Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

1. About this notice

This Notice of Privacy Practices ("Notice") is issued by Pasadena Clinical Group, a California professional psychology corporation ("PCG," "we," "us," or "our"), in compliance with the federal Health Insurance Portability and Accountability Act of 1996 and its implementing regulations (45 C.F.R. Parts 160 and 164, "HIPAA"); the Health Information Technology for Economic and Clinical Health Act ("HITECH"); the California Confidentiality of Medical Information Act (Cal. Civ. Code §56 et seq., "CMIA"); the Lanterman-Petris-Short Act, where applicable (Cal. Welf. & Inst. Code §5328); the California Patient Access to Health Records Act (Cal. Health & Safety Code §123100 et seq.); the regulations governing Confidentiality of Substance Use Disorder Patient Records (42 C.F.R. Part 2, "Part 2"); and applicable rules of the California Board of Psychology, Board of Behavioral Sciences, and Medical Board of California.

This Notice applies to Protected Health Information ("PHI") created or received by PCG. "PHI" means individually identifiable health information transmitted or maintained in any form. California law in many respects is stricter than HIPAA, particularly for mental-health records, substance-use information, HIV/AIDS information, genetic information, and minors' records. Where laws conflict, PCG applies the more protective standard.

Information collected through our website outside of the clinical relationship (e.g., website analytics, employment applications) is governed by our Privacy Policy, not by this Notice.

2. Our duties

PCG is required by law to: (a) maintain the privacy and security of your PHI; (b) provide you with this Notice of our legal duties and privacy practices; (c) follow the terms of the Notice currently in effect; (d) notify you following a breach of unsecured PHI as required by 45 C.F.R. §164.400 et seq. and Cal. Civ. Code §1798.82; and (e) accommodate reasonable requests for confidential communications.

3. Uses and disclosures that do not require your written authorization

Subject to limitations under California law and Part 2, PCG may use or disclose PHI without your written authorization for the following purposes:

• Treatment. To provide, coordinate, or manage your care, including consultations among clinicians within PCG and, with your knowledge, with other treating providers (e.g., your primary care physician, psychiatrist, or referring clinician). California law generally requires written authorization to disclose mental-health records to other providers; PCG obtains such authorization at intake or at the time of need.
• Payment. To bill insurance carriers, third-party administrators, EAPs, clearinghouses, and patients for services rendered, and to obtain authorizations and reauthorizations.
• Health care operations. For quality assessment and improvement, training, supervision of supervisees, peer review, accreditation, licensing, credentialing, audits, business management, and de-identification.
• Business associates. To service providers performing functions on our behalf (e.g., electronic health record vendors, secure messaging vendors, billing services, telehealth platforms, fax services, payment processors, e-signature platforms) under written Business Associate Agreements that bind them to safeguards comparable to ours.
• Required by law. When mandated by federal, state, or local law (e.g., qualifying subpoenas, court orders, public-health reporting, audits).
• Public health activities. To public health authorities for purposes such as preventing or controlling disease, child abuse or neglect, FDA-regulated product safety, and worker exposure (per 45 C.F.R. §164.512(b)).
• Mandated reporting — child abuse or neglect. California's Child Abuse and Neglect Reporting Act (Cal. Penal Code §11164 et seq.) requires us to report known or suspected child abuse or neglect.
• Mandated reporting — elder or dependent adult abuse. California's Elder Abuse and Dependent Adult Civil Protection Act (Cal. Welf. & Inst. Code §15630) requires us to report known or suspected abuse, neglect, or financial exploitation of elders and dependent adults.
• Tarasoff duty (serious and imminent threat). Under Cal. Civ. Code §43.92 and Tarasoff v. Regents of the University of California, if you communicate a serious threat of physical violence against a reasonably identifiable victim, we have a duty to make reasonable efforts to communicate the threat to the victim and to a law enforcement agency. We may also disclose PHI to prevent or lessen a serious and imminent threat to the health or safety of any person, consistent with 45 C.F.R. §164.512(j).
• Health oversight activities. To agencies authorized by law to oversee the health-care system, including the California Board of Psychology, Board of Behavioral Sciences, Medical Board of California, the U.S. Department of Health and Human Services Office for Civil Rights ("HHS-OCR"), and the California Department of Justice.
• Judicial and administrative proceedings. In response to a court order, or in response to a subpoena, discovery request, or other lawful process for which the issuing party has provided satisfactory assurances of notice to you (or sought a protective order), as permitted by 45 C.F.R. §164.512(e). California law (Code of Civil Procedure §1985.3) imposes additional notice requirements for subpoenaed medical records.
• Law enforcement. In limited circumstances permitted by 45 C.F.R. §164.512(f), including identification and location of a suspect, fugitive, material witness, or missing person; reporting deaths suspected to have resulted from criminal conduct; and disclosing crimes occurring on premises.
• Coroners, medical examiners, funeral directors. As permitted by 45 C.F.R. §164.512(g) and California law.
• Organ, eye, or tissue donation. As permitted by 45 C.F.R. §164.512(h).
• Research. Only with documented IRB or privacy-board approval, a waiver of authorization, or de-identification meeting 45 C.F.R. §164.514. PCG does not currently use PHI for research without specific authorization.
• Workers' compensation. As permitted under California workers' compensation laws.
• Specialized government functions. For military, national security, protective services for the President and certain other officials, correctional institutions, and certain other functions as permitted by 45 C.F.R. §164.512(k).
• To you. Upon request, in accordance with the access rights described below.

