Patient Information


Welcome to Neighborhood HealthSource, your source for primary healthcare for all ages. Thank you for choosing us as your clinic. We are confident you will be pleased with your care here.

If you have an emergency needing immediate attention, call 911 for assistance.

Click on a page section below for detailed information.  

Payment Information Hospitalizations
Health Insurance We Accept Prenatal Care
Service Availability After the Clinic is Closed
How to Pay if You Don't Have Insurance Patient Rights and Responsibilities
Making an Appointment 
Notice of Health Information Practices
Planning for your Appointment

 

Payment Information:

We offer our services to both insured and uninsured patients.

 

Health Insurance We Accept:

Our clinics accept most private health insurance plans as well as Medical Assistance (MA)/Medicaid and Medicare:

  • Medica
  • Metropolitan Health Plan
  • HealthPartners
  • BlueCross
  • Hennepin Health
  • UCare
  • PreferredOne
  • MinnesotaCare
  • MDH Sage
  • MFPP

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MNsure Open Enrollment is Here! 

Open Enrollment is November 1, 2017 - January 14, 2018

If you are uninsured, we can help you get insurance coverage. Our Patient Access Coordinators will give you information about insurance options and eligibility requirements, help you use available tax credits to reduce the cost of insurance, and offer support with the MNSure state market place. They are experienced with Medicaid and Medicare, MFPP and other insurance options. 

When you meet with a Patient Access Coordinator, please bring:

  • Social security numbers for everyone applying for insurance
  • Dates of birth of all applicants, preferably with birth certificates or passports
  • Driver’s License or other acceptable ID
  • Most recent tax forms, including W2s
  • Proof of income for the last 30 days, including social security income, self employment and unemployment
  • If not a US Citizen, proof of immigration status such as Permanent resident cards or employment authorization cards
  • If offered insurance at work, dates of open enrollment and Employer identification number (also known as Company Tax ID)

Patient Access Coordinators can also help you navigate the health care system, schedule follow-up appointments with specialists, and connect you to resources in your community. Appintments with PACs are available in English and Spanish, and usually last an hour. To learn more or to make an appointment, call 612-287-2466 or email This email address is being protected from spambots. You need JavaScript enabled to view it.

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How to Pay if You Don't Have Insurance

We offer our services to uninsured patients, and to those insured patients who are unable to afford deductibles or co-pays, on a sliding fee scale. The scale is based on income and family size. Please contact one of our Patient Access Coordinators at This email address is being protected from spambots. You need JavaScript enabled to view it. prior to scheduling your first visit to determine if you are eligible to participate in this Sliding Fee Schedule program. You will be asked to bring one of the following proof-of-income documents: 

  • All paystubs from the last 30 days
  • A printout of unemployment payments
  • A copy of your most recent income tax form
  • IRS W2 forms from last year from each employer

Your income and family size will determine which portion of our services will be discounted, and which portion you will be responsible for.

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Making an Appointment:

To schedule an appointment, please call 612-588-9411. We would like you to call ahead for an appointment. To help us give you the right kind of appointment, please tell the scheduler about your medical concern. If you need an appointment on the same day you call, call early in the morning. We will do the best we can to serve you, but there may be a longer wait time. Because they require longer visits, preventive care needs such as well-child exams, physicals and family planning should be scheduled two to three weeks in advance.

If the will patient need an interpreter or language translation services, please tell the scheduler when making the appointment. We do not recommend relying on family members, friends or private interpresters to assist with your visit because we cannot be certain of their medical language skills. Although you certainly have a right to include such individuals at the time of your visit, we will use staff interpreters and will not pay for private interpretation service.

For your convenience, Neighborhood HealthSource also operates a patient portal. This portal can be used to request an appointment electronically. For more information about how to set up your electronic account, please see our Patient Portal tab.

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Planning for your Appointment:

  • Plan to arrive 15 minutes prior to your appointment time
  • Bring a list of all your prescriptions
  • Bring your insurance card and/or sliding fee documentation
  • Bring any registration forms you have completed in advance
  • Note about childcare: We do not provide child care services, so if you bring children who do not have an appointment please bring someone along to care for them during your appointment.

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Hospitalizations:

We collaborate with most metro-area hospitals. If you need to be hospitalized, your choice of hospitals is usually determined by insurance and health needs. 

