Notice of Privacy Practices

Fasikl Medical Solutions Notice of Privacy Practices

Your Information. Your Rights. Our Responsibilities.

This Notice describes how Fasikl Medical Solutions (FMS) uses and discloses medical information about you to carry out treatment, payment, or health care operations and for other specific purposes that are permitted or required by law. The Notice also describes your rights and FMS’s duties concerning your protected health information, under the U.S. Health Insurance Portability and Accountability Act (“HIPAA”).

Please review it carefully.

Your Rights

You have the right to:

Your Choices

You have some choices in the way that we use and share information as we:

Our Uses and Disclosures

We may use and share your information as we:

Our Duties & Responsibilities

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.

Get an electronic or paper 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. We may charge a reasonable, cost-based fee.

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 for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

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 the disclosures except for 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 the notice 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 us using the information on page 1.
  • 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 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
  • We will not retaliate against you for filing a complaint.

How to Send Your Request

Send any such requests, in writing, to the Fasikl Medical Solutions 8500 Normandale Lake Blvd, Suite 400B, Bloomington, MN 55437, or contact our Privacy Officer at 763-244-1004.

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. Let us know 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 to:

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

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

In the case of fundraising:

  • We may contact you for fundraising efforts, but you can tell us not to contact you again.

Our Uses and Disclosures

How do we typically use or share your health information?

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

Treat you

We can use your health care information to treat you. We may also share your information with other healthcare providers for the purpose of treatment and care.

Example: A doctor treating you requests information from us about your health condition.

Run our organization

We can use and share your health information to run our practice, improve your care, and contact you when necessary.

Example: We use health information about you to manage your treatment and services.

We may use your health care information to carry out health care operations.

Example, we may use information in your health record to monitor the quality of company performance and/or to train company personnel.

We form contracts with certain entities known as Business Associates to perform services on our behalf. We may disclose protected health information to our Business Associates so that they can perform the job we asked them to do, e.g., to bill your third-party payer for services rendered. We require the Business Associates to safeguard the protected health information appropriately.

Bill for your services

We can use and share your health information to bill and get payment from health plans or other entities. We will use health care information to receive payment for products and services.

Example: We provide information about you to your health insurance plan so that it can cover 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/ocr/privacy/hipaa/understanding/consumers/index.html.

Example: We may contact you to provide information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Help with public health and safety issues

We can share health information about you for certain situations, such as:

  • Preventing or controlling disease, injury, or disability
  • Helping with product recalls
  • Reporting adverse reactions to medications
  • Reporting suspected abuse, neglect, or domestic violence
  • Preventing or reducing a serious threat to anyone’s health or safety
  • Report adverse events regarding equipment and supplies

Do research

We may use or share your information for health research purposes.

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.

Respond to organ and tissue donation requests

We can share health information about you with organ procurement organizations.

Work with a medical examiner or funeral director

We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests

We may also release health information about you as required to comply with laws relating to workers’ compensation or similar programs:

  • For workers’ compensation claims
  • For law enforcement purposes or with a law enforcement official
  • With health oversight agencies for activities authorized by law
  • For special government functions such as military, national security, and presidential protective services

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.

Other Required or Permitted Disclosures

We may disclose your health care information to the following entities and/or under the given circumstances:

  • To law enforcement agencies as required by law or in response to a valid subpoena or other legal process;
  • To health oversight agencies (medical licensing boards, e.g.) for activities authorized by law, such as audits, investigations, and inspections necessary for Fasikl Medical Solutions licensure and for the government to monitor the health care system, etc.;
  • In response to a court order, administrative order, subpoena, discovery request, or other lawful process by another person involved in a dispute involving a patient, but only if efforts have been made to tell the patients about the request or to obtain an order protecting the requested health care information;
  • To notify, or assist in notifying, a family member, personal representative, or another person responsible for the patient’s care, of the patient’s location, or general condition;
  • To a correctional institution or its agents, if a patient is or becomes an inmate of such an institution,
  • When necessary for the patient’s health or the health and safety of others;
  • When necessary to prevent a serious threat to the patient’s health and safety or the health and safety of the public or another person;
  • As required by military command authorities, when the patient is a member of the armed forces, and to the appropriate military authority about foreign military personnel;
  • To authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law;
  • To authorized federal officials so they may provide protection to the president, other authorized persons, or foreign heads of state, or conduct special investigations;
  • To a government authority such as social service or protective services agency, if Fasikl Medical Solutions reasonably believes the patient to be a victim of abuse, neglect, or domestic violence, but only to the extent required by law, if the patient agrees to the disclosure, or if the disclosure is allowed by law and Fasikl Medical Solutions believes it is necessary to prevent serious harm to the patient or to someone else or the law enforcement or public official that is to receive the report represents that it is required and will not be used against the patient.

Our Duties & 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.

Fasikl Medical Solutions takes its responsibility for maintaining your protected health information in confidence very seriously. Protected health information means information about you that may identify you and that relates to your past, present, or future physical or mental health or condition and related health care services. It also includes basic demographic information. We are required by law to maintain the privacy of protected health information and to provide you with this Notice describing our legal duties and privacy practices.

For more information, see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Authorized Use and Disclosure

We will obtain your written Authorization before using or disclosing protected health information about you for purposes other than those listed above or otherwise permitted or required by law. You may revoke an Authorization at any time. Such revocations must be made in writing. Upon receipt of the written revocation, we will stop using or disclosing protected health information about you, except to the extent that we have already taken action in reliance on the Authorization.

Changes to the Terms of this Notice

We reserve the right to modify the terms of this Notice and to make the new Notice provisions effective for all protected health information that we maintain. When we make changes to our Notice, the revised Notice will be available upon request in our office and on our website.

More Stringent Laws

Specific state laws provide additional protections for your health information. In some cases, these laws are more restrictive than federal privacy regulations. Where state law is more protective of your privacy, we will follow the more stringent requirements.

For example, we will not disclose your prescription records or information related to certain sensitive conditions, such as mental health, substance abuse treatment, reproductive health, or HIV/AIDS, without your written permission, unless otherwise permitted or required by law. In addition, f you are a minor and have the legal right under state law to consent to a particular type of health care service, we will protect the confidentiality of records related to that service in accordance with state law.

For More Information or To Report A Problem

If you have questions or would like additional information about our privacy practices, you may contact Fasikl Medical Solutions by phone at 612-286-1099 or in writing to: 8500 Normandale Lake Blvd, Suite 400B, Bloomington, MN 55437

Effective Date of this Notice: June 4, 2025