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The Board of Psychology within the California Department of Consumer Affairs oversees all questions and formal complaints regarding psychological care. To inquire or file a grievance, you may visit their website at www.psychology.ca.gov, email bopmail@dca.ca.gov, call 866-503-3221, or send mail to the Board at 1625 North Market Blvd, Suite N-215, Sacramento, California 95834.

Notice to Consumers

Notice of Privacy Practices

This section describes how health information may be used and disclosed and how you can get access to this information. 

 

Our Office's Pledge Pertaining to Health Information:

Health information about you and your health care is personal. Our office is committed to protecting health information about you. We create a record of the care and services you receive from us. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all the records of your care generated by this mental health care practice. This notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights to the health information we keep about you and describe certain obligations we have regarding the use and disclosure of your health information. Our office is required by law to:

 

  • Make sure that protected health information (“PHI”) that identifies you is kept private.

  • Give you this notice of provider’s legal duties and privacy practices with respect to health information.

  • Follow the terms of the notice that is currently in effect.

  • We can change the terms of this Notice, and such changes will apply to all information we have about you. The new Notice will be available upon request, in our office, and on my website.


How We May Use and Disclose Health Information About You:

The following categories describe different ways that we use and disclose health information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all the ways we are permitted to use and disclose information will fall within one of the categories.

 

For Treatment Payment, or Health Care Operations: Federal privacy rules (regulations) allow health care providers who have direct treatment relationship with the patient/client to use or disclose the patient/client’s personal health information without the patient’s written authorization, to carry out the health care provider’s own treatment, payment or health care operations. We may also disclose your protected health information for the treatment activities of any health care provider. This too can be done without your written authorization. For example, if a clinician were to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your personal health information, which is otherwise confidential, to assist the clinician in diagnosis and treatment of your mental health condition.

 

Disclosures for treatment purposes are not limited to the minimum necessary standard. Because therapists and other health care providers need access to the full record and/or full and complete information to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care providers with a third party, consultations between health care providers and referrals of a patient for health care from one health care provider to another.

 

Lawsuits and Disputes: If you are involved in a lawsuit, we may disclose health information in response to a court or administrative order. We may also disclose health information about a client’s child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

 

Uses and Disclosures Requiring Your Authorization:

Psychotherapy Notes. We do keep “psychotherapy notes” as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your Authorization unless the use or disclosure is:
 

  • For our use in treating you.

  • For our use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy.

  • For our use in defending legal proceedings instituted by you.

  • For use by the Secretary of Health and Human Services to investigate compliance with HIPAA.

  • Required by law and the use or disclosure is limited to the requirements of such law.

  • Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.

  • Required by a coroner who is performing duties authorized by law.

  • Required to help avert a serious threat to the health and safety of others.

 

Marketing Purposes. As a psychotherapist, we will not use or disclose your PHI for marketing purposes.

Sale of PHI. As a psychotherapist, we will not sell your PHI in the regular course of my business.

 

Certain Uses and Disclosures Not Requiring Your Authorization:

Subject to certain limitations in the law, we 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 our office preference is to obtain an Authorization from you before doing so.

  • For law enforcement purposes, including reporting crimes occurring on our office 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 our office preference is to obtain an Authorization from you, we may provide your PHI to comply with workers’ compensation laws.

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

 

Uses and Disclosures Requiring You to Have the Opportunity to Object:

  • Disclosures to family, friends, or others. We 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.

 

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 us not to use or disclose certain PHI for treatment, payment, or health care operations purposes. We are not required to agree to your request, and may say “no” if we 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 we Send PHI to You. You have the right to ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and we 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 we have about you. We will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request, and we may charge a reasonable, cost-based fee for doing so.

  • The Right to Get a List of the Disclosures We Have Made. You have the right to request a list of instances in which we have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided us with an Authorization. We will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list we will give you will include disclosures made in the last six years unless you request a shorter time. We will provide the list to you at no charge, but if you make more than one request in the same year, we 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 we correct the existing information or add the missing information. We may say “no” to your request but 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.

Professional Disclosure Statement

PRACTICE POLICIES

Appointments and Cancellations
Please remember to cancel or reschedule 24 hours in advance. You will be responsible for the entire fee if cancellation is less than 24 hours.

The standard meeting time for psychotherapy is 53 minutes (60 minutes to include progress note). It is up to you, however, to determine the length of time of your sessions. Requests to change the 45-minute session needs to be discussed with the therapist in order for time to be scheduled in advance. A $10.00 service charge will be charged for any checks returned for any reason for special handling.

Cancellations and re-scheduled session will be subject to a full charge if NOT RECEIVED AT LEAST 24 HOURS IN ADVANCE. This is necessary because a time commitment is made to you and is held exclusively for you. If you are late for a session, you may lose some of that session time.

 

Telephone Accessibility 
If you need to contact your therapist between sessions, please leave a brief, nondescript voicemail with our business line or HIPAA-compliant messaging system through the Simple Practice app. We are typically not immediately available; however, your therapist will attempt to return your call within 24 hours. Please note that in-person sessions are highly preferable to phone sessions. However, if you are out of town, sick or need additional support, phone and telehealth sessions are available. If a true emergency arises, please call 911, 988, or any local emergency room.

