Notice of Privacy Practices

Nondiscrimination Notice and Access to Communication Services 

ProHEALTH does not discriminate on the basis of sex, age, race, color, national origin, or disability. 

Free services are available to help you communicate with us. Such as, letters in other languages, or in other formats like large print. Or, you can ask for an interpreter. To ask for help, please call the toll-free number 1-877-625-2405. TTY 711. 

If you think you weren’t treated fairly because of your sex, age, race, color, national origin, or disability, you can send a complaint to: 

Optum Civil Rights Coordinator 

11000 Optum Circle 

Eden Prairie, MN 55344 

Fax: 855-351-5495 


If you need help with your complaint, please call the toll-free number 1-877-625-2405. TTY 711. You must send the complaint within 60 days of when you found out about the issue. 

You can also file a complaint with the U.S. Dept. of Health and Human services. 


Complaint forms are available at Phone: Toll-free 1-800-368-1019, 800-537-7697 (TDD) 

Mail: U.S. Dept. of Health and Human Services. 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 

Language Assistance Services and Alternate Formats 

This information is available in other formats like large print. To ask for another format, please call the toll-free number 877-625-2405. TTY 711.

ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Please call 877-625-2405. 

ATENCIÓN: Si habla español (Spanish), hay servicios de asistencia de idiomas, sin cargo, a su disposición.  Llame al [877-625-2405]

請注意:如果您說中文 (Chinese),我們免費為您提供語言協助服務。請致電:[877-625-2405]。 

XIN LƯU Ý: Nếu quý vị nói tiếng Việt (Vietnamese), quý vị sẽ được cung cấp dịch vụ trợ giúp về ngôn ngữ miễn phí. Vui lòng gọi [877-625-2405]. 

알림: 한국어(Korean)를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다. [877- 625-2405]번으로 전화하십시오

PAUNAWA: Kung nagsasalita ka ng Tagalog (Tagalog), may makukuha kang mga libreng serbisyo ng  tulong sa wika. Mangyaring tumawag sa [877-625-2405]. 

ВНИМАНИЕ: бесплатные услуги перевода доступны для людей, чей родной язык является русском  (Russian). Позвоните по номеру [877-625-2405]. 

تنبیھ: إذا كنت تتحدث العربیة (Arabic ،(فإن خدمات المساعدة اللغویة المجانیة متاحة لك. الرجاء الأتصال بـ [2405-625-877.[ 

ATANSYON: Si w pale Kreyòl ayisyen (Haitian Creole), ou kapab benefisye sèvis ki gratis pou ede w nan  lang pa w. Tanpri rele nan [877-625-2405]

ATTENTION : Si vous parlez français (French), des services d’aide linguistique vous sont proposés  gratuitement. Veuillez appeler le [877-625-2405]. 

UWAGA: Jeżeli mówisz po polsku (Polish), udostępniliśmy darmowe usługi tłumacza. Prosimy zadzwonić  pod numer [877-625-2405]. 

ATENÇÃO: Se você fala português (Portuguese), contate o serviço de assistência de idiomas gratuito.  Ligue para [877-625-2405]. 

ATTENZIONE: in caso la lingua parlata sia l’italiano (Italian), sono disponibili servizi di assistenza  linguistica gratuiti. Si prega di chiamare il numero [877-625-2405]. 

ACHTUNG: Falls Sie Deutsch (German) sprechen, stehen Ihnen kostenlos sprachliche  Hilfsdienstleistungen zur Verfügung. Rufen Sie [877-625-2405] an. 

注意事項:日本語 (Japanese) を話される場合、無料の言語支援サービスをご利用いただけ ます。[877-625-2405] にお電話ください。 

توجھ: اگر زبان شما فارسی (Farsi (است، خدمات امداد زبانی بھ طور رایگان در اختیار شما می باشد.  .بگیرید تماس] 877-625-2405] 

पा ध्यान द�: य�द आप �हंद� (Hindi) भाषी ह� तो आपके �लए भाषा सहायता सेवाएं �न:शुल्क उपलब्ध  ह�। कपा पर काल कर� [877-625-2405

CEEB TOOM: Yog koj hais Lus Hmoob (Hmong), muaj kev pab txhais lus pub dawb rau koj. Thov hu rau [877-625-2405].  

