Notice of Privacy Practices

01Introduction

Welcome to Holistic Mind Therapy where your privacy is our priority. This Notice of Privacy Practices ("Notice") explains how your protected health information ("PHI") may be used and disclosed, and how you can access this information. Please review this notice carefully.

02Our Commitment to Your Privacy

We are committed to maintaining the privacy of your personal and health information. We are required by law to provide you with this Notice of Privacy Practices that explains our legal duties and privacy practices concerning your PHI.

03Uses and Disclosures of Your Protected Health Information

We typically use and share your PHI for the following purposes:

To treat you: We may use and disclose your PHI to provide, coordinate, or manage your mental health care and related services.
To bill for your services: We may use and disclose your PHI for billing and payment purposes, including working with your insurance company or other third-party payer.
To run our organization: We will disclose your PHI as necessary and as permitted by law for our healthcare operations, including clinical improvement, professional peer review, business management, accreditation and licensing, and other activities necessary to maintain optimal levels of service.

3.1Business Associates

We may disclose your PHI to our business associates, who provide us with services necessary to maintain business operations. We will only provide the minimum information necessary for these associates to perform their functions as it relates to our operations. For example, we may use a third-party merchant processor to assist in our credit card billing services, but this merchant will never have access to your medical record. All business associates are obligated to comply with privacy and security laws and are contractually committed to protecting your PHI.

We are also permitted to share your PHI in other ways listed below. We typically must meet certain conditions in the law before we can share your information for these purposes. For more information, see https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html.

To comply with legal requirements: We will share information about you if state or federal laws require it, including with the Department of Health and Human Services to show our compliance with federal privacy law.
To report suspected abuse, neglect, or domestic violence: We may disclose PHI to the appropriate agency if there is belief of abuse, neglect, or domestic violence, or to prevent a serious threat to health or safety.
To respond to lawsuits and legal actions: We can share PHI in response to a court or administrative order, or in response to a subpoena.
For workers’ compensation claims: We may disclose a limited amount of PHI as necessary to comply with a workers’ compensation request.

3.2.1Certain Other Purposes Permitted or Required by Law

For public health activities or in connection with public health investigations;
To a governmental oversight agency conducting audits or investigations, or pursuant to information requests in civil or criminal proceedings;
To coroners or funeral directors, when the request is appropriate and consistent with law;
If you are a member of the military, for national security or intelligence activities; and
For any other purpose required by law.

3.2.2Clinical Supervision and Case Consultation

In order to provide the highest quality care and adhere to professional standards, we may participate in clinical supervision and consultation. During these consultations, aspects of your case may be discussed to obtain guidance or ensure quality treatment. No identifying information (such as your name, date of birth, or other protected health information) will be disclosed. These discussions follow professional ethical guidelines and HIPAA privacy standards to ensure your confidentiality is protected.

3.3Authorizations

We will obtain your written authorization before using or disclosing your PHI for purposes other than those listed in this Notice.

04Your Rights Regarding Your PHI

The right to get an electronic or paper copy of your medical record: You can ask to see or get a copy of your record and other health information we have about you. We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
The right to ask us to correct your medical record: You may request an amendment if you believe your PHI is inaccurate or incomplete. We may say no to your request, but we will tell you why in writing within 60 days.
The right to request restrictions on information we use or share: You can ask us not to use or share certain health information for treatment, payment, or operations. We are not required to agree, and we may say no if it would affect your care.
The right to receive a list of those with whom we have shared your information: You can ask for an accounting of the times we have shared your health information for six years prior to the date you ask, who we shared it with, and why. One accounting per year is free; we may charge a reasonable fee for additional requests within 12 months.
The right to request confidential communications: You can ask us to contact you in a specific way or to send mail to a different address. We will say yes to all reasonable requests.
The right to receive a paper copy of this Notice.
The right to choose someone to act for you: If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will verify authority before acting on such requests.
The right to file a complaint if you feel your rights are violated: You may complain to us using the contact information in Section VI of this Notice. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you for filing a complaint.

05Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

We may disclose your PHI to designated family, friends, and others involved in your care or in payment for your care. If you are unavailable, incapacitated, or facing an emergency, we may share limited PHI if we determine it is in your best interest. We may also disclose limited PHI to an authorized disaster relief entity to help locate family or others involved in your care.

If you are unable to tell us your preference, for example if you are unconscious, we may share your information if we believe it is in your best interest. We may also share information to lessen a serious and imminent threat to health or safety.

Marketing purposes
Sale of your information
Most sharing of psychotherapy notes
Disclosure of information about substance use disorders

5.2Psychotherapy Notes

We must obtain your specific written authorization prior to disclosing psychotherapy notes unless otherwise permitted by law. We may disclose psychotherapy notes without authorization only to: (1) carry out certain treatment, payment, or operations (for example, to defend ourselves in a legal action you bring); (2) the Secretary of Health and Human Services as required by law; (3) health oversight activities authorized by law; or (4) medical examiners or coroners as permitted by law.

5.3Substance Use Disorder Information

Unless otherwise required by law, we must obtain your written authorization to disclose any information we maintain about your personal use of drugs or alcohol.

5.4Fundraising

We will not use or disclose your information as part of fundraising efforts.

06Contact Information

Holistic Mind Therapy

301 W Las Tunas Dr, Suite A1 #1009, San Gabriel CA 91776

(323)457-4447

april@holisticmind-therapy.com

www.holisticmind-therapy.com

07Changes to this Notice

We reserve the right to change this Notice. The revised Notice will be effective for information we already have about you as well as any information we receive in the future. We will provide a copy of the revised Notice upon request.

Thank you for choosing Holistic Mind Therapy. We are dedicated to protecting your privacy and providing quality care.