Notice of Privacy Policy and Patient Rights and Responsibilities

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.

We are required by state law to maintain the privacy and security of your health information. For avoidance of doubt, because we do not bill insurance, we are not subject to the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), but we are subject to the requirements of the Minnesota Health Records Act, Minn. Stat. § 144.291 et seq. 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 and let us know in writing. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

Your Rights

When it comes to your health information, you have certain rights. You have the right to:

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 summary of your health information, usually within 30 days of your request.

Under Minnesota law, if you ask to see or receive a copy of your record for purposes of reviewing current medical care, we may not charge you a fee. If you request copies of your patient records of past medical care, or for certain appeals, we may charge you specified fees.

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 decline your request, but we’ll tell you why in writing within 60 days.

Request confidential communication

You can request us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. We may ask you to sign a document to this effect.

We will approve all reasonable requests if the forms that we provide are properly filled out.

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 decline your request if it may affect your care.

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 in the six years prior to the date you ask, including 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 will provide one accounting per 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 file a complaint with the Minnesota Board of Medical Practice at (612) 617-2130 or 1-800-657-3709.

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, please tell us and we will make every effort to accommodate your request.

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

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.

Our Uses and Disclosures of Your Health Information

We may use or share your health information to:

Treat you. We may use your health information to treat you and we may share it with other professionals who are treating you only with your consent or in case of an emergency. Example: To fill your prescription or our pharmacist asks your doctor about your overall health condition.
Run our organization. We can use and share your health information to run our pharmacy, improve your care, and contact you when necessary. Example: To package and mail your medications.
Help with public health and safety issues. We may 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 law requires it.
Address law enforcement and other government requests. We may use or share health information about you 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, national security, and presidential protective services.
Respond to lawsuits and legal actions. We may share health information about you in response to a court administrative order or in response to a subpoena.
Fundraise. We may contact you for fundraising efforts, but you can tell us not to contact you again and we will honor your request.

Updates to this Notice

We may change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request and on our website.

Questions about this notice?

Phone:: (612) 584-4647
Toll free:: (833) 542-2612
Email:: info@roundtablerx.org
Secure fax:: (866) 254-9105

Last updated: November 2026