Heightened protections for substance-use information (42 C.F.R. Part 2). If you receive substance-use disorder treatment from a "Part 2 program," disclosures of that information are subject to additional restrictions under federal law and generally require your written consent that complies with 42 C.F.R. §2.31, except in narrow emergency, audit, court-order, or research circumstances.

Heightened protections for psychotherapy notes. Psychotherapy notes — separately maintained personal notes of a therapist documenting or analyzing the contents of conversation during a counseling session — are not part of the medical record and require your written authorization for almost all uses and disclosures (45 C.F.R. §164.508(a)(2)), with very narrow exceptions (e.g., your treating clinician's own use, training, defense in a legal action brought by you, mandated reporting, threats to safety).

Heightened protections for HIV/AIDS information, genetic information, mental-health records, and minors' records apply under California Health & Safety Code §120975 et seq.; California Civil Code §56.17 (genetic information); CMIA §56.10(c)(11); and Family Code §6924, respectively. We will obtain specific written authorization where required.

4. Uses and disclosures requiring your written authorization

The following uses and disclosures will be made only with your written authorization, which must comply with HIPAA and CMIA:

• Most uses and disclosures of psychotherapy notes.
• Marketing communications, except as expressly permitted (e.g., face-to-face communications with you, promotional gifts of nominal value).
• Sale of PHI (PCG does not sell PHI).
• Most disclosures to family members, friends, employers, attorneys, courts (other than under court order), or other third parties not listed above.
• Any use or disclosure not described in this Notice.

You may revoke an authorization in writing at any time, except to the extent we have already taken action in reliance on it. Revocation does not affect disclosures previously made with your authorization.

5. Limited disclosures with your verbal agreement, opportunity to object, or implicit permission

Unless you object, we may share limited PHI: (a) with a family member, close personal friend, or other person identified by you who is involved in your care or payment for your care, but only the information directly relevant to that involvement; and (b) for notification of family or others in the event of disaster relief or emergency, consistent with 45 C.F.R. §164.510. We will provide you a reasonable opportunity to object before sharing in this manner. In the case of incapacity or emergency, we will exercise professional judgment to act in your best interest.

