Notice of Privacy Practices

We are committed to protecting your privacy and confidentiality to the full extent of the law. This notice describes how psychological and medical information about you may be used and disclosed and how you can get access to this information. This notice conforms to the Federal Health Insurance Portability and Accountability Act (HIPAA) effective April 14, 2003. It also conforms to the health care privacy laws of California. Please read it carefully.

I. Uses and Disclosures Not Requiring Your Authorization

We may use or disclose your protected health information (PHI) for certain treatment, payment, and health care operations purposes without your authorization. In certain circumstances we can only do so when the person or business requesting your PHI gives me a written request that includes certain promises regarding protecting the confidentiality of your PHI. To help clarify these terms, here are some definitions:

• PHI refers to information in your health record that could identify you. For example, it may include your name, the fact you are receiving treatment here, and other basic information pertaining to your treatment. Use applies only to activities within our office and practice group, such as sharing, employing, applying, utilizing, and analyzing information that identifies you.

• Disclosure applies to activities outside of my office or practice group, such as 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 we provide, coordinate, or manage your health care and other services related to your health care. For example, we may provide your information to your physician to ensure the physician has the necessary information to diagnose or treat you.

• Payment refers to when your PHI may be used, as necessary, in activities related to obtaining payment for your health care services. 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. We may use or disclose, as needed, your protected health information in support of business activities. For example, when we review an administrative assistant’s performance, we may need to review what that employee has documented in your record.

II. Uses and Disclosures Requiring Your Authorization

We may use or disclose PHI for purposes outside of treatment, payment, and health care operations when your appropriate authorization is obtained. Additionally, certain categories of information have extra protections by law, and thus require special written authorization for disclosures.

• Psychotherapy Notes – We will obtain a special authorization before releasing your psychotherapy notes. “Psychotherapy Notes" are notes I have made about our conversation during a private, group, joint, or family counseling session, which we keep separate from the rest of your record. These notes are given a greater degree of protection than PHI.

• HIV Information – Special legal protections apply to HIV/AIDS related information. We will obtain a special written authorization from you before releasing information related to HIV/AIDS.

• Alcohol and Drug Use Information – Special legal protections apply to information related to alcohol and drug use and treatment. We will obtain a special written authorization from you before releasing information related to alcohol and/or drug use/treatment. In those instances when we are asked for information for purposes outside of treatment and payment operations, we will obtain an authorization from you before releasing this information. You may revoke or modify all such authorizations (of PHI, psychotherapy notes, HIV Information, and/or Alcohol and Drug Use Information) at any time provided each revocation is in writing and signed by you. However it will not go into effect until we receive it.

III. Uses and Disclosures Requiring Neither Your Consent Nor Authorization

We may use or disclose PHI without your consent or authorization in the following circumstances:

• Child Abuse – Whenever we, in our professional capacity, have knowledge of or observe a child I know or reasonably suspect has been the victim of child abuse or neglect, we must immediately report such to a police department or sheriff’s department, county probation department, or county welfare department. Also, if we have knowledge of or reasonably suspect that mental suffering has been inflicted upon a child or that his or her emotional well-being is endangered in any other way, we may report such to the above agencies.

• Adult and Domestic Abuse – If we, in our professional capacity, have observed or have knowledge of an incident that reasonably appears to be physical abuse, abandonment, abduction, isolation, financial abuse, or neglect of an elder or dependent adult, or if we are told by an elder or dependent adult that he or she has experienced these or if I reasonably suspect such, we must report the known or suspected abuse immediately to the local ombudsman or the local law enforcement agency. We do not have to report such an incident if we have been told by an elder or dependent adult that he or she has experienced behavior constituting physical abuse, abandonment, abduction, isolation, financial abuse or neglect; AND we are not aware of any independent evidence that corroborates the statement that the abuse has occurred; AND the elder or dependent adult has been diagnosed with a mental illness or dementia, or is the subject of a court-ordered conservatorship because of a mental illness or dementia; AND in the exercise of clinical judgment we reasonably believe that the abuse did not occur.

• Health Oversight – If a complaint is filed against us with the California Board of Psychology, the Board has the authority to subpoena confidential mental health information from me relevant to that complaint.

