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Privacy Policy

This notice describes how your medical information may be used or disclosed and how you can
gain access to it. Please read this notice carefully.

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 is a federal program
that requires strict confidentiality for all your personal health information. That includes all your
medical and dental information used or disclosed by us in any form, whether electronic, written
or verbal. The Act gives you significant rights to understand and control how your health
information is used. The Act also provides penalties for the misuse of Protected Health
Information (PHI).

PHI is any information about you, including demographic data that identifies you and your past,
present or future physical or mental health condition, as well as related healthcare services. This
Privacy Policy describes how we may use or disclose your PHI to provide treatment, payment or
healthcare operations or other purposes that are permitted or required by law. This policy also
describes your rights to access and control your PHI.

Uses and Disclosures of Protected Health Information

Your PHI may be used or disclosed by our physician, office staff or others involved in your care
and treatment, whether providing healthcare services to you, paying your healthcare bills,
supporting the operation of our practice or any other lawful use.

Treatment: We will use and disclose your PHI to provide, coordinate or manage your healthcare
and related services. This includes the coordination or management of your healthcare by a third
party. For example, your PHI may be given to a physician you have been referred to in order to
ensure that he or she has the necessary information to diagnose or treat you.

Healthcare Operations: We may use or disclose your PHI to support our business activities.
These activities may include quality assessment, employee review and conducting or arranging
other business activities. We may also use a sign-in sheet at the registration desk where you will
be asked to sign your name and indicate your physician. We may call you by name in our
reception area when your physician is ready to see you. We may use or disclose your PHI, as
necessary, to contact you to remind you of your appointment. We may phone your home and
leave a message (on an answering machine or with the person answering the phone) to remind
you of an upcoming appointment, the need to schedule a new appointment or to call our office.
We may also mail a postcard reminder or letter to your home address. Please tell us if you prefer
that we call or contact you at another phone number or location.

We may use or disclose your PHI under the following circumstances without your authorization.
These include, as required by law:

  • public health issues
  • communicable diseases
  • health oversight
  • abuse or neglect
  • Food and Drug Administration requirements
  • legal proceedings
  • law enforcement
  • coroners, funeral directors and organ donation
  • medical research
  • criminal activity; prison inmates
  • military activity and national security
  • Workers' Compensation

Required Uses and Disclosures: The law requires us to disclose to you when we are
investigated by the Secretary of the Department of Health and Human Services to determine our
compliance with HIPAA. Other permitted and required uses and disclosures will be made only
with your consent, authorization or opportunity to object unless required by law. You may
revoke this authorization in writing at any time except to the extent that your physician or the
physician's practice has taken action in reliance on the use or disclosure indicated in your
authorization.

Payment: Your PHI will be used, as needed, to obtain payment for healthcare services. For
example, obtaining approval for a hospital stay may require that your relevant PHI be disclosed
to your health insurance plan to obtain approval for a hospital admission or a health-related
procedure.

Your Rights
You have the right to inspect and copy your PHI. Under federal law, however, you may not
inspect or copy the following records:

  • psychotherapy notes
  • information compiled in reasonable anticipation of, or use in civil, criminal or
    administrative actions or proceedings
  • PHI that is subject to law prohibiting access to said PHI

You have the right to request a restriction of your health information. This means you may ask us
not to use or disclose any part of your PHI for the purposes of treatment, payment or healthcare
operations. You may also request nondisclosure of any part of your PHI to family members or
friends who may be involved in your care or for notification purposes described in these Privacy
Practices. Your request must state the specific restriction and to whom you want the restriction to
apply.

Your physician is not required to agree to your requested restriction. If your physician believes it
is in your best interests to permit use and disclosure of your PHI, your PHI will not be restricted.
You then have the right to use another healthcare professional.

You have the right to request to receive confidential communications from us by alternative
means or at an alternative location. You have the right to obtain a paper copy of this Notice from
us, upon request, even if you have agreed to accept this Notice alternatively (e.g., electronically).

You have the right to have your physician amend your PHI. If we deny your request for
amendment, you have the right to file a statement of disagreement with us and we may prepare a
rebuttal to your statement and provide you with a copy of any such rebuttal. You have the right
to receive an accounting of certain disclosures we have made, if any, of your PHI.
We reserve the right to change the terms of this Notice and will inform you of any changes. You
then have the right to object or withdraw as provided in this Notice.

Complaints
You may complain to us or to the Secretary of Health and Human Services if you believe your
privacy rights have been violated by us. You may file a complaint by notifying our privacy
officer at our office and main telephone number. We will not retaliate against you for exercising
your right to file a complaint.

This Notice was published and is effective on or before 8/1/2015.

Comprehensive ADHD Center
550 Deep Valley Drive, Suite 319
Rolling Hills Estates, CA 90274
Call Now: 310-357-6763