Privacy Practices

Health Insurance Portability and Accountability Act (HIPAA)

This notice describes how medical information about you may be used or disclosed and how you can get access to this information.
We are required by law to comply with this Notice.

Please Read This Carefully


We are committed to maintaining the confidentiality of your health information. By law, we are required to maintain the privacy of protected health information (PHI) and to provide individuals with notice of our legal duties and privacy practices with respect to your PHI.

How We May Use or Disclose Your Health Information

In your clinical record (stored in a paper chart and/or electronic health record system), we maintain identifying information about you that we collected from you or on your behalf. It may include information about your past, present, or future physical or mental health condition, and payment for your services. The clinical record is the property of this clinic, but the information in the record belongs to you.

This Notice describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law.

We May not Use or Disclose Your PHI
Except as described in this Notice, we will not use or disclose your PHI without your written consent. If you do approve us to use or disclose your PHI, you may revoke your permission at any time.

We use your health information to provide your services. We may share your health information with doctors, counselors, treatment staff, clerks, support staff, and other health care personnel who are involved in your care. We may also share your health information within our network of care as needed to ensure a high standard of care. In addition, we may use or share your health information in response to an emergency. We may share your information with others in the same or similar field who provide services we do not provide.

We are part of the Los Angeles County Department of Mental Health Network and therefore information from the treatment record may be shared with any agency within the Los Angeles County Mental Health System (county operated and contracted) without obtaining further consent.

Your Treatment Options
In order to ensure you receive the highest level of care and personalized treatment, we may use and disclose your health information to tell you about your health condition or to recommend possible treatment choices or alternatives.
Appointment Reminders
We may use and disclose your health information to contact you as a reminder that you have an appointment at one of our facilities via standard mail (postcard), telephone, email, or text messaging.
We may use and disclose information about you by having you sign in when you arrive in the lobby. We may call out your name when we are ready to see you.
We may use and disclose your health information to obtain payment for the services we provide. Examples include: we may give your health plan information about the treatment you received so your health plan will pay or refund us for the treatment; we may contact your health plan to confirm your coverage or to ask for prior authorization for a proposed treatment.
Health Care Operations

We may use and share your health information to operate this clinic. Examples include: quality assurance and improvement actions, reviewing the performance and qualifications of health care professionals, training students / interns in clinical activities, accreditation, legal services, audits, business planning and development, and general administrative purposes. For example, we may use your health information to review our treatment and services and to evaluate our staff’s performance in caring for you. We may combine health information about our clients to decide what added services the clinic should offer or whether new treatments are effective.

Breach Notifications
We may use and disclose your health information to tell you in the event that there has been unlawful or unauthorized access to your health information, such as when someone not authorized to see your health information looks at your information or your health information is accidentally lost or is stolen. We will also report these occurrences to State and federal authorities, and may need to use your health information to do so. If this happens, we will provide you with a written notice via first-class mail to your last known address.
As Required By Law (Federal, State, Local)
We are required to report suspected abuse, neglect and domestic violence to the appropriate government authority. We are required to report if there are serious threats to anyone’s health and safety (examples include: suspected harm to self or others, disease prevention, or adverse medication reactions).
Special Rules for Disclosure of Psychiatric, Substance Abuse, and HIV-Related Information
In general, health information relating to care for psychiatric conditions, substance abuse or HIV-related testing and treatment may not be disclosed without your permission or a court order. There are exceptions to this general rule, such as HIV test results may be disclosed to your provider of health care without written authorization.
Specialized Government Functions and National Security
We may disclose your health information to federal officials, to conduct lawful intelligence, counterintelligence and other national security actions allowed by law.
Disaster Relief Purposes
We may disclose your health information to an organization assisting in a disaster relief effort so that your family can be notified about your condition, status, and location. We will give you the opportunity to agree to this disclosure or object to this disclosure, unless we decide that we need to disclose your health information in order to respond to the emergency circumstances.
For Health Oversight Purposes
We may disclose your health information to a health oversight agency for purposes allowed by law. For example, we may share your health information for audits, investigations, inspections, accreditation, licensure, and disciplinary actions.
Special Circumstances

Organ and Tissue Donation: If you are an organ donor, we may release your health information to an organization involved in organ and tissue donations.

Coroners, Medical Examiners, Funeral Directors and Information About Decedents: When required by law, your health information may be released to a coroner or medical examiner.

Workers’ Compensation: We may disclose your health information as allowed by workers’ compensation laws or related programs.