• Judicial or Administrative Proceedings – If you are involved in a court proceeding and a request is made about the professional services that we have provided you, we must not release your information without:

o Your written authorization or the authorization of your attorney or personal representative; or

o A court order; or o A subpoena duces tecum (a subpoena to produce records) where the party seeking your records provides me with a showing that you or your attorney have been served with a copy of the subpoena, affidavit, and the appropriate notice, and you have not notified me that you are bringing a motion in the court to quash (block) or modify the subpoena. The privilege does not apply when you are being evaluated for a third party or where the evaluation is court-ordered. We will inform you in advance if this is the case.

• Serious Threat to Health or Safety – If we believe that you present an imminent, serious risk of injury or death to yourself, we may make disclosures we consider necessary to protect you from harm. If you communicate to me a specific threat of imminent harm against another individual or if we believe that there is clear, imminent risk of injury being inflicted against another individual, we may make disclosures that I believe are necessary to protect that individual from harm.

• Worker’s Compensation – we may disclose PHI as authorized by, and to the extent necessary to comply with, laws relating to worker’s compensation or other similar programs, that provide benefits for work-related injuries or illness without regard to fault.

IV. Patient’s Rights and Psychologist’s Duties Patient’s Rights:

• Right to Request Restrictions – You have the right to request restrictions on certain uses/disclosures of PHI. However, we are not required to agree to the request.

• Right to Receive Confidential Communications by Alternative Means and at Alternative Locations – You have the right to request and receive confidential communications by HIPAA Notice of Privacy Practice member to know that you are seeing us. On your request, I\we will send your bills to another address.)

• Right to Inspect and Copy – You have the right to inspect or obtain a copy (or both) of PHI in our mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record. We may deny your access to PHI under certain circumstances, but in some cases you may have this decision reviewed. On your request, we will discuss with you the details of the request and denial process.

• Right to Amend – You have the right to request an amendment of PHI for as long as it is maintained in the record. We may deny your request. On your request, we will discuss with you the details of the amendment process.

• Right to an Accounting – You generally have the right to receive an accounting of all disclosures of PHI for which you have neither provided consent nor authorization (as described in Section III of this notice). On your request, we will discuss with you the details of the accounting process.

• Right to a Paper Copy – You have the right to obtain a paper copy of the HIPAA Notice of Privacy Practices from me upon request. Psychologist’s Duties: • We are required by law to maintain the privacy of PHI and to provide you with a notice of my legal duties and privacy practices with respect to PHI. • We reserve the right to change the privacy policies and practices described in this notice. • If we revise my policies and procedures, we will notify you at our next session or by mail at the most recent address you have provided us.

V. Sharing of Personal Information: 
Lucidity Sleep Psychiatry will not share, sell, or disclose your personal information or mobile opt-in data to third parties without your explicit consent, except where required by law. Your information is kept confidential and used solely for the purposes you have agreed to. All the above categories exclude text messaging originator opt-in data and consent; this information will not be shared with third parties. Text messaging opt-in data is not being shared with third parties.
 

• Out of Text Messages – You have the right to opt out of receiving text messages from us at any time. To opt-out, you can reply "STOP" to any text message you receive from us. 

• Consent and Opt-In – By providing your phone number and opting in to receive text messages, you consent to the collection and use of your personal information as described in this policy. We ensure that your consent is obtained explicitly and that you are informed about the types of messages you will receive. 

VI. Questions and Complaints

If you have questions about this notice, disagree with a decision we make about access to your records, or have other concerns about your privacy rights, please contact us at:

Lucidity Sleep Psychiatry

450 S. Melrose Dr.

Vista, CA 92081

(760) 650-2290 ext 2000

If you believe that your privacy rights have been violated, you may file a complaint with the US Department of Health and Human Services. All complaints must be submitted in writing. We do not retaliate against you for exercising your right to file a complaint. We can provide you with the appropriate address upon request.

VII. Restrictions, and Changes to Privacy Practices

We reserve the right to change the terms of this notice and to make the revised notice effective for all protected health information we maintain. The most current version of this notice is available in our office and upon request.