NOTICE OF PRIVACY PRACTICES
Effective Date: August 20, 2026 (replaces the notice effective April 20, 2026)
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.
Get a 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.
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 only when permitted by applicable law.
Ask Us to Correct Your Medical Record
You can ask us to correct health information about you that you think is incorrect or incomplete.
We may say "no" to your request, but we will tell you why in writing within 60 days.
Request Confidential Communications
You can ask us to contact you in a specific way (for example, by phone or mail to a particular address).
We will say "yes" to all reasonable requests.
We may deliver forms, statements, notices, and other documents related to your care electronically (for example, by email or text message) using the contact information you provide. Electronic channels are not fully secure. You may ask us to use a different method, or to stop using a particular method, at any time.
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 could affect your care. If we do agree, we may still share this information if you need emergency treatment.
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 Have Shared Information
You can ask for a list (accounting) of the times we have shared your health information for six years prior to the date you ask, who we shared it with, and why.
We will include all disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We will 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 someone has authority to act as your personal representative, such as a parent of a minor or someone with your medical power of attorney, 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 our Privacy Officer using the information at the end of this notice.
You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by calling 1-877-696-6775 or visiting www.hhs.gov/hipaa/filing-a-complaint.
We will not retaliate against you for filing a complaint.
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. Tell us 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 or payment for your care
Share information in a disaster relief situation
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 Permission:
Marketing purposes
Sale of your information
We do not sell patient information. We will not use or disclose your health information for marketing without your written authorization or condition treatment on giving one. Communications about your care, including appointment reminders and follow-up recommendations, are described below under Contact You About Your Care.
Our Uses and Disclosures
We typically use or share your health information in the following ways.
Treat You
We can use your health information and share it with other professionals who are treating you.
Example: We share information with your primary care provider or a referring provider to coordinate your care.
Share Information with ReVibe Fitness and Wellness, Inc.
ReVibe Fitness and Wellness, Inc. is a separate company that shares our location and licenses us the ReVibe name. It provides fitness and wellness services, not chiropractic care. If you participate in those services and you authorize us to do so, we may share relevant health information with its health and wellness professionals so that what you do there and the care you receive here work together. We share only the minimum information necessary for that purpose. You may revoke that authorization in writing at any time, except as to information we have already shared.
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.
Certain administrative and operational services, including scheduling, reception, and administrative access to our electronic health record, may be provided by ReVibe Fitness and Wellness, Inc. under a management services arrangement. Any personnel with access to your health information operate under a Business Associate Agreement, access information only as necessary to perform their functions, and are trained on HIPAA privacy and security requirements.
Bill for Your Services
We can use and share your health information to bill and get payment from health plans or other entities.
Example: We give information about you to your health insurance plan so it will pay for your services.
Contact You About Your Care
We may contact you by phone, text message, email, or mail using the contact information you give us. These contacts include appointment reminders and confirmations, scheduling and account notifications, billing and benefit notices such as an Advance Beneficiary Notice, recommendations to return for follow-up or a recheck, replies to messages you send us, and requests for feedback about your care.
Text message and email are not fully secure. You may ask us at any time, and in any reasonable way, to use a different method or to stop using one, including by replying STOP to a text message. We will honor that request promptly, and it will not affect your care.
AI-Assisted Clinical Documentation
Our clinic uses AI-assisted documentation tools built into our electronic health records system. With your consent, visits may be audio recorded to generate a draft clinical note. All data is processed securely in compliance with HIPAA. Your provider reviews and finalizes all documentation for accuracy. You may decline audio recording before it begins or ask us to stop recording at any time.
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 must meet many conditions in the law before we can share your information for these purposes.
Help with Public Health and Safety Issues
We can share health information about you for certain situations such as preventing disease, helping with product recalls, reporting adverse reactions to medications, reporting suspected abuse, neglect, or domestic violence, and preventing or reducing a serious threat to anyone's health or safety.