ចំណ‌ប់ឣ‍រម�ណ៍ៈ េបើសិនអ�កនិយ‌យភាសាែខ�រ(Khmer)េសវ‌ជំនួយភាសាេដ‌យឥតគិតៃថ� គឺមានសំរ‌ប់អ�ក។ សូមទូរស័ព� េ�េលខ [877-625-2405]។ 

PAKDAAR: Nu saritaem ti Ilocano (Ilocano), ti serbisyo para ti baddang ti lengguahe nga awanan  bayadna, ket sidadaan para kenyam. Maidawat nga awagan iti [877-625-2405]. 

DÍÍ BAA’ÁKONÍNÍZIN: Diné (Navajo) bizaad bee yániłti’go, saad bee áka’anída’awo’ígíí, t’áá jíík’eh, bee  ná’ahóót’i’. T’áá shoodí kohjį’ [877-625-2405] hodíilnih. 

OGOW: Haddii aad ku hadasho Soomaali (Somali), adeegyada taageerada luqadda, oo bilaash ah, ayaad  heli kartaa. Fadlan wac [877-625-2405].

Medical Information Privacy Notice 

Effective January 1, 2022 

We2 are required by law to protect the privacy of your health information. We are  also required to provide you this notice, which explains how we may use  information about you and when we can give out or “disclose” that information to  others. You also have rights regarding your health information that are described  in this notice. We are required by law to abide by the terms of this notice. 

The terms “information” or “health information” in this notice include any  information we maintain that reasonably can be used to identify you and that  relates to your physical or mental health condition, the provision of health care to  you, or the payment for such health care. We will comply with the requirements  of applicable privacy laws related to notifying you in the event of a breach of your  health information. 

We have the right to change our privacy practices and the terms of this notice. If  we make a material change to our privacy practices, and if we maintain a  website, we will post a copy of the revised notice on our website If we maintain a physical delivery site, we will also post a  copy in at our office. The notice will also be available upon request. We reserve  the right to make any revised or changed notice effective for information we  already have and for information that we receive in the future.  

How We Collect, Use, and Disclose Information 

We collect, use, and disclose your health information to provide that information:

To you or someone who has the legal right to act for you (your personal  representative) in order to administer your rights as described in this notice;  and 

To the Secretary of the Department of Health and Human Services, if  necessary, to make sure your privacy is protected.  

We have the right to collect, use, and disclose health information for your  treatment, to bill for your health care and to operate our business. For example,  we may collect, use and disclose your health information: 

For Payment. We may collect, use, and disclose health information to obtain  payment for health care services. For example, we may collect information from, or disclose information to, your health plan in order to obtain payment  for the medical services we provide to you. We may ask you for advance  payment.  

For Treatment. We may collect, use, and disclose health information to aid in  your treatment or the coordination of your care. For example, we may collect information from, or disclose information to your physicians or hospitals to  help them provide medical care to you. 

For Health Care Operations. We may collect, use, and disclose health  information as necessary to operate and manage our business activities related to providing and managing your health care. For example, we might  analyze data to determine how we can improve our services. We may also  de-identify health information in accordance with applicable laws. After that information is de-identified, it is no longer subject to this notice and we may use it for any lawful purpose. 

To Provide You Information on Health-Related Programs or Products  such as alternative medical treatments and programs or about health-related  products and services, subject to limits imposed by law.  

For Reminders. We may collect, use, and disclose health information to send  you reminders about your care, such as appointment reminders with  providers who provide medical care to you or reminders related to medicines  prescribed for you. 

