Notice of Health Information Privacy Practices

ABOUT THIS NOTICE

This Notice applies to personally-identifiable healthcare information you have submitted or plan to submit to us. For collection of personal information other than healthcare data, see our Terms of Use link. Our dedication to quality health care and our respect for your rights require us to inform you about our uses and disclosure of your protected health information (PHI), and your rights to see and control that PHI.  Any questions?  Contact us at the address and telephone number above.

We deliver quality health care with integrity, fairness, and the highest regard for the dignity and privacy of our patients.  We will abide by the terms in this Notice, and we reserve the right to modify this Notice at any time.  Modified new terms will take effect for all PHI we possess at the time of the change.  You can request a paper copy of the most recently revised Notice, and you can check our website for the latest changes.

YOUR HEALTH INFORMATION AND HOW WE COLLECT IT

Whenever you call or visit us, we make a record in three parts.  Your Healthcare Record consists of our notes of symptoms, medications, medical history, exam and test results, diagnoses, treatments, progress milestones, and treatment planning, plus our copy of portions of records from other healthcare providers you have seen.  The Billing Record consists of our payment agreement(s) with you, details of services rendered, bills and receipts, and correspondence with your insurance companies and other responsible payers.  Our Process Notes (also known as psychotherapy notes) are the separate notes made by your behavioral health specialists drawn from your conversations with them in both individual and group therapy sessions.

How We Collect PHI. We collect PHI from you in writing, by examination and through our conversations with you.  With your consent for treatment, we collect it from your previous and concurrent healthcare providers and laboratories, from members of your family and household, and from your health insurance company and employer plan sponsor.

How We Move and Store Your PHI. We acquire and move your PHI by telephone and voicemail, fax, mail, express courier, email, and computer file transfers.  We enter some data directly into our computers.  We store other paper records in your folder in locked cabinets, and scan these records from time to time into electronic form.  All electronic records are created and protected by unique passwords and encryption.  At any given time, your record consists of both paper and electronic information.  Our staff are trained to protect your PHI and have signed confidentiality agreements as a condition for working with us and serving you.

USES AND DISCLOSURES OF YOUR HEALTH INFORMATION

We use and disclose your PHI for treatment, payment, and healthcare operations as follows:

For Treatment.  Among our staff and with outside healthcare providers as necessary for your diagnosis and treatment and continued or coordinated care, and with family and friends whom you have designated as your assistants or representatives.

For Payment.  Among our staff, and with outside health plans, insurance companies, and payers to determine what services and benefits these third-parties will pay for, and to obtain payment from still other kinds of third parties such as family members responsible for such costs.

For Healthcare Operations.  Among our staff and outside parties who have agreed to protect your PHI to:  document the care you have received; make plans and reminders for future appointments and treatment; conduct authorized medical research and public health activities; train health professionals; obtain licensing and accreditation of our practice by government and professional agencies and by health plans and insurance companies; and assure and improve quality.

With Business Associates.  Non-healthcare contractors help us with some of our work in the three areas listed above, such as medical transcription and copying services, paper scanning, voicemail maintenance, and computer database backup and programming services.  To protect your PHI, we limit disclosures to the minimum necessary for the contractors to do their jobs, and obtain signed agreements binding these firms to protect your privacy.

Special Disclosures Required by Law

Special laws can sometimes require that we disclose your PHI without your consent -- under special circumstances.  We make a record noting these special disclosures and to whom they are made.  We take reasonable steps to double-check whether the special circumstances exist, and then we disclose only the minimum necessary to meet these special requirements:

• Public Health Risks and FDA Reporting
• Government Oversight and Investigations
• Lawsuits by Non-government Entities
• Law Enforcement and Court Orders
• Serious Threats to the Safety of Yourself and Others
• (imminent danger, elder-abuse, child-abuse, inability to drive safely)
• Military and National Security
• Correctional Institutions
• Workers Compensation
• Bona Fide Emergencies

If you have questions about how some of these special laws might apply to you, please contact our Privacy Officer at (650) 364-5504 at 650 Main Street, Redwood City, CA 94063.

YOUR RIGHTS

You have a number of rights regarding our records containing PHI about you.

Right to a Paper Copy of This Notice.  We are mailing or hand-delivering a copy of this Notice to you.  The latest version will always be available on our website, or by making a request to our Privacy Officer at the address and telephone given on the first page.

Right to Authorize Collection and Use of PHI.  We will ask you to authorize us in writing before we disclose your PHI other than for general healthcare treatment, payment, and operational uses.

Right to Inspect and Copy.  Although the records we create are our property, you have the right to inspect and copy Healthcare and Billing Records, but not the Process/Psychotherapy Notes.  You must make your request in writing, and we may charge for the costs to copy your record.

Right to Amend.  You may request in writing that we add up to 250 words amending or correcting information in your Healthcare Record.

Right to Communicate PHI by Other Means, Other Locations.  You have the right to make a reasonable request in advance that we send you information in a special way, or to a special address or telephone number.

Right to Limit Disclosures.  By writing to us in advance, you can request that we limit either the kind of information we disclose, the people to whom we disclose it, or the method by which we send information in the course of our treatment, obtaining payment, and healthcare operations.  Except where special laws or emergencies require us to disclose without limitation, we will try to accommodate your request.  But the law does not require us to comply with your request if it would interfere with your treatment or our ability to obtain payment.

Right to Revoke Consent.  You may revoke your consent at any time we are available to read mail, hear calls, or accept visits.  We will advise you whether a revocation would make it impossible for us to continue treatment.  We are not obligated to continue treatment if we cannot exchange information on time with others as necessary to treat you or to obtain payment.

Right to Have an Accounting of Disclosures.  Upon your request, we will send you a listing of disclosures we have made for any purposes other than treatment, payment, and healthcare operations.  We may charge you for the cost of accounting more than once per year.

TO REPORT A PROBLEM OR GET MORE INFORMATION

Any questions?  Need additional details?  Want the latest version of this Notice?  Do you believe that we have not properly protected your privacy, or violated your privacy rights?  Or do you disagree with a decision we made regarding your information rights?  If so, please contact our Privacy Officer at (650) 364-5504 at 650 Main Street, Redwood City, CA 94063.  Or write to the Office of Civil Rights, U.S. Department of Health and Human Services, Room 509 Hubert Humphrey Building, 200 Independence Avenue SW, Washington, DC 20201.