This notice describes how health information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.

Our pledge regarding your health information

Health information about you and your care is personal, and we are committed to protecting it. We create a record of the care and services you receive in order to provide you with quality care and to meet certain legal requirements. This notice applies to all records of your care generated by the practice, and it explains the ways we may use and disclose your health information, your rights, and our obligations. We are required by law to keep protected health information (“PHI”) that identifies you private, to give you this notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect.

How we may use and disclose your health information

For treatment, payment, or health care operations. Federal privacy rules allow providers with a direct treatment relationship to use or disclose your PHI without your written authorization to carry out treatment, payment, and health care operations — for example, when your clinician consults with another licensed provider about your care, or coordinates and refers your care.Lawsuits and disputes. If you are involved in a lawsuit, we may disclose health information in response to a court or administrative order, or to a subpoena or discovery request — but only after efforts have been made to tell you about the request or to obtain a protective order.

Uses and disclosures that require your authorization

• Psychotherapy notes. We keep psychotherapy notes as defined in 45 CFR § 164.501. Any use or disclosure of these notes requires your authorization, except for limited purposes permitted by law (such as our own use in treating you, training and supervision, defending ourselves in legal proceedings you bring, HHS compliance investigations, or to avert a serious threat to health or safety).
• Marketing. We will not use or disclose your PHI for marketing purposes.
• Sale of PHI. We will not sell your PHI.

Uses and disclosures that do not require your authorization

Subject to limitations in the law, we may use and disclose your PHI without authorization when required by state or federal law; for public-health activities (including reporting suspected child, elder, or dependent-adult abuse, or preventing a serious threat to anyone’s health or safety); for health-oversight activities; for judicial and administrative proceedings; for limited law-enforcement purposes; to coroners or medical examiners; for research; for specialized government functions; for workers’ compensation; and for appointment reminders or to tell you about treatment alternatives and health-related benefits.

Uses and disclosures that require an opportunity to object

We may share your PHI with a family member, friend, or other person you identify as involved in your care or payment for your care, unless you object. In an emergency, your consent may be obtained retroactively.

Your rights regarding your health information

• Request limits on uses and disclosures of your PHI (we are not required to agree).
• Request restrictions on disclosures to a health plan for items or services you paid for out-of-pocket in full.
• Ask us to contact you in a specific way or at a specific address — we will agree to all reasonable requests.
• See and get a copy of your record (other than psychotherapy notes), generally within 30 days, for a reasonable cost-based fee.
• Get a list of certain disclosures we have made, generally within 60 days.
• Ask us to correct or add to your PHI if you believe it is wrong or incomplete.
• Get a paper or electronic copy of this notice on request.

Special protections for substance use disorder records (42 CFR Part 2)

Some records we create may contain information about the diagnosis or treatment of a substance use disorder. Federal law — 42 CFR Part 2 — gives these records privacy protections that are, in important respects, more stringent than HIPAA. Where Part 2 applies, the following additional rules govern how that information may be used and disclosed:

• Your written consent is generally required. We may not disclose records that would identify you as having or having had a substance use disorder except with your written consent, or in the limited circumstances Part 2 specifically permits (such as a bona fide medical emergency, certain audit or evaluation activities, or under a court order that meets Part 2’s special requirements). This is stricter than HIPAA, which allows many treatment, payment, and health-care-operations disclosures without your authorization.
• Redisclosure is restricted. When we disclose Part 2 records with your consent, the recipient generally may not redisclose that information unless further disclosure is expressly permitted by your written consent or is otherwise allowed by Part 2.
• Your rights and our duties. You have the right to be notified of our Part 2 privacy practices; to give, and to revoke, written consent for disclosures of your substance use disorder records; to request an accounting of certain disclosures; and to complain about a suspected Part 2 violation without fear of retaliation. We are required by law to protect these records under Part 2 and to abide by the terms of this notice.
• Limits on use in legal and government proceedings. Your Part 2 records may not be used or disclosed to initiate or substantiate any criminal charge against you, or to conduct any criminal, civil, administrative, or legislative investigation or proceeding against you, without your written consent or a court order that meets the specific requirements of 42 CFR Part 2.

Suspected violations of Part 2 may be reported to the U.S. Department of Health and Human Services (see the complaint information below). A fuller statement of your rights under Part 2 is available from our Privacy Officer on request.

How to complain about our privacy practices

If you think your privacy rights have been violated, you may file a complaint with our Privacy Officer, Dr. Stacy Bonds, 84 W Santa Clara St, STE 700, San Jose, CA 95113, (858) 367-7274. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, by mail (200 Independence Avenue SW, Washington, D.C. 20201), by phone (1-877-696-6775), or at hhs.gov/ocr/privacy/hipaa/complaints. We will not retaliate against you for filing a complaint.

This notice went into effect on December 29, 2021.