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Prenatal Care:

If you suspect or know that you are pregnant, it is important to make an appointment as soon as possible. You and your baby need lots of attention, especially during the first three months of pregnancy. We have providers at every clinic who provide prental care, and we will refer you to a nearby hospital for the delivery of your baby. Once you bring your baby home, we can proivde all early childhood primary care. 

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Service Availability after the Clinic is Closed:

If you have an emergency needing immediate attention, call 911 for assistance. If you have an urgent health problem after regular clinic hours, call us at 612-588-9411. An operator will take your name and phone number, the patient’s name, and the reason for your call. We will return your call within the hour to advise you about what steps to take at home, whether you should seek immediate care at a clinic or hosptial, or whether your need can wait until the next day for an appointment at one of our clinics.

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Patient Rights and Responsibilities:

Dignity as an individual human being

You have the right to the same consideration and treatment as anyone regardless of your: 

  • Ability to pay
  • Beliefs
  • Marital status
  • Age, sex, race, or national origin
  • Sexual orientation
  • Physical or mental ability

Privacy regarding your health care

We take your privacy as a patient seriously.

Please do not have anyone else call to talk about your medical condition. To protect your confidentiality, we can give information only to you. We give information about children under age 18 only to their parents or legal guardians. If you are under 18, we may see you for family planning, sexually transmitted diseases, pregnancy, mental health and substance abuse related visits without parental consent and will not reveal your information.

All children under 18 should have a parent with them for the visit. If this is not possible, another adult should be with the child, and a parent should be available by phone. If someone other than a parent or legal guardian brings your child (under age 18) to an appointment, please send a signed note with them giving permission for that person to authorize care. 

Confidentiality of your records 

Your records are the property of the clinic and are kept in strictest confidence. The clinic can show them to others only when: 

  • You give written permission, such as requests for copies to other health care providers 
  • A court requires the clinic to produce them
  • Nothing in the information names or identifies you
  • You file a workers’ compensation claim

You have the right to review your medical record with your health care provider. Other patient rights are described in the Notice of Health Information Practices. A current copy is available for you at the front desk. 

Understand Your Health Care

You have the right to ask:

  • What is my problem exactly?
  • What are the recommended treatments?
  • How much will each one cost?
  • How long will each one take?
  • What are the risks, if any?

Consent or Refusal of Treatment

As the patient, it is your decision. You have the right to refuse recommended treatment or exams. Make sure you read and understand consent forms before signing them. However, you are also responsible for understanding the risks of your decisions. Please don’t hesitate to ask questions. 

With these rights, you also have the following responsibilities:

  • To be honest with the clinic staff 
  • To understand your health problems to your satisfaction 
  • To follow the treatment plan, or tell your care provider that you don’t think you can or want to follow the plan 
  • To keep appointments or notify the clinic when you cannot keep them 
  • To give the clinic your current address and phone number 
  • To pay for your care according to the sliding fee scale, or provide information on your insurance coverage 

Concerns About Your Care 

If you have any concerns about any aspect of your care, ask to speak to the Director of Clinical Operations. If the problem is not resolved to your satisfaction, your concern will be referred to the Executive Director.

How to Become Involved In the Clinics 

Neighborhood HealthSource is a private, nonprofit organization with a community-based Board of Directors. Over half of the Board members are patients at the clinics. If you are interested in serving on the Board or in another area, or have other suggestions, call our Executive Director at 612-588-9411.

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Notice of Health Information Practices:

Effective 9/23/2013

THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED OR DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW CAREFULLY.

To effectively treat you, Neighborhood HealthSource must collect health information about you and disclose it to other people. Your health information is confidential and we have policies and procedures in place to protect it. This notice describes: what types of information we collect, when and to whom we may give your information, and other information. This Notice of Health Information Practices is not a contract which forms the basis of any private right of action.

We are required to abide by the terms of our Notice of Privacy Practices currently in effect. We reserve the right to change our privacy practices and the terms of this notice at any time, and to have those changes be effective for all information that we have, including health information we created or received before the effective date of the new notice. Except, when required by law, any significant change in our privacy practices will not be implemented prior to the effective date of the new notice. We will post a copy of the current notice in each facility and on our website at www.neighborhoodhealthsource.org.