Inmate/Probation: If you are an inmate or under the custody of a law enforcement official, we may disclose your PHI to the correctional institute or law enforcement official.

Military Personnel

If you are a member of the armed forces, we may disclose your health information as mandated by military authorities or the Department of Veterans Affairs.

Law Enforcement
  • We may disclose your health information to law enforcement agencies:
  • If the police bring you to the hospital and document that exigent circumstances exist to test your blood for alcohol or substance abuse; or
  • If the police present a valid search warrant; or
  • If the police present a valid court order; or
  • To report abuse, neglect, or assaults as required or permitted by law; or
  • To report certain threats to third parties or crimes committed on the premises; or
  • To identify or locate a suspect, fugitive, material witness or missing person, if required or permitted by law; or
  • To report your discharge, if you were involuntarily detained after a peace officer initiated a 72-hour hold for psychiatric evaluation and requested notification.

We may also disclose health information about a client who is a victim of a crime, without a court order or without being required to do so by law if the disclosure has been requested by a law enforcement official and the victim agrees to the disclosure or, in the case of the victim’s incapacity, the following occurs:

  • The law enforcement official represents to us that (i) the victim is not the subject of the investigation and (ii) an immediate law enforcement activity to meet a serious danger to the victim or others depends upon the disclosure; and
  • We determine that the disclosure is in the victim’s best interest.
Business Associates

We may share your health information with our business associates so they can perform the job we have asked them to do (such as: billing services, electronic health record company, data management companies, record storage company, legal, or accounting consultants). To protect your health information, we have written contracts with our business associates requiring them to safeguard your information.

We may disclose your PHI to researchers when their research has been approved by the Clinic’s Executive Management Team and Risk Manager, who have reviewed the research proposal and established protocols to protect the privacy of your health information. In instances where identifiable PHI is involved, you have the right to approve or deny authorization for participation in the research study.
Except as described in this Notice, or as allowed by State or federal law, we will not use or share your health information without your written authorization. We cannot sell, use or disclose your health information for marketing purposes, without your written authorization.
Individuals Involved in Your Care or Payment of Your Care
We may disclose your health information to a family member, a relative, a close friend, or other individual involved in your medical care or payment for your medical care if we obtain your verbal agreement, or if we give you an opportunity to object to such a disclosure, and you do not raise an objection. If you are unable to agree or object at the time we give you the opportunity to do so, we may decide that it is in your best interest, based on our professional judgment, to share your health information, such as if you are incapacitated or during an emergency.
Judicial and Administrative Proceedings
If you are involved in a lawsuit or a dispute, we may disclose your health information in response to a court or administrative order. We may also disclose your health information in response to a subpoena, discovery request, or other legal procedure by someone else involved in the dispute, but only if efforts have been made to tell you about the request (which may include written notice to you) or to obtain an order protecting the health information requested.
Your Rights
  • You may ask to see or get a copy of your records. These requests are usually done in writing and may take 30 days to process.
  • You can ask us to correct your health and claims records if you think they are incorrect or incomplete. We will tell you in writing within 60 days if we are able to make that change and why.
  • You may request for confidential communications, for us to contact you in a specific way, or send mail to a specific address. We will consider all reasonable requests.
  • You have the right to request limits on certain uses and disclosures of your PHI, by a written request specifying what information you want to limit and what limitations on our use or disclosure of that information you wish to have imposed. We reserve the right to accept or reject your request, and will notify you of our decision.
  • You can ask for a list of those with whom we’ve shared your information up to 6 years prior to the date you ask. We may include all disclosures except those about treatment, payment, and health care operations, and certain other disclosures.
  • You have the right to receive a copy of this privacy notice.
  • You may choose someone to act for you.

Changes to this Notice of Privacy Practices

We reserve the right to amend this Notice at any time in the future. Should we make any changes, it will apply to all PHI obtained and maintained. We will keep a copy of our Notice of Privacy Practices in our reception area.


If you believe your privacy rights have been violated by us, you may file a complaint with our Privacy Officer or with the U.S. Department of Health and Human Services Office for Civil Rights at (800) 368-1019 (TDD: 800-537-7697) or by sending a letter to: Region IX, Office for Civil Rights U.S. Department of Health and Human Services 90 7th St. Suite 4-100 San Francisco, CA 94103 You may also file a complaint at this link:

The law prohibits retaliation against an individual for filing a complaint.