Notice of Privacy Practices

Your Protected Health Information

Protected health information (“PHI”) is information about you, including demographic data, that can reasonably be used to identify you and that relates to your past, present, or future physical or mental health or condition, the provision of healthcare to you, or payment for that care.

How We Use & Disclose PHI

Federal law permits us to use and disclose your PHI without your written authorization in the following circumstances:

Treatment

We may use and disclose your PHI to provide, coordinate, or manage your healthcare and related services. This includes sharing your information with other physicians or healthcare providers involved in your treatment. For example, we may share your records with a specialist to whom we refer you.

Payment

We may use and disclose your PHI to obtain payment for the healthcare services we provide to you. For example, we may submit claims to Medicare, Medi-Cal, or private insurance companies and include your PHI in those claims.

Healthcare operations

We may use and disclose your PHI to support the business activities of our practice, including quality assessment, staff training, accreditation, licensing, and business planning.

Other permitted uses

• As required by law
• For public health activities (such as disease reporting)
• To report suspected abuse or neglect
• To avert a serious threat to health or safety
• For workers’ compensation purposes
• For certain government functions (military, national security)
• To coroners, medical examiners, or funeral directors
• To organ procurement organizations

Uses Requiring Your Authorization

We will not use or disclose your PHI for any purpose other than those listed above without your written authorization. You may revoke your authorization at any time in writing, except to the extent we have already acted in reliance on it. Uses and disclosures requiring your written authorization include:

• Marketing purposes
• Sale of your PHI
• Most disclosures of psychotherapy notes
• Any other use or disclosure not described in this Notice

Your Rights

Right to access your records

You have the right to inspect and receive a copy of your PHI maintained in our records, with limited exceptions. We may charge a reasonable fee for copies. To request access, submit a written request to our Privacy Officer.

Right to amend

You have the right to request that we amend PHI you believe is incorrect or incomplete. We may deny your request under certain circumstances and will explain our reasons in writing.

Right to an accounting of disclosures

You have the right to request a list of certain disclosures of your PHI we have made in the previous six years, other than disclosures for treatment, payment, or healthcare operations.

Right to request restrictions

You have the right to request restrictions on how we use or disclose your PHI. We are not required to agree to all requests, but we will comply if you request that we not disclose information to a health plan for services you paid for in full out of pocket.

Right to request confidential communications

You have the right to request that we communicate with you about your health information in a certain way or at a certain location (for example, only by mail or only at a specific phone number).

Right to a paper copy of this Notice

You have the right to receive a paper copy of this Notice upon request, even if you agreed to receive it electronically.

Right to be notified of a breach

You have the right to be notified if there is a breach of your unsecured PHI.

Our Duties

We are required by law to:

• Maintain the privacy of your PHI
• Provide you with this Notice of our legal duties and privacy practices
• Abide by the terms of the Notice currently in effect
• Notify you in the event of a breach of your unsecured PHI

We reserve the right to change this Notice and to make the revised Notice effective for PHI we already have about you as well as PHI we receive in the future. A current copy will always be available at our office and on this website.

How to File a Complaint

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services. We will not take any action against you for filing a complaint.

To file a complaint with HHS, contact the Office for Civil Rights at:
200 Independence Avenue S.W., Washington, D.C. 20201
Phone: 1-800-368-1019  ·  Website: www.hhs.gov/ocr

To file a complaint about California medical record privacy, you may also contact the California Medical Board or the California Attorney General’s Office.

Contact the Privacy Officer