OUR PLEDGE REGARDING HEALTH INFORMATION
We understand that health information about you is personal. We are committed to protecting the privacy of your health information by complying with all applicable federal and state privacy and confidentiality laws.

We are required by law to maintain the privacy of your health information and to provide you with this notice about the ways in which we may use and disclose health information about you, our legal obligations and privacy practices, and your privacy rights. We also are required to notify you if there is a breach of your health information.

HEALTH INFORMATION COVERED BY THIS NOTICE
Personal health information is information that we create or receive that identifies you and relates to your past, present or future physical, mental health or condition; the provision of health care to you; or to the past, present or future payment for health care furnished to you.

WHO WILL FOLLOW THIS NOTICE

  • All Neighborhood HealthSource Providers.
  • All residents, medical students and other trainees affiliated with Neighborhood HealthSource.
  • All volunteers who may assist you while you receive services at Neighborhood HealthSource.
  • All employees, staff and other Neighborhood HealthSource workers.

YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
Your rights regarding your health information are explained in this section. To exercise any of these rights we may ask you to submit a request in writing. Forms to request any of the following are available on our website at www.neighborhoodhealthsource.org, and at each clinic location. These forms contain the necessary information we need to process your request.

Access: You have the right to look at or get copies of your health information, with limited exceptions. If you request copies, we may charge you a fee to cover the costs of copying, mailing and other supplies. We may deny your request in very limited circumstances. If we deny your request, you may be entitled to a review of that denial.

Amendment: If you feel that your health information is wrong or something is missing, you have the right to request that we amend it. We may deny your request if we did not create the information you want amended or for certain other reasons. If we deny your request, we will provide you a written explanation. You may respond with a statement of disagreement regarding our decision to be included in your records.

Accounting of Disclosures: You have the right to receive a list of disclosures we have made of your health information. This right does not apply to disclosures for treatment, payment, health care operations and certain other purposes. If you request this list more than once in a 12-month period, we may charge you a reasonable, cost-based fee. Your request must state a time period which may not be longer than six years.

Restriction Requests: You have the right to request that we place restrictions on our use or disclosure of your health information for treatment, payment or health care operations. We may not be able to agree to all requests for restriction, but if we do, we will abide by our agreement (except in an emergency). Unless we are required by law to submit claims for services to your health plan, we agree to restrict disclosures to your health plan for payment or health care operations if you pay in full at the time of service.

Confidential Communication: Normally, we will communicate with you at the address and phone number you give us. You have the right to request that we communicate with you in confidence about your health information by alternative means or to an alternative location. For example, you may ask that we contact you only at work or by mail. We will accommodate all reasonable requests.

Right to a Paper Copy of This Notice: You have the right to a paper copy of this notice at any time even if you have agreed to receive this notice electronically. To obtain a paper copy of this notice, you may request a copy at any of our clinic locations or you may obtain a copy of this notice at our website, www.neighborhoodhealthsource.org.

Opt Out Option for Fundraising and Marketing: Neighborhood HealthSource may use and release some of your information to contact you about supporting its activities through donations. The information that may be used or released for this purpose is limited to the following: demographic information such as your name, address and contact information. You can choose not to be contacted by contacting Neighborhood HealthSource Privacy Administration at the phone number or address listed at the end of this notice.

Others Acting on Your Behalf: These rights may also be exercised by someone who has the legal right to act on your behalf.

USES AND DISCLOSURES OF HEALTH INFORMATION WITHOUT AUTHORIZATION
To provide you the best quality care, we need to use and disclose health information. We safeguard your health information whenever we use or disclose it. We follow our Notice of Health Information Practices and the law when we use and disclose health information. We may use and disclose your health information without your written authoriziation as follows:

Treatment, Payment and Health Care Operations: We may use and disclose your health information for:

  • Treatment - Provide, coordinate, or manage your health care (including working with another provider)
  • Payment (such as billing to you or your insurance company for services provided), and
  • Our health care operations. These are non-treatment and non-payment activities that let us run our business or provide services. These include quality assessment and improvement, care management, reviewing the competence of qualifications of health professionals, and conducting training programs.