 

Social Media and Telecommunication 
Due to the importance of your confidentiality and the importance of minimizing dual relationships, our therapists and associated staff do not accept friend or contact requests from current or former clients on any social networking site (Facebook, LinkedIn, etc.). Our office practice believes that adding clients as friends or contacts on these sites can compromise your confidentiality and our respective privacy. It may also blur the boundaries of our therapeutic relationship. If you have questions about this, please bring them up when you meet with your provider and can talk more about it.

 

Electronic Communication
We cannot ensure the confidentiality of any form of communication through electronic media, including text messages. If you prefer to communicate via email or text messaging for issues regarding scheduling or cancellations, we will do so. While we may try to return messages in a timely manner, we cannot guarantee immediate response and request that you do not use these methods of communication to discuss therapeutic content and/or request assistance for emergencies.

Services by electronic means, including but not limited to telephone communication, the Internet, facsimile machines, and e-mail is considered telemedicine by the State of California. Under the California Telemedicine Act of 1996, telemedicine is broadly defined as the use of information technology to deliver medical services and information from one location to another. If you and your therapist chose to use information technology for some or all your treatment, you need to understand that:

  1. You retain the option to withhold or withdraw consent at any time without affecting the right to future care or treatment or risking the loss or withdrawal of any program benefits to which you would otherwise be entitled.

  2. All existing confidentiality protections are equally applicable.

  3. Your access to all medical information transmitted during a telemedicine consultation is guaranteed, and copies of this information are available for a reasonable fee.

  4. Dissemination of any of your identifiable images or information from the telemedicine interaction to researchers or other entities shall not occur without your consent.

  5. There are potential risks, consequences, and benefits of telemedicine. Potential benefits include, but are not limited to improved communication capabilities, providing convenient access to up-to-date information, consultations, support, reduced costs, improved quality, change in the conditions of practice, improved access to therapy, better continuity of care, and reduction of lost work time and travel costs. 

Effective therapy is often facilitated when the therapist gathers within a session or a series of sessions, a multitude of observations, information, and experiences about the client. Therapists may make clinical assessments, diagnosis, and interventions based not only on direct verbal or auditory communications, written reports, and third person consultations, but also from direct visual and olfactory observations, information, and experiences. When using information technology in therapy services, potential risks include, but are not limited to the therapist's inability to make visual and olfactory observations of clinically or therapeutically potentially relevant issues such as: your physical condition including deformities, apparent height and weight, body type, attractiveness relative to social and cultural norms or standards, gait and motor coordination, posture, work speed, any noteworthy mannerism or gestures, physical or medical conditions including bruises or injuries, basic grooming and hygiene including appropriateness of dress, eye contact (including any changes in the previously listed issues), sex, chronological and apparent age, ethnicity, facial and body language, and congruence of language and facial or bodily expression. Potential outcomes may include the therapist not being aware of what he/she would consider important information, that you may not recognize as significant to present verbally to the therapist.

 

Minors
If you are a minor, your parents may be legally entitled to some information about your therapy. Your therapist will discuss with you and your parents what information is appropriate for them to receive, and which issues are more appropriately kept confidential.

 

Termination
Ending relationships can be difficult. Therefore, it is important to have a termination process to achieve some closure. The appropriate length of the termination depends on the length and intensity of the treatment. Your therapist may terminate treatment after appropriate discussion with you and a termination process if they determine that the psychotherapy is not being effectively used or if you are in default on payment. We will not terminate the therapeutic relationship without first discussing and exploring the reasons and purpose of terminating. If therapy is terminated for any reason or you request another therapist, we will provide you with a list of qualified psychotherapists to treat you. You may also choose someone on your own or from another referral source.

Should you fail to schedule an appointment for three consecutive weeks, unless other arrangements have been made in advance, for legal and ethical reasons, we must consider the professional relationship discontinued.

Confidentiality & Mandated Reporting Disclosures

Confidentiality
The session content and all relevant materials to the client’s treatment will be held confidential unless the client requests in writing to have all or portions of such content released to a specifically named person/persons. Limitations of such client held privilege of confidentiality exist and are itemized below:

 

  1. If a client threatens or attempts to commit suicide or otherwise conducts themselves in a way there is a substantial risk of incurring serious bodily harm.

  2. If a client threatens grave bodily harm or death to another person.

  3. If the therapist has a reasonable suspicion that a client or other named victim is the perpetrator, observer of, or actual victim of physical, emotional or sexual abuse of children under the age of 18 years.

  4. Suspicions as stated above in the case of an elderly person who may be subjected to these abuses.

  5. Suspected neglect of the parties named in items #3 and # 4.

  6. If a court of law issues a legitimate subpoena for information stated on the subpoena.

  7. If a client is in therapy or being treated by order of a court of law, or if information is obtained for the purpose of rendering an expert’s report to an attorney.

Occasionally, your therapist/examiner may need to consult with other professionals in their areas of expertise to provide the best treatment for you. Information about you may be shared in this context without using your name.

 

If you and your therapist accidentally see each other outside of the therapy office, they will not acknowledge you first. Your right to privacy and confidentiality is of the utmost importance, and we do not wish to jeopardize your privacy. However, if you acknowledge your therapist first, they will likely be willing to speak briefly with you, but feel it appropriate not to engage in any lengthy discussions in public or outside of the therapy office.

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