top of page

Privacy Policy

The Federal Health Insurance Portability and Accountability Act (HIPAA) requires mental health professionals to issue this official Notice of Privacy Practices. This notice describes how information about you is protected, the circumstances under which it may be used or disclosed and how you may gain access to this information. 


Anyone authorized to enter information into your medical record, or any employees who may need access to your information must abide by this Notice. All subsidiaries, business associates (e.g., a billing service), sites and locations of this practice may share medical information with each other for treatment, payment purposes or health care operations described in this Notice. Except where treatment is involved, only the minimum necessary information needed to accomplish the task will be shared.




Psychologists are allowed to use your Protected Health Information (PHI), for treatment, payment, and health care operations purposes. PHI is any information in your health record that could identify you. Use applies to any activities that I must carry out within my practice of your PHI, for example, sharing, employing, applying, utilizing, and analyzing your information. 


Disclosure applies to releasing, transferring, or providing access to information about you to other parties.

Authorization is your written permission to disclose confidential health information. All authorizations to disclose must be made on a specific and required form.

Treatment is when I provide, coordinate, or manage your health care and other services related to your health care. For example, with your written authorization I may provide your information to your physician to ensure the physician has the necessary

information to diagnose or treat you.

Payment is sometimes obtained from insurance companies (or other authorized external parties) for your health care services and your PHI may be used. This may include the use of a billing service or providing you documentation of your care so that you may obtain reimbursement from your insurer.

Health Care Operations are activities that relate to the performance and operation of my practice. I may use or disclose, as needed, your protected health information in support of business activities. For example, when I review an administrative assistant’s performance, I may need to review what that employee has documented in your record.


Written authorization is needed to release any part of your health record with or without PHI, other than for the reasons listed above or otherwise permitted or required by law. Below are examples of when your health record or PHI would need to be released without your authorization. If you would like to take away access to your health record, you can request in writing to have their privileges revoked. 


The following discusses situations where your authorization is not needed to disclose your health record or PHI. The ethics code of the American Psychological Association, California State law, and the federal HIPAA regulations all protect the privacy of all communications between a patient and a mental health professional and therefore regulate when those exceptions should be made.

In situations where there is known child abuse or neglect, dependent adult or elderly abuse, neglect or financial exploitation, or other serious safety situations where there threat of serious harm, suicidal or homicidal imminent threat, your information will be released without authorization. 

Additionally, I may disclose your PHI to a health oversight agency for oversight activities authorized by law, including licensure or disciplinary actions. If a patient files a complaint or lawsuit against me, I may disclose relevant information regarding that patient in order to defend myself. Also, if you are involved in a court proceeding and a request is made for information by any party about your treatment and the records thereof, such information is privileged under state law, and is not to be released without a court order. Information about all other psychological services (e.g., psychological evaluation) is also privileged and cannot be released without your authorization or a court order. The privilege does not apply when you are being evaluated for a third party

or where the evaluation is court ordered. You must be informed in advance if this is the case.

Finally, I may disclose PHI regarding you as authorized by and to the extent necessary to comply with laws relating to worker's compensation or other similar programs, established by law, that provide benefits for work-related injuries or illness without regard to fault.


Certain categories of information have extra protections by law, and thus require special written authorizations for disclosures. Special legal protections apply to HIV/AIDS related information. I will obtain a special written authorization from you before releasing information related to HIV/AIDS.


Special legal protections apply to information related to alcohol and drug use and treatment. I will obtain a special written

authorization from you before releasing information related to alcohol and/or drug use/treatment. You may revoke all such authorizations (of PHI, HIV information, and/or Alcohol and Drug Use Information) at any time, provided each revocation is in writing, signed by you, and signed by a witness. You may not revoke an authorization to the extent that (1) I have relied on that authorization; or (2) if the authorization was obtained as a condition of obtaining insurance coverage, law provides the insurer the right to contest the claim under the policy.


1. Restrictions – You can request restrictions on certain uses/disclosures of PHI. However, I am not required to agree to the request.


2. Confidential Communications by Alternative Means – You can request and receive confidential communications by alternative means and locations.


3. Inspections and Copies – You can inspect or obtain a copy of PHI in my records as these records are maintained. I can discuss with you the process involved.

4. Amendments – You can request an amendment of PHI for as long as it is maintained in the record. I can deny your request; however, we can have a discussion about why and the details of the amendment process.

5. Accounting of Disclosures – You can receive an accounting of all disclosures of PHI. Feel free to ask questions about what this means and the process involved. 

6. Paper Copies – You have the right to obtain a paper copy of the Notice of Privacy Practices from me upon request.

Please view the website below to learn all about your consumer rights:


The law requires me to maintain the privacy of all PHI and to provide you with a notice of

my legal duties and privacy practices with respect to PHI. I have the right to change the privacy policies on this page according to what is within federal and state law. If the policy changes, i will notify you in writing or via email within 30 days, or as soon as possible. 

*This notice will go into effect on January 1, 2020 and will remain until a new notice of laws  and regulations for privacy and all protected health information is available.

Hands in agreement
bottom of page