For Communications to You. We may communicate, electronically or via  telephone, these treatment, payment or health care operation messages  using telephone numbers or email addresses you provide to us.  

We may collect, use, and disclose your health information for the following  purposes under limited circumstances:  

As Required by Law. We may disclose information when required to do so  by law.  

To Persons Involved with Your Care. We may collect, use, and disclose  your health information to a person involved in your care or who helps pay for  your care, such as a family member, when you are incapacitated or in an  emergency, or when you agree or fail to object when given the opportunity. If  you are unavailable or unable to object, we will use our best judgment to  decide if the disclosure is in your best interests. Special rules apply regarding  when we may disclose health information to family members and others  involved in a deceased individual’s care. We may disclose health information  to any persons involved, prior to the death, in the care or payment for care of  a deceased individual, unless we are aware that doing so would be  inconsistent with a preference previously expressed by the deceased. 

For Public Health Activities such as reporting or preventing disease  outbreaks to a public health authority. We may also disclose your information to the Food and Drug Administration (FDA) or persons under the jurisdiction  of the FDA for purposes related to safety or quality issues, adverse events or  to facilitate drug recalls. 

For Reporting Victims of Abuse, Neglect or Domestic Violence to government authorities that are authorized by law to receive such information,  including a social service or protective service agency. 

For Health Oversight Activities to a health oversight agency for activities  authorized by law, such as licensure, governmental audits and fraud and  abuse investigations.

For Judicial or Administrative Proceedings such as in response to a court  order, search warrant or subpoena. 

For Law Enforcement Purposes. We may disclose your health information  to a law enforcement official for purposes such as providing limited  information to locate a missing person or report a crime.  

To Avoid a Serious Threat to Health or Safety to you, another person, or  the public, by, for example, disclosing information to public health agencies or  law enforcement authorities, or in the event of an emergency or natural  disaster.  

For Specialized Government Functions such as military and veteran  activities, national security and intelligence activities, and the protective  services for the President and others. 

For Workers’ Compensation as authorized by, or to the extent necessary to  comply with, state workers compensation laws that govern job-related injuries or illness. 

For Research Purposes such as research related to the evaluation of certain  treatments or the prevention of disease or disability, if the research study  meets federal privacy law requirements. 

To Provide Information Regarding Decedents. We may disclose  information to a coroner or medical examiner to identify a deceased person,  determine a cause of death, or as authorized by law. We may also disclose  information to funeral directors as necessary to carry out their duties. 

For Organ Procurement Purposes. We may collect, use, and disclose  information to entities that handle procurement, banking or transplantation of organs, eyes or tissue to facilitate donation and transplantation. 

To Correctional Institutions or Law Enforcement Officials if you are an inmate of a correctional institution or under the custody of a law enforcement official, but only if necessary (1) for the institution to provide you with health  care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution. 

To Business Associates that perform functions on our behalf or provide us  with services if the information is necessary for such functions or services.  Our business associates are required, under contract with us and pursuant to  federal law, to protect the privacy of your information and are not allowed to collect, use, and disclose any information other than as specified in our  contract and permitted by law.  

Additional Restrictions on Use and Disclosure. Certain federal and state  laws may require special privacy protections that restrict the use and disclosure of certain health information, including highly confidential  information about you. Such laws may protect the following types of  information: 

  1. Alcohol and Substance Abuse 
  2. Biometric Information 
  3. Child or Adult Abuse or Neglect, including Sexual Assault  
  4. Communicable Diseases; 
  5. Genetic Information
  6. HIV/AIDS 
  7. Mental Health 
  8. Minors Information 
  9. Prescriptions
  10. Reproductive Health
  11. Sexually Transmitted Diseases

If a use or disclosure of health information described above in this notice is  prohibited or materially limited by other laws that apply to us, it is our intent to  meet the requirements of the more stringent law.  

