Notice of Privacy Practices

Our duties to you

• The law requires us to keep your protected health information private and secure, and to give you this notice of our legal duties and privacy practices.
• We must follow the terms of the notice currently in effect.
• We will not use or share your information in ways this notice does not describe unless you give us written permission.

If a breach occurs

The law requires us to notify you after a breach of your unsecured protected health information. We will tell you without unreasonable delay, and no later than 60 days after we discover the breach. The notice will describe what happened, what information was involved, what you can do to protect yourself, and what we are doing in response.

Changes to this notice

We reserve the right to change the terms of this notice, and a change will apply to all the protected health information we keep, including information we created or received before the change. If we change the notice, we will post the revised version on this page with its new effective date, keep copies at our office, and give you a copy whenever you ask.

How we use and share your information

We can use and share your information without your written permission for the purposes below. Federal law allows each of them. California law sometimes allows less, and where it does, the description below follows California law.

Treatment, payment, and running our practice

Treatment

We use your information to treat you, and we can share it with other physicians, therapists, and health care providers who are treating you or whom we consult about your care. For example, your psychiatrist may send your primary care physician a note about a new medication.

Payment

We may use and disclose your PHI in order to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits.

Health care operations

We can use and share your information to run our practice, improve your care, and contact you when needed. For example, we may review records to evaluate the quality of the care you received, or send you appointment reminders.

Our business associates

We may share your information with companies that perform services for us, such as the companies that host our electronic health record, patient portal, and email. Each must sign a contract, called a business associate agreement, that requires it to protect your information.

Family, friends, and disaster relief

We may share information that is directly relevant to a person’s involvement in your care, or in paying for it, with a family member, other relative, domestic partner, close friend, or anyone else you name. If you are available and able to make health care decisions, we will share only if you agree, or if we give you the chance to object and you do not. If you are not available, or cannot decide because of an emergency or incapacity, we may share it if we judge that doing so is in your best interest. In a disaster, we may give a disaster relief organization limited information, such as your name, city of residence, age, sex, location, and general condition, to answer inquiries and help notify your family.

Other uses and disclosures the law allows or requires

Required by law

We share information when a federal, state, or local law requires it, including with the U.S. Department of Health and Human Services if it asks to see that we are complying with federal privacy law.

Public health

We may share information with public health authorities to prevent or control disease, injury, or disability, and we may report adverse reactions to medications or problems with medical products to the U.S. Food and Drug Administration.

Abuse, neglect, and domestic violence

We may report suspected abuse, neglect, or domestic violence to government authorities when the law requires or allows it, including under California’s child abuse and elder and dependent adult abuse reporting laws.

Serious threats to health or safety

If one of our physicians believes in good faith that sharing information is necessary to prevent or lessen a serious and imminent threat to the health or safety of a reasonably foreseeable victim, we may share it with people reasonably able to prevent or lessen the threat, including the person threatened.

Health oversight

We may share information with agencies that oversee health care, such as the Medical Board of California, for audits, investigations, inspections, and licensing.

Lawsuits and legal proceedings

We may share information in response to a court or administrative order. We may also respond to a subpoena or other lawful request in a legal proceeding when the conditions the law sets are met, such as notice to you or a protective order. We will not comply with a court order from another state that acts as a subpoena unless it has been issued under California’s procedure for out-of-state subpoenas. Substance use disorder treatment records from federally covered programs have added protection, described below.

Law enforcement

We share information with law enforcement only when the law requires it, for example in response to a court order, a valid search warrant, or a subpoena, or when California law specifically authorizes it.

Coroners and medical examiners

We may share information with a coroner, medical examiner, or forensic pathologist who is investigating a death.

Organ and tissue donation

After a patient’s death, we may share information with an organ procurement organization or tissue bank to help with transplantation.

Research

We may share information for health research when the conditions the law sets are met, such as approval by an institutional review board or privacy board. Researchers may not further disclose the information in a way that identifies you.

Workers’ compensation

We may share information for workers’ compensation claims as workers’ compensation laws allow.

Special government functions

We may share information for military, national security, and presidential protective services purposes when a law requires or specifically authorizes it.

Uses that need your written permission

We will not do any of the following without your written authorization:

• Use or share psychotherapy notes, except in the few cases the law allows, such as use by the clinician who wrote them to treat you, our defense in a legal action you bring against us, or when the law requires it. Psychotherapy notes are notes a mental health professional keeps separately from the rest of your record about the contents of a counseling session. They do not include medication and prescription records, session start and stop times, test results, or summaries of your diagnosis, symptoms, treatment plan, or progress.
• Use or share your information for marketing.
• Sell your information.
• Use or share your information in any other way this notice does not describe.

If you give us an authorization, you can revoke it at any time by telling us in writing. A revocation does not undo anything we have already done in reliance on the authorization.

Mental health and substance use records

Information about outpatient psychotherapy

California gives extra protection to information about your outpatient treatment with a psychotherapist, a term that includes psychiatrists. If a person or agency that California law otherwise allows to receive medical information asks for information specifically about that treatment, it must send us a signed written request that states what it wants and how it will use it, how long it will keep the information, that it will use the information for no other purpose, and that it will destroy or return the information when that time ends. It must also send you a copy of the request within 30 days of receiving the information, unless you have waived that notice in writing. This rule does not apply when we share information with your other health care providers for diagnosis or treatment, to certain law enforcement and licensing investigations, or to follow-up on reports of abuse or of a serious threat.