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 are complying with federal privacy law.
Respond to Lawsuits and Legal Actions
We may disclose your health information when required or permitted by applicable law, including in response to a court or administrative order and, when otherwise legally permitted, in response to other lawful processes.
Address Workers' Compensation, Law Enforcement, and Other Government Requests
We can use or share health information about you for workers' compensation claims, for law enforcement purposes or with a law enforcement official, with health oversight agencies for activities authorized by law, and for special government functions such as military and national security.
Respond to Organ and Tissue Donation Requests
We can share health information about you with organizations involved in organ, eye, or tissue donation and transplantation when permitted by applicable law.
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.
Do Research
We can use or share your information for health research under appropriate conditions.
Substance Use Disorder Records
We are not a substance use disorder treatment program. We may, however, receive records that are protected by the federal substance use disorder confidentiality rules at 42 CFR Part 2, for example when we request your records from another provider who has treated you. Those records carry protections beyond what HIPAA requires. If you have given a single consent covering future use and disclosure of those records for treatment, payment, and health care operations, we may use and disclose them for those purposes as HIPAA permits, until you revoke that consent in writing. For any other use or disclosure of those records, and for Part 2 records we receive in any other way, Part 2 materially limits what HIPAA alone would allow, and where the two differ we follow the more restrictive rule.
Part 2 records we receive, and testimony describing what is in them, will not be used or disclosed in any civil, criminal, administrative, or legislative proceeding against you unless you give written consent or a court issues an order after you or the holder of the record has been given notice and an opportunity to be heard. A court order authorizing use or disclosure must be accompanied by a subpoena or other legal requirement compelling disclosure before the record is used or disclosed.
Additional Rights Under Minnesota Law
The Minnesota Health Records Act, Minnesota Statutes sections 144.291 to 144.298, gives you protections in addition to HIPAA. Minnesota generally requires your signed consent before we release your health records, including for some purposes that HIPAA alone would allow without it. Minnesota law allows release without your consent in limited circumstances, such as a medical emergency. Where Minnesota law is more protective of your information than HIPAA, we follow Minnesota law.
A consent to release your health records is generally valid for one year, unless you specify a different period or a different period is set by law. Two consents do not expire after one year: consent to release your records to a provider who is being advised or consulted with in connection with your current treatment here, and consent to release your records to your health insurer, health plan, or third-party administrator for payment of claims, fraud investigation, or quality of care review, so long as those records are not released further in a form that identifies you without your consent. You may revoke any consent in writing at any time, except as to information we have already released in reliance on it. Minnesota also limits what we may charge you for copies of your records, and we may not charge you at all when you request a copy in order to review your current care.
Our 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 the notice currently in effect and give you a copy of it.
We will not use or share your information other than as described in this notice unless you give us written authorization. If you do, you may revoke that authorization at any time in writing, except to the extent we have already acted on it.
We protect your health information through physical, technical, and administrative safeguards. Patient records are maintained in a secure electronic health records system with access limited to authorized personnel. All computers, devices, and systems that access patient data are password-protected and encrypted where applicable.
Changes to the Terms of This Notice
We can change the terms of this notice, and the changes will apply to all information we have about you, including information we created or received before the change. The notice currently in effect is always available on request and posted at www.reviberehabilitation.com/notice-of-privacy-practices.
Contact Information
If you have questions about this notice, want to exercise any of your rights, or wish to file a complaint, please contact:
Privacy Officer: Dr. Gavin Spennewyn, DC
ReVibe Chiropractic and Rehabilitation
Wyn Chiropractic & Rehabilitation PLLC
14300 Buck Hill Rd, Suite E
Burnsville, MN 55306
Phone: (952) 866-9010
Email: info@reviberehabilitation.com
Website: www.reviberehabilitation.com
You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights:
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 1-877-696-6775
Website: www.hhs.gov/hipaa/filing-a-complaint