This notice describes how your health information may be used and disclosed and how you can access this information. Please review it carefully.
I. My Pledge Regarding Health Information
Your privacy and trust are central to the work we do. I am committed to protecting your personal health information (PHI) in accordance with the Health Insurance Portability and Accountability Act (HIPAA) and California law. I create a record of the care and services you receive from me. I need this record to provide you with quality care and to comply with certain legal requirements, including federal and state privacy laws, licensing board regulations, and professional ethics codes. This Notice applies to all records created or maintained by America’s First Responder Services. This notice will tell you about the ways in which I may use and disclose health information about you. I also describe your rights to the health information I keep about you, and describe certain legal and ethical obligations regarding the use and disclosure of your health information.
You have the right to understand how your health information may be used or shared, and I have a legal obligation to:
-Keep your protected health information (PHI) confidential and secure
-Provide you with this notice of my legal duties and privacy practices with respect to health information
-Follow the terms outlined in this Notice
-Notify you in the event of a breach affecting the privacy or security of your PHI
This Notice may be updated from time to time. The most current version will be available upon request and on my website.
II. How I may Use and Disclose Health Information About You:
The following categories describe different ways that I use and disclose health information. For each category of uses or disclosures I will explain what I mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways I am permitted to use and disclose information will fall within one of the categories.
For Treatment, Payment, or Healthcare Operations: Federal privacy rules (regulations) allow healthcare providers who have direct treatment relationship with the patient/client to use or disclose the patient/client’s personal health information without the patient’s written authorization, to carry out the healthcare provider’s own treatment, payment, or health care operations. I may also disclose your PHI for the treatment activities of any healthcare provider. This too can be done without your written authorization. For example, if a healthcare provider were to consult with another licensed healthcare provider about your condition, we would be permitted to use and disclose your PHI, which is otherwise confidential, in order to assist the health care provider in diagnosis and treatment of your condition. These consultations support continuity of care and are conducted in accordance with HIPAA and professional guidelines. If I consult with another provider, I will make every effort to avoid using identifying information unless necessary. “Treatment” also includes case consultation or referral to another provider if needed to support your care.
Lawsuits and Disputes: If you are involved in a legal proceeding and I receive a valid subpoena, court order, or other lawful request, I may be legally required to disclose protected health information (PHI). This may occur in situations where you are receiving court-ordered treatment, or where information is being sought for an evaluation, expert report, or legal testimony. If you initiate legal action against me or file a licensing complaint, I may disclose relevant PHI as necessary to respond and defend myself.
If you voluntarily raise your mental health status as part of a legal proceeding (e.g., in a custody case, disability claim, or civil lawsuit), this may limit your confidentiality protections under the law. However, I do not release records automatically in response to legal requests. When appropriate, I may assert psychotherapist-patient privilege on your behalf and will not release information unless required to do so by law or a direct court order. Any disclosures made will be limited to the minimum necessary information required.
III. Certain Uses and Disclosures Require Your Authorization
In general, I will not use or disclose your protected health information (PHI) for purposes outside of treatment, payment, or health care operations without your written authorization. Some types of information carry special legal protections, and your explicit permission is required before they can be released — unless an exception applies as outlined below. If you provide authorization to disclose PHI, you may revoke any authorization you have provided at any time, in writing. Revoking your authorization will not affect any actions I have already taken based on your prior permission.
Psychotherapy Notes: Psychotherapy notes, also called “session notes,” are kept separately from your general clinical record. These notes are given special protection under HIPAA and cannot be shared without your written authorization, except in limited circumstances. I may use or disclose your session notes without your permission only in the following situations:
-For my use in providing you with treatment;
-For my use in training or supervising other licensed professionals to improve their clinical skills;
-To defend myself in legal proceedings initiated by you;
-For oversight or investigations by the Secretary of Health and Human Services regarding my compliance with HIPAA;
-When required by law, and only to the extent the law requires;
-For specific health oversight activities involving the originator of the notes;
-To a coroner or medical examiner performing duties required by law;
-When necessary to prevent or mitigate serious and imminent threat to the health or safety of yourself or others.
Outside of these limited circumstances, I will obtain your written authorization before using or disclosing your psychotherapy notes for any other reason.
Marketing Purposes: I will not use or disclose your PHI for marketing purposes without your written consent.
Sale of PHI: I will never sell your PHI in the regular course of business. Your information will not be exchanged for financial or commercial benefit.
IV. Certain Uses and Disclosures Do Not Require Your Authorization
Subject to certain limitations under federal and state law, I may use or disclose your protected health information (PHI) without your written authorization for the following purposes:
-When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.
-For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.
-For health oversight activities, including audits, investigations, inspections, licensure, or disciplinary actions authorized by law.