Substance use disorder treatment records

If we receive records of substance use disorder treatment from a program covered by the federal confidentiality rules at 42 CFR part 2, we cannot use or share those records, or testimony about what they contain, in a civil, criminal, administrative, or legislative investigation or proceeding against you unless you give written consent, or a court orders it after you or the holder of the record has been given notice and a chance to be heard. A court order that allows the use or sharing must come with a subpoena or other legal requirement that compels it before the record can be used or shared.

Added protections under California law

California’s Confidentiality of Medical Information Act generally requires your written authorization before we disclose your medical information, unless California law lists an exception. Beyond the protections described above, California law means that:

• We will not share, sell, or use your medical information for marketing, or for any purpose not necessary to provide health care services to you, unless you expressly authorize it or California law requires or permits it.
• We will not share medical information for immigration enforcement unless you expressly authorize it or California law requires or permits the disclosure.
• We will not release information about a person seeking or obtaining an abortion, gender-affirming health care, or gender-affirming mental health care in response to a subpoena or request based on another state’s law that interferes with those rights. We will not help another state’s agencies, or federal law enforcement to the extent federal law permits, identify a person who sought that care lawfully in California, except as California law allows.
• You can see your records sooner than federal law requires, and get some copies free. See Your rights.

Your rights

To use any of these rights, contact our Privacy Officer using the information under Questions and complaints. We may ask you to make some requests in writing, and we may ask for reasonable proof of your identity.

See or get a copy of your records

You can look at, or get a paper or electronic copy of, your medical and billing records. If we keep them electronically and you ask for an electronic copy, we will provide it in the form and format you ask for if we can readily produce it, or otherwise in a readable electronic form we agree on. As California law requires, we will let you inspect your records within 5 working days of your request, and we will send copies within 15 days. You can also ask us, in a signed written request, to send a copy directly to another person you choose.

We may charge a reasonable, cost-based fee for copies, and no more than 25 cents a page for paper copies. One copy of the records you need to support a claim or appeal for a public benefit program, such as Medi-Cal, Social Security disability, or SSI, is free if you give us a written request and proof of the claim or appeal; we will send it within 30 days. This does not apply if a private attorney who is paying the costs of the claim represents you. We will never withhold your records because of an unpaid bill.

If we deny your request, we will explain why in writing. In some cases you can have the denial reviewed by a licensed health care professional who was not involved in the decision. If we decline to show you mental health records, California law lets you name a licensed physician, psychologist, marriage and family therapist, clinical social worker, or professional clinical counselor, who can then inspect or receive copies of the records.

Ask us to correct your records

You can ask us to correct health information that you think is wrong or incomplete. We will respond within 60 days. If we say no, we will tell you why in writing, and you can give us a statement of disagreement to keep with your record. After you inspect your records, California law also lets you add a written addendum of up to 250 words for each item you believe is incomplete or incorrect, and we will include it whenever we share that part of your record.

Ask us to contact you confidentially

You can ask us to contact you in a particular way, for example on your cell phone rather than at home, or to send mail to a different address. We will agree to all reasonable requests and will not ask you why.

Ask us to limit what we use or share

You can ask us not to use or share certain information for treatment, payment, or our operations, or with people involved in your care. We are not required to agree, and we may say no if it could affect your care. If we agree, we will follow the agreement unless the information is needed for your emergency treatment or the law requires otherwise.

If you, or someone other than your health plan, pay for a service out of pocket and in full, you can ask us not to share information about that service with your health plan for payment or our operations. We will say yes unless a law requires us to share it.

Get a list of the disclosures we made

You can ask for a list, called an accounting, of the times we shared your information in the six years before your request, who received it, and why. It will not include disclosures for treatment, payment, or our operations, or certain others, such as ones you asked us to make. Your first list in any 12-month period is free; we may charge a reasonable, cost-based fee for another one within that 12 months.

Get a copy of this notice

You can ask for a paper copy of this notice at any time, even if you agreed to receive it electronically.

Choose someone to act for you

If someone has legal authority to act for you, such as an agent under your power of attorney for health care or a court-appointed conservator, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority before we act on their request.

File a complaint

You can complain if you believe we have violated your privacy rights. See Questions and complaints.

Questions and complaints

If you have questions about this notice or our privacy practices, want to use any of your rights, or believe your privacy rights have been violated, contact our Privacy Officer. You can file a complaint with us by mail, email, or phone.

You can also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights: online through the OCR Complaint Portal; by email to OCRComplaint@hhs.gov; by mail to Centralized Case Management Operations, U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Room 509F HHH Bldg., Washington, D.C. 20201; or by calling 1-877-696-6775. The Office for Civil Rights generally requires a complaint within 180 days of when you knew of the problem. How to file a complaint with HHS.

We will not retaliate against you for filing a complaint.

Language assistance

ATTENTION: If you speak a language other than English, free language assistance services are available to you. Appropriate auxiliary aids and services to provide information in accessible formats are also available free of charge. Call 1-650-248-2467 (TTY: 711) or speak to your provider.

The same notice follows in 15 other languages. Our full nondiscrimination notice is on our nondiscrimination page.