Except for uses and disclosures described and limited as set forth in this notice,  we will use and disclose your health information only with a written authorization  from you. This includes, except for limited circumstances allowed by federal  privacy law, not using or disclosing psychotherapy notes about you, selling your  health information to others, or using or disclosing your health information for  certain promotional communications that are prohibited marketing  communications under federal law, without your written authorization. Once you  give us authorization to release your health information, we cannot guarantee  that the recipient to whom the information is provided will not disclose the  information. You may take back or “revoke” your written authorization at any time  in writing, except if we have already acted based on your authorization. To find  out how to revoke an authorization, use the contact information below under the  section titled “Exercising Your Rights.”  

What Are Your Rights 

The following are your rights with respect to your health information: 

You have the right to ask to restrict uses or disclosures of your information  for treatment, payment, or health care operations. You also have the right to  ask to restrict disclosures to family members or to others who are involved in  your health care or payment for your health care. Please note that while we will try to honor your request and will permit requests consistent with  our policies, we are not required to agree to any restriction other than  with respect to certain disclosures to health plans as further described  in this notice. 

You have the right to request that we not send health information to  health plans in certain circumstances if the health information concerns a  health care item or service for which you or a person on your behalf has paid  us in full. We will agree to all requests meeting the above criteria and that are  submitted in a timely manner.  

You have the right to ask to receive confidential communications of  information in a different manner or at a different place (for example, by  sending information to a P.O. Box instead of your home address). We will  accommodate reasonable requests. In certain circumstances, we will accept your verbal request to receive confidential communications; however, we may  also require you confirm your request in writing. In addition, any request to  modify or cancel a previous confidential communication request must be  made in writing. Mail your request to the address listed below.  

You have the right to see and obtain a copy of certain health information we maintain about you such as medical records and billing records. If we  maintain a copy of your health information electronically, you will have the  right to request that we send a copy of your health information in an electronic  format to you. You can also request that we provide a copy of your  information to a third party that you identify. In some cases, you may receive  a summary of this health information. You must make a written request to  inspect or obtain a copy your health information or have your information sent  to a third party. Mail your request to the address listed below. In certain  limited circumstances, we may deny your request to inspect and copy your  health information. If we deny your request, you may have the right to have  the denial reviewed. We may charge a reasonable fee for any copies.  

You have the right to ask to amend certain health information we maintain about you such as medical records and billing records if you believe the  information is wrong or incomplete. Your request must be in writing and  provide the reasons for the requested amendment. Mail your request to the  address listed below. If we deny your request, you may have a statement of your disagreement added to your health information.  

You have the right to receive an accounting of certain disclosures of your  information made by us during the six years prior to your request. This  accounting will not include disclosures of information made: (i) for treatment,  payment, and health care operations purposes; (ii) to you or pursuant to your  authorization; and (iii) to correctional institutions or law enforcement officials;  and (iv) other disclosures for which federal law does not require us to provide  an accounting.  

You have the right to a paper copy of this notice. You may ask for a copy  of this notice at any time. Even if you have agreed to receive this notice  electronically, you are still entitled to a paper copy of this notice. If we  maintain a website, we will post a copy of the revised notice on our website.  You may also obtain a copy of this notice on our website, or by calling 1-212-750-1110. 

Exercising Your Rights 

Contacting your Provider. If you have any questions about this notice or  want information about exercising any of your rights, please 1-212-750-1110. Submitting a Written Request. You can mail your written requests to  exercise any of your rights, including modifying or cancelling a confidential  communication, requesting copies of your records, or requesting  amendments to your record, to us at the following address: 


Privacy Administrator 

120 West 23rd Street

New York, NY 10011 

If you believe your privacy rights have been violated, you may file a complaint  with us at the address above. 

You may also notify the Secretary of the U.S. Department of Health and  Human Services of your complaint. We will not take any action against you for  filing a complaint. 

2 This Medical Information Notice of Privacy Practices applies to the following providers that are affiliated with Optum, Inc.: David Moen, MD, PC; Perham Physical Therapy, Ltd. and Waypoint  Minnesota, P.C.