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. For example, if you are being  treated by a physician or a psychiatrist, I can disclose your PHI to him or her to help  coordinate your care, although my preference is for you to give me an Authorization to  do so. 

  • 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 example, I  might send your PHI to your insurance company to get paid for the health care services  that I provided to you, although my preference is for you to give me an Authorization to  do so. 

  • 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. For example, I may need to disclose your PHI to my attorney to obtain advice  about complying with applicable laws. 

Certain Uses and Disclosures Require Your Authorization 

  • Psychotherapy Notes. I do not keep “psychotherapy notes” as that term is defined in  45 CFR § 164.501; rather, I keep a medical record of your treatment and you may  request a copy of such record at any time, or you may request that I prepare a summary  of your treatment. There may be reasonable, cost-based fees involved in copying the  record or preparing the summary.

  • Marketing Purposes. 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. 

Certain Uses and Disclosures Do Not Require Your Authorization 

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

  • When disclosure is required by state or federal law, and the use or disclosure complies  with and is limited to the relevant requirements of such law. 

  • For public health activities, including reporting suspected child, elder, or dependent adult  abuse, or preventing or reducing a serious threat to anyone’s health or safety.

  • For health oversight activities, including audits and investigations. 

  • For judicial and administrative proceedings, including responding to a court or  administrative order, although my preference is to obtain an Authorization from you  before doing so. 

  • For law enforcement purposes, including reporting crimes occurring on my premises.

  • To coroners or medical examiners, when such individuals are performing duties  authorized by law. 

  • For research purposes, including studying and comparing the mental health of patients  who received one form of therapy versus those who received another form of therapy for  the same condition. 

  • Specialized government functions, including, ensuring the proper execution of military  missions; protecting the President of the United States; conducting intelligence or  counter-intelligence operations; or, helping to ensure the safety of those working within  or housed in correctional institutions. 

  • For workers' compensation purposes. Although my preference is to obtain an  Authorization from you, I may provide your PHI in order to comply with workers'  compensation laws. 

  • Appointment reminders and health related benefits or services. I may use and disclose  your PHI to contact you to remind you that you have an appointment with me. I may also  use and disclose your PHI to tell you about treatment alternatives, or other health care  services or benefits that I offer. 

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 that you indicate is involved in your care or the payment for your  health care, unless you object in whole or in part. The opportunity to consent may be  obtained retroactively in emergency situations. 

Your Rights Regarding Your PHI 

You have the following rights with respect to your PHI: 

  • The Right to Request Limits on Uses and Disclosures of Your PHI. You have the  right to ask me not to use or disclose certain PHI for treatment, payment, or health care operations purposes. I am not required to agree to your request, and I may say “no” if I  believe it would affect your health care. 

  • The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You  have the right to request restrictions on disclosures of your PHI to health plans for  payment or health care operations purposes if the PHI pertains solely to a health care  item or a health care service that you have paid for out-of-pocket in full. 

  • The Right to Choose How I Send PHI to You. You have the right to ask me to contact  you in a specific way (for example, home or office phone) or to send mail to a different  address, and I will agree to all reasonable requests. 

  • The Right to See and Get Copies of Your PHI. Other than “psychotherapy notes,” you  have the right to get an electronic or paper copy of your medical record and other  information that I have about you. I will provide you with a copy of your record, or a  summary of it, if you agree to receive a summary, within 10 business days of receiving  your written request, and I may charge a reasonable, cost-based fee for doing so. 

  • The Right to Get a List of the Disclosures I Have Made. You have the right to request  a list of instances in which I have disclosed your PHI for purposes other than treatment,  payment, or health care operations, or for which you provided me with an Authorization. I  will respond to your request for an accounting of disclosures within 60 days of receiving  your request. The list I will give you will include disclosures made in the last six years  unless you request a shorter time. I will provide the list to you at no charge, but if you  make more than one request in the same year, I will charge you a reasonable cost based fee for each additional request. 

  • The Right to Correct or Update Your PHI. If you believe that there is a mistake in your  PHI, or that a piece of important information is missing from your PHI, you have the right  to request that I correct the existing information or add the missing information. I may  say “no” to your request, but I will tell you why in writing within 60 days of receiving your  request. 

  • The Right to Get a Paper or Electronic Copy of this Notice. You have the right get a  paper copy of this Notice, and you have the right to get a copy of this notice by e-mail.  And, even if you have agreed to receive this Notice via e-mail, you also have the right to  request a paper copy of it. 

How to Complain About My Privacy Practices 

If you think I may have violated your privacy rights, or if you object to a decision I made about  access to your PHI, you are entitled to file a complaint with me, as the Privacy Officer for my  practice. My address and telephone number are: 5101 Douglas Fir Road, Calabasas CA 91302  / Phone: 818-252-9249. 

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

  • Sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201;

  • Calling 1-877-696-6775; or, 

  • 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 October 1, 2023.