NOTICE OF PRIVACY PRACTICES

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.

I am required by law to maintain the privacy and security of your protected health information (“PHI”) and to provide you with this Notice of Privacy Practices (“Notice”). I must abide by the terms of this Notice, and I must notify you if a breach of your unsecured PHI occurs. I can change the terms of this Notice, and such changes will apply to all information I have about you. The new Notice will be available upon request, in my office, and on my website.

Except for the specific purposes set forth below, I will use and disclose your PHI only with your written authorization (“Authorization”). It is your right to revoke such Authorization at any time by giving me written notice of your revocation.

Uses (Inside Practice) and Disclosures (Outside Practice) Relating to Treatment, Payment, or Health Care Operations Do Not Require Your Written Consent.

I can use and disclose your PHI without your Authorization for the following reasons:

• For your treatment. I can use and disclose your PHI to treat you, which may include disclosing your PHI to another health care professional.
• To obtain payment for your treatment. I can use and disclose your PHI to bill and collect payment for the treatment and services provided by me to you.
• For health care operations. I can use and disclose your PHI for purposes of conducting health care operations pertaining to my practice, including contacting you when necessary.

Certain Uses and Disclosures Do Not Require Your Authorization

Subject to certain limitations in the law, I can use and disclose your PHI without your Authorization for the following reasons:

• When disclosure is required by state or federal law.
• For public health activities, including reporting suspected abuse or preventing serious threats to health or safety.
• For health oversight activities, including audits and investigations.
• For judicial and administrative proceedings, including responding to court orders.
• For law enforcement purposes, including reporting crimes occurring on my premises.
• To coroners or medical examiners.
• For research purposes.
• Specialized government functions.
• For workers’ compensation purposes.
• Appointment reminders and health related benefits or services.

Marketing: As a psychotherapist, I will not use or disclose your PHI for marketing purposes.

Sale of PHI: As a psychotherapist, I will not sell your PHI in the regular course of my business.

Psychotherapy Notes: I do not keep “psychotherapy notes” as that term is defined in 45 CFR§ 164.501. I maintain a record of your treatment which you may request.

Certain Uses and Disclosures Require You to Have the Opportunity to Object

Disclosures to family, friends, or others: I may provide your PHI to a family member, friend, or other person involved in your care unless you object.

YOUR RIGHTS REGARDING YOUR PHI

• The Right to Request Limits: You can request limits on uses and disclosures of your PHI.
• The Right to Request Restrictions for Out-of-Pocket Expenses: You can request restrictions on disclosures to health plans for services paid for in full out-of-pocket.
• The Right to Choose How I Send PHI to You: You can ask me to contact you in a specific way.
• The Right to See and Get Copies of Your PHI: You can request a copy of your medical record.
• The Right to Get a List of the Disclosures I Have Made: You can request a list of disclosures made for purposes other than treatment, payment, or health care operations.
• The Right to Correct or Update Your PHI: You can request corrections to your PHI.
• The Right to Get a Paper or Electronic Copy of this Notice: You can request a copy of this Notice in paper or electronic format.

HOW TO COMPLAIN ABOUT MY PRIVACY PRACTICES

If you think I may have violated your privacy rights, you may file a complaint with me:

Privacy Officer:
11440 W. Bernardo Court, Suite 300, San Diego, CA 92127
Phone: (619) 289-7178

You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by:

1. Sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201;
2. Calling 1-877-696-6775; or,
3. Visiting www.hhs.gov/ocr/privacy/hipaa/complaints.

I will not retaliate against you if you file a complaint about my privacy practices.

EFFECTIVE DATE OF THIS NOTICE

This notice went into effect on 12/1/2023

DATE THIS NOTICE WAS LAST UPDATED

This notice was last updated on 12/14/2024