EAR, NOSE & THROAT SPECIALTY CARE

Notice of Privacy Practices

During your treatment at Ear, Nose & Throat Specialty Care (ENTSC), doctors, nurses and
other caregivers may gather information about your medical history and your current health.


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.

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.

Copy of medical record

  • Receive an electronic or paper copy of your medical record.
  • You can ask to see or copy your medical record and other health information. Ask us how to do this.
  • We will provide a copy or summary within a reasonable time, unless protected by law.
  • No fee for reviewing current medical care records.
  • Fees may apply for past records or certain appeals.
  • Requests must be made in writing.
  • If denied, you may request review by a health care professional.
  • We will act within 30 days.

Request to amend medical record

  • Ask us to correct information you believe is incorrect or incomplete.
  • We may deny your request, but will explain why in writing within 60 days.
  • You may submit a statement of disagreement.

Request confidential communications

  • Ask us to contact you in a specific way or location.
  • Requests must be in writing.
  • We will honor all reasonable requests.

Request to limit use/sharing of TPO

  • Ask us not to use or share information for treatment, payment, or operations.
  • We are not required to agree.
  • If you pay out-of-pocket in full, you can request we not share with your insurer.
  • We will agree unless required by law.
  • We may still share information in emergencies.

List of disclosures

  • Request a list of disclosures for the past six years.
  • One free list per year; additional requests may incur a fee.

Copy of this notice

You can request a paper copy at any time, even if you agreed to electronic delivery.

File a complaint

  • Contact us if you feel your rights were violated.
  • You may file with the U.S. Department of Health and Human Services.
  • We will not retaliate against you.

Your Choices

Request us not to share

  • With family, friends, or others involved in your care.
  • In disaster relief situations.
  • In a hospital directory.
  • If unconscious, we may act in your best interest.
  • We may share to prevent serious threats to health or safety.

We will never share without permission

  • Marketing purposes
  • Sale of your information
  • Most psychotherapy notes
  • Minnesota law may require additional consent

Fundraising

We may contact you for fundraising, but you can opt out.

Our Uses and Disclosures

How we use your information

Treatment

We use your information to provide and manage your care. We may share it with other professionals with your consent.

Operations

We use your information to run our practice and improve care. Consent is required before sharing with other providers for their operations.

Billing

We use your information to bill and receive payment from insurers or other entities.

Other Uses

Public health and safety

  • Prevent disease
  • Product recalls
  • Report reactions or abuse
  • Prevent threats to safety

Research

We may use your information for research unless you object.

Legal compliance

We share information when required by law.

Organ donation

We may share information with consent.

Medical examiner

We may share information after death; consent required for funeral directors.

Government requests

  • Workers’ compensation
  • Law enforcement (with consent unless required)
  • Health oversight agencies
  • Military or national security (with consent unless required)

Legal actions

We may share information in response to court orders or subpoenas.

Other state law

Minnesota law generally requires consent for treatment, payment, and operations disclosures unless exceptions apply.

Our Responsibilities

  • Maintain privacy and security of your information
  • Notify you of breaches
  • Follow this notice
  • Obtain permission for uses not described here

You may change your consent at any time in writing.

Changes to This Notice

This Notice of Privacy Practices is effective as of 3/12/2026.

We may update this notice, and changes will apply to all information we maintain.

Contact Information

Name and contact of Privacy Official: _____

6099 Wayzata Boulevard Suite 200
St. Louis Park, MN