-For judicial and administrative proceedings, including responding to a court or administrative order. This may also include disclosures to licensing boards or government agencies conducting investigations, audits, or inquiries into legal or ethical concerns. While I may be legally required to respond, my preference is to obtain a written authorization from you when possible before disclosing information in these contexts.
-For law enforcement purposes, including reporting crimes that occur on my premises, complying with a valid court order, subpoena, or warrant, or in situations where disclosure is necessary to prevent a serious and imminent threat to health or safety. In rare cases, disclosure may also occur when required to assist law enforcement in the investigation of a crime involving the therapeutic setting, such as fraud, false claims, or attempts to use the therapeutic relationship to avoid prosecution.
-To avert a serious threat to health or safety, I may use or disclose PHI if I believe there is a serious and imminent threat to your health or safety, or to the health or safety of another person or the public. In such cases, I may notify law enforcement, emergency personnel, or—when appropriate—the identifiable individual(s) at risk, in accordance with California’s duty to protect laws (Tarasoff v. Regents of the University of California).
-To coroners or medical examiners, when such individuals are performing duties authorized by law, such as identifying a deceased person or determining the cause of death.
-For research purposes, when the research has been approved by an institutional review board or privacy board and appropriate safeguards are in place. This may include studying and comparing treatments or outcomes across clients, but only under strict conditions and de-identification standards where applicable.
-For specialized government functions, including activities related to ensuring the proper execution of military missions; protecting the President of the United States and other high-level officials; conducting lawful intelligence or counterintelligence operations; or assisting in the safety and security of individuals in correctional institutions.
-For correctional institutions, if you are in the custody of law enforcement or confined in a correctional facility, I may disclose PHI as necessary to ensure your health and safety, the safety of others, or the lawful operation of the facility.
-For workers’ compensation purposes, as necessary to comply with California workers’ compensation laws. Although I may prefer to obtain your authorization, such disclosures are permitted by law to ensure benefits and coordination of care.
-For appointment reminders and information about health-related benefits or services, I may use your PHI to contact you about upcoming appointments or to provide information about treatment alternatives or services I offer that may be beneficial to you.
V. Certain Uses and Disclosures Require You to Have the Opportunity to Object
Disclosures to family, friends, or others: I may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or in the payment for your health care, unless you object in whole or in part. The opportunity to agree or object may be obtained in advance or, when appropriate, retroactively in emergency situations or when you are incapacitated. If you are able to make decisions, I will always ask for your preference before disclosing this information.
VI. You Have the Following Rights With Respect to Your PHI
If you wish to exercise any of the rights listed below, your request must be submitted in writing. You may send your request via mail or the secure client portal. If you believe your privacy rights have been violated, you have the right to file a complaint with me or with the U.S. Department of Health and Human Services. You will not be penalized or retaliated against for filing a complaint.
The Right to Request Limits on Uses and Disclosures of Your PHI
You have the right to ask me not to use or disclose certain PHI for treatment, payment, or health care operations. I am not required to agree to your request, and I may say “no” if I believe it would affect your care or my ability to provide treatment.
The Right to Request Restrictions for Out-of-Pocket Expenses Paid in Full
If you pay out-of-pocket in full for a specific health care item or service, you have the right to request that your PHI related to that service not be shared with your health plan. I am required to honor this request unless the disclosure is otherwise required by law.
The Right to Choose How I Send PHI to You
You have the right to request how I contact you—for example, by phone, mail, or email—and at what address or number. I will agree to all reasonable requests, especially if your request is to protect your privacy or safety.
The Right to See and Get Copies of Your PHI
Other than psychotherapy notes, you have the right to inspect or receive an electronic or paper copy of your clinical record and other information that I maintain about you. Under California law, I will provide access for review within 5 working days, copies within 15 working days, or a treatment summary within 10 working days (or 30 calendar days if the record is extensive). I may charge a reasonable, cost-based fee for copies or summaries.
The Right to Get a List of the Disclosures I Have Made
You have the right to request a list (accounting) of disclosures I have made of your PHI for purposes other than treatment, payment, or health care operations, or those made with your written authorization. I will respond within 60 days of receiving your request. The list will include disclosures made in the past six years unless you specify a shorter time frame. The first request in a 12-month period is free. I may charge a reasonable cost-based fee for additional requests in that time.
The Right to Correct or Update Your PHI
If you believe that there is a mistake in your PHI, or that important information is missing, you have the right to request an amendment. I may deny the request if the existing record is accurate or complete, but I will provide a written explanation within 60 days of receiving your request.
The Right to Get a Paper or Electronic Copy of This Notice
You have the right to receive a paper copy of this Notice at any time, even if you agreed to receive it electronically. You may also request that a copy be emailed to you.