Electronic Health Records: Neighborhood HealthSource uses an electronic health record that allows care providers within Neighborhood HealthSource facilities to store, update and use your health information. They may do so as needed at the time you are seeking care, even if they work at different locations. We do this so it is easier for your providers to access your health information when you are seeking care and to better coordinate and improve the quality of your care.

This electronic health record is a secure system that is maintained by Neighborhood HealthSource and our staff that uses the system are trained to ensure your information is private.

Appointment Reminders and Treatment Alternatives: We may use and disclose health information to contact you as a reminder that you have an appointment for treatment or health care. We may also tell you about treatments and health-related benefits or services that you may find helpful.

Individuals involved in Your Care or Payment for Your Care: If we feel it is in your best interest, we will disclose health information to a family member, friend or others involved in your care if you are unable to agree due to your incapacity or emergency circumstances, or are not present.

Business Associates: These are services provided through contracts with business associates, such as accountants, computer consultants, lab consultants, etc. Information may be disclosed so they are able to perform their jobs. By contract, we require our business associates to safeguard your health information.

Special Situations
We may also use and disclose health information without an authorization in the following situations:

Law Enforcement: For purposes as permitted or required by law or in response to a search warrant or court order.

Correction Facility: Health information of an inmate or other person in custody to law enforcement or a correctional institution as necessary for your health and safety and the health and safety of others.

Abuse, Neglect or Threat: Health information to the proper authorities about possible abuse or neglect of a child or a vulnerable adult. If there is a serious threat to a person’s health or safety, we may disclose information to the person or to law enforcement.

Food and Drug Administration (FDA) Regulations: Health information to entities regulated by the FDA to measure the quality, safety and effectiveness of their products.

Military Authorities/National Security: Health information to authorized people from the U.S. military, foreign military and U.S. national security or protective services.

Public Health Risks: Health information about you for public health purposes, such as:

  • reporting and controlling disease (such as cancer or tuberculosis), injury or disability
  • notifying persons of recalls, repairs or replacements of products they may be using, or
  • notifying a person who may have been exposed to a disease or may be at risk for catching or spreading a disease or condition.

Health Oversight Activities: Health information to government, licensing, auditing and accrediting agencies for actions allowed or required by law. For example: audits, investigations, inspections and licensing.

Required by Other Laws: Health information as required by other laws. For example:

  • We may disclose health information the U.S. Department of Health and Human Services during an investigation.
  • We may disclose health information under workers’ compensation or similar laws.
  • We may disclose health information:
    • to social services and other agencies or people allowed to receive information about certain injuries or health conditions for social service, health or law enforcement reasons
    • about an unemancipated minor or a person who has a legal guardian or conservator regarding a pending abortion
    • about an emancipated minor or a minor receiving confidential services to prevent a serious threat to the health of the minor.
    • to coroners, medical examiners and funeral directors in regard to a deceased person. This may be necessary for example, to identify a deceased person or determine the cause of death.
    • for special government functions, such as disclosures to authorized federal officials for national security activities, as required by law.

Legal Process: Health information in response to a state or federal court order, legal orders, subpoenas or other legal documents.

Health Records under State Law: Release of health records (such as medical charts or x-rays) by licensed Minnesota providers usually requires the signed permission of a patient or the patient’s legal representative. Exceptions include you having a medical emergency, you seeing a related provider for current treatment, and the releases required or allowed by law.

WITH YOUR AUTHORIZATION
We may use or disclose health information only with your written permission, except as described above. If you give written permission, you may revoke that authorization at any time by notifying us in writing. A form to revoke your permission is available from Neighborhood HealthSource where you received services, or by contacting us. Your permission will end when we receive the signed form or when we have acted on your request. However, we are unable to take back any disclosures we have already made with your permission.

FOR MORE INFORMATION OR TO REPORT A PROBLEM
If you want more information about our privacy practices, have questions, concerns, or believe that we may have violated your privacy rights, please contact Neighborhood HealthSource Privacy Administration: 3300 Fremont Ave N, Minneapolis, MN 55412 or 612-588-9411

You also may submit a written complaint to the U.S. Department of Health and Human Services, Office for Civil Rights. Visit www.hhs.gov/ocr/privacy/hipaa/complaints for complete information on filing a complaint. We support your right to protect the privacy of your medical information. We will not retaliate in any way if you choose to file a complaint.

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