Notice of Privacy Practices

Our Pledge Regarding Your Health Information

We understand that health information about you and your health care is personal. We are committed to protecting this information. We create a record of the care and services you receive at our practice. We need this record to provide you with quality care and to comply with legal requirements.

This notice applies to all records of your care generated by Complete Family Services, Inc., whether made by your therapist or our staff. This notice tells you about the ways we may use and disclose health information about you, your rights regarding your health information, and our obligations regarding the use and disclosure of your health information.

How We May Use and Disclose Health Information

For Treatment

We may use your health information to provide, coordinate, or manage your treatment or services. We may share health information with other providers involved in your care, with your consent.

For Payment

We may use and disclose your health information to bill and collect payment for services provided. This may include providing information to your insurance company or issuing a Superbill for out-of-network reimbursement.

For Health Care Operations

We may use and disclose health information for quality improvement, training, licensing, and other activities related to operating our practice.

As Required by Law

We may disclose health information when required by federal, state, or local law, including court orders, subpoenas, and mandatory reporting obligations.

To Avert a Serious Threat to Health or Safety

We may use and disclose health information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person, consistent with California's duty-to-warn (Tarasoff) obligations and related statutes.

California-Specific Disclosures

Under California law, your therapist is obligated to break confidentiality in the following situations:

• If there is reasonable suspicion of child abuse, dependent adult abuse, or elder abuse, the therapist is required to report this to the appropriate authorities.
• If a client presents a serious danger of violence to another person, the therapist must notify the police and inform the intended victim (California's Tarasoff duty to warn).
• If a client threatens to harm himself or herself, the therapist may be obligated to seek hospitalization or contact family members or others who can provide protection.
• If a court of law issues a legitimate subpoena, the therapist may be required to provide the information specifically described in the subpoena.

In addition, certain communications may be required in legal proceedings involving child custody, conservatorship, and court-ordered evaluations, as described by the California Evidence Code.

Your Rights Regarding Your Health Information

• Right to inspect and copy. You have the right to inspect and obtain a copy of your health information. We may charge a reasonable fee for copying costs.
• Right to request amendments. If you believe your health information is incorrect or incomplete, you may request that we amend it.
• Right to an accounting of disclosures. You may request a list of disclosures we have made of your health information, other than for treatment, payment, or health care operations.
• Right to request restrictions. You may request that we restrict certain uses or disclosures of your health information. We are not required to agree, except in limited circumstances.
• Right to request confidential communications. You may request that we communicate with you in a certain way or at a certain location.
• Right to a paper copy. You have the right to obtain a paper copy of this notice upon request, even if you have agreed to receive it electronically.
• Right to file a complaint. You may file a complaint without retaliation if you believe your privacy rights have been violated.

Filing a Complaint

If you believe your privacy rights have been violated, you may file a complaint with:

• Our practice (contact information below)
• The U.S. Department of Health and Human Services Office for Civil Rights
• The California Department of Consumer Affairs Board of Psychology

You will not be penalized or retaliated against for filing a complaint.

Changes to This Notice

We reserve the right to change our privacy practices and the terms of this notice at any time. Changes will apply to all health information we maintain. The current version of this notice is always available on this page and in our office.

Contact

Privacy Officer: Dr. Corinne Hickson Barez, PhD