Notice of Privacy Practices

Our Pledge Regarding Health Information

California Psychological Services, Inc. understands that health information about you and your health care is personal. California Psychological Services, Inc. is committed to protecting health information about you. California Psychological Services, Inc. creates a record of the care and services you receive. This record is necessary to provide you with quality care and to comply with certain legal requirements.

This notice applies to all records of your care generated by this mental health care practice. It describes the ways in which California Psychological Services, Inc. may use and disclose health information about you, your rights regarding the health information we maintain, and certain obligations we have regarding its use and disclosure.

California Psychological Services, Inc. is required by law to:

• Maintain the privacy of protected health information (“PHI”) that identifies you.
• Notify you, to the maximum extent possible and practicable, of any disclosure of PHI, including breaches of unsecured PHI as required by the federal HITECH Act and California law.
• Involve you, to the maximum extent possible and practicable, in any decisions or disclosures related to your PHI.
• Provide you with this notice of legal duties and privacy practices with respect to health information.
• Follow the terms of the notice currently in effect.

California Psychological Services, Inc. may change the terms of this Notice, and such changes will apply to all information on file. The new Notice will be available upon request, at our office, and on our website.

How We May Use and Disclose Your Health Information

For Treatment, Payment, or Health Care Operations

Federal privacy rules allow health care providers with a direct treatment relationship with you to use or disclose your PHI without written authorization to carry out treatment, payment, or health care operations. For example, if a clinician consults with another licensed provider about your condition, California Psychological Services, Inc. may use and disclose your PHI to assist in diagnosis and treatment.

Disclosures for treatment purposes are not limited to the minimum necessary standard, because therapists and other providers need complete information to deliver quality care. “Treatment” includes coordination and management of health care with a third party, consultations between providers, and referrals from one provider to another.

Lawsuits and Disputes

If you are involved in a lawsuit, California Psychological Services, Inc. may disclose health information in response to a court or administrative order, a subpoena, discovery request, or other lawful process—but only if efforts have been made to notify you about the request or to obtain a protective order.

Certain Uses and Disclosures Require Your Authorization

Psychotherapy Notes

California Psychological Services, Inc. keeps “psychotherapy notes” as defined in 45 CFR § 164.501. Any use or disclosure of such notes requires your written Authorization unless the use or disclosure is:

1. a. For California Psychological Services, Inc.’s use in treating you.
2. b. For training or supervising mental health practitioners to improve their skills in group, joint, family, or individual counseling or therapy.
3. c. For California Psychological Services, Inc.’s use in defending itself in legal proceedings instituted by you.
4. d. For use by the Secretary of Health and Human Services to investigate compliance with HIPAA.
5. e. Required by law and the use or disclosure is limited to the requirements of such law.
6. f. Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.
7. g. Required by a coroner performing duties authorized by law.
8. h. Required to help avert a serious threat to the health and safety of others.

Marketing Purposes

California Psychological Services, Inc. will not use or disclose your PHI for marketing purposes without your written Authorization, as required by HIPAA and California law.

Sale of PHI

California Psychological Services, Inc. will not sell your PHI in the regular course of business.

Other Uses Requiring Authorization

Under the California Confidentiality of Medical Information Act (CMIA, Civil Code § 56 et seq.), additional disclosures beyond those permitted under federal HIPAA rules may require your written authorization. California Psychological Services, Inc. will obtain your authorization before making any disclosure not otherwise permitted by law.

Certain Uses and Disclosures Do Not Require Your Authorization

Subject to certain limitations in the law, California Psychological Services, Inc. may 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.
• Mandatory Reporting: California law requires reporting of suspected child abuse or neglect (Penal Code § 11164 et seq.), elder or dependent adult abuse (Welfare & Institutions Code § 15630 et seq.), and certain other conditions. Reports will be made as required.
• Serious Threat to Health or Safety: California law (Civil Code § 43.92; Tarasoff duty) may require or permit disclosure to prevent a serious and imminent threat to the health or safety of an identifiable person or the public.
• For public health activities, including reporting communicable diseases as required by the California Department of Public Health.
• For health oversight activities, including audits and investigations by state or federal agencies.
• For judicial and administrative proceedings, including responding to a court or administrative order (with preference to obtain your Authorization first).
• For law enforcement purposes, including reporting crimes occurring on our premises.
• To coroners or medical examiners performing duties authorized by law.
• For research purposes, subject to applicable privacy safeguards required by law.
• For specialized government functions, including military missions, national security, and correctional institution safety.
• For workers’ compensation purposes, as required by California Labor Code § 3762 (preference is to obtain Authorization first).
• For appointment reminders and information about treatment alternatives or health care services we offer.

Certain Uses and Disclosures Require Your Opportunity to Object

Disclosures to Family, Friends, or Others

California Psychological Services, Inc. may provide your PHI to a family member, friend, or other person you indicate is involved in your care or 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 With Respect to Your PHI

Complaints

If you believe California Psychological Services, Inc. has violated your privacy rights, you may file a complaint with any of the following. California Psychological Services, Inc. will not retaliate against you for filing a complaint.