your Health Information May Be Disclosed With Your Written Consent

For any purpose other than the ones described above, we may only use or share your health information when you give us your written authorization to do so. For example, you will need to sign an authorization form before we can send your health information to your life insurance company. You may revoke an authorization at any time.

  • Marketing: We must also obtain your written authorization before using your health information to send you any marketing materials. The only exceptions to this requirement are that:

    • We can provide you with marketing materials in a face-to-face encounter if we so choose

    • We may communicate with you occasionally about products or services relating to your treatment or the treatment of family members, to coordinate or manage your care, or provide you with information about different treatment options, practice news and events that may be relevant to you, as well as information about our providers or care settings. 

  • Highly Confidential Information: Federal and state law requires special privacy protections for certain “Highly Confidential Information” about you, including any part of your health information that is about: 

    • Child abuse and neglect

    • Domestic abuse of an adult with a disability 

    • Mental illness or developmental disability treatment or services

    • Alcohol or drug dependency diagnosis, treatment, or referral

    • Sexual assault

    • Information maintained in psychotherapy notes

Before we share your Highly Confidential Information for a purpose other than those permitted by law, we must obtain your written permission.

Your Rights Regarding Health Information We Maintain About You

  • Right to Inspect and Copy: You have the right to inspect and receive a copy of your PHI. A request to inspect your records may be made to your clinician who will work with your administrative staff to give you access to your records. For copies of your PHI, requests must go to the Intake Coordinator at admin@cardinalpsychotherapy.com. For PHI in a designated record set that is maintained in an electronic format, you can request an electronic copy of such information. There may be a charge for copies of your PHI.

  • Right to Request Amendment: If you believe that any health information we have about you is incorrect or incomplete, you have the right to ask us to change the information, for as long as Cardinal Psychotherapy maintains the information. To request an amendment to your health information, your request must be in writing, signed, and submitted to Cardinal Psychotherapy. If we deny your request, we will provide you a written explanation. You may respond with a statement of disagreement that will be maintained with your records. If we accept your request to amend the information, we will make reasonable efforts to inform others, including people you name, of the amendment and to include the changes in any future disclosures of that information. 

  • Right to Request Restrictions on Use and Disclosure: You have the right to request a restriction or limitation on certain uses and disclosures of your health information.

To request restrictions, you must make your request in writing to Cardinal Psychotherapy.  In your request, you must tell us:

  • What information you wish to limit 

  • Whether you wish to limit our use, disclosure, or both

  • To whom you want the limits to apply – for example, if you want to prohibit disclosures for insurance payment, health care operations, for disaster relief purposes, to persons involved in your care, or to your spouse. 

You or your personal representative must sign it. 

We are not required to agree to your request, but we will attempt to accommodate reasonable requests when appropriate. We retain the right to terminate an agreed-to restriction if we believe such termination is appropriate. In the event of a termination by us, we will notify you of such termination. You also have the right to terminate, in writing or orally, any agreed-to restriction. 

  • Right to an Accounting of Disclosures: With some exceptions, you have the right to receive an accounting of certain disclosures of your PHI. Your accounting request must be in writing and signed by you or your personal representative, and submitted to Cardinal Psychotherapy. Your request must specify the time in which the disclosures were made. These disclosures may not go back further than six years from the date of the request. 

  • Right to Request Alternate Communications: You have the right to request that we communicate with you about medical matters in a confidential manner or at a specific location. For example, you may ask that we only contact you via mail to a post office box. You must submit your request in writing to Cardinal Psychotherapy.  We will not ask you the reason for your request. Your request must specify how or where you wish to be contacted. We will accommodate all reasonable requests. 

  • Right to Receive a Copy of this Notice: You have the right to a paper copy of this Notice of Privacy Practices even if you have agreed to receive the Notice electronically. You may ask us to give you a copy of this Notice at any time. 

  • Right to Cancel Authorization to Use or Disclose: Other uses and disclosures of your health information not covered by this Notice or the laws that govern us will be made only with your written authorization. You have the right to revoke your authorization in writing at any time, and we will discontinue future uses and disclosures of your health information for the reasons covered by your authorization. We are unable to take back any disclosures that were already made with your authorization, and we are required to retain the records of the care that we provided to you. 

For further information: If you have questions, or would like additional information, you may contact the owner at andrea@cardinalpsychotherapy.com

To File a Complaint: You may submit any complaints with respect to violations of your privacy rights to Cardinal Psychotherapy.  You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services if you feel that your rights have been violated. There will be no retaliation from Cardinal Psychotherapy for making a complaint.

Changes to this Notice: If we make a material change to this Notice, we will provide a revised Notice available on our website at www.cardinalpsychotherapy.com.

Contact Information: Unless otherwise specified, to exercise any of the rights described in this Notice, for more information, or to file a complaint, please contact the owner at andrea@cardinalpsychotherapy.com

Effective Date: This Notice is effective as of 5/1/2021


Cardinal Psychotherapy, 7250 Hudson Blvd. North, Suite 205, Oakdale MN 55128, Contact us at (651) 447-3605