6. Your rights with respect to your PHI

• Right to inspect and obtain a copy. You have the right to inspect and obtain a copy of your PHI in our designated record set, including in electronic form when feasible, subject to limited exceptions (e.g., psychotherapy notes; information compiled for use in a legal proceeding; information that would endanger life or safety per 45 C.F.R. §164.524). California law (Cal. Health & Safety Code §123100 et seq.) generally affords access within five days for a summary or fifteen days for copies, and the federal "Information Blocking" rule (45 C.F.R. Part 171) prohibits unreasonable interference with patient access to electronic health information. We may charge a reasonable, cost-based fee permitted by law.
• Right to amend. If you believe PHI we maintain is inaccurate or incomplete, you may request an amendment. We may deny the request if the information is accurate, complete, not in our designated record set, not created by us (and the originator is available), or not subject to access. We will respond in writing.
• Right to an accounting of disclosures. You may request an accounting of certain disclosures we have made of your PHI in the six (6) years preceding the request. The accounting excludes disclosures for treatment, payment, health-care operations, disclosures made with your authorization, disclosures to you, and certain others permitted by 45 C.F.R. §164.528.
• Right to request restrictions. You may request restrictions on uses or disclosures for treatment, payment, or health-care operations, or to family or friends. We are not required to agree, except that we must agree to a request not to disclose PHI to a health plan for purposes of payment or health-care operations if you have paid for the service in full, in cash, out of pocket (45 C.F.R. §164.522(a)(1)(vi)).
• Right to confidential communications. You may request that we communicate with you by alternative means (e.g., by phone instead of mail) or at alternative locations. We will accommodate reasonable requests.
• Right to a paper copy of this Notice. Available on request even if you have agreed to receive it electronically.
• Right to be notified of a breach. Of unsecured PHI, in accordance with 45 C.F.R. §164.400 et seq. and Cal. Civ. Code §1798.82.
• Right to choose a personal representative. Subject to applicable law, including special rules for minors and incapacitated adults.

To exercise any of these rights, contact our Privacy Officer at the address below. We may require requests to be made in writing on a form we provide. We will verify your identity before responding.

7. Minors

For minors who consent to their own care under California law (e.g., minors 12 years of age or older consenting to mental-health services under Family Code §6924), the minor — not the parent — generally controls disclosures of PHI, with limited exceptions specified in §6924 (such as required parental contact when clinically appropriate). For minors whose care is consented to by a parent or legal guardian, the parent or guardian generally has access, except that California law restricts parental access where access would have a detrimental effect on the provider's professional relationship with the minor or the minor's physical safety or psychological well-being (Cal. Health & Safety Code §123115).

8. Deceased individuals

PHI of a deceased individual remains protected for fifty (50) years after the date of death (45 C.F.R. §164.502(f)). Disclosures to family and others involved in the decedent's care or payment for care, and to personal representatives, are permitted as set forth in 45 C.F.R. §164.502(g) and §164.510(b).

9. Complaints; non-retaliation

You may file a complaint with PCG or with HHS-OCR. PCG will not retaliate against you for filing a complaint or exercising your rights.

• PCG Privacy Officer: Pasadena Clinical Group, Attn: Privacy Officer, 301 N. Lake Ave, STE 600, Pasadena, CA 91101 · office@pasadenaclinicalgroup.com · (626) 354-6440.
• HHS Office for Civil Rights: 200 Independence Avenue, S.W., Washington, D.C. 20201 · 1-877-696-6775 · www.hhs.gov/ocr.
• California Attorney General — Privacy Enforcement and Protection Unit: oag.ca.gov.
• California Board of Psychology: psychology.ca.gov.
• California Board of Behavioral Sciences: bbs.ca.gov.

10. Effective date and changes

This Notice is effective on the date listed above. PCG reserves the right to change the terms of this Notice and to make the new terms applicable to all PHI we maintain. The current Notice will be posted in our offices and on this website, and a paper copy will be provided on request.

11. Contact for privacy concerns

Pasadena Clinical Group · Privacy Officer · 301 N. Lake Ave, STE 600, Pasadena, CA 91101 · (626) 354-6440 · office@pasadenaclinicalgroup.com

This Notice is informational. Disputes concerning this Notice or PCG's compliance with it are handled through the complaint procedures above and the dispute-resolution provisions in the executed Treatment Consent (including any binding arbitration provision under California Code of Civil Procedure §1295). Use of the website is also subject to our Terms & Conditions, which include mediation, arbitration, jury-trial waiver, and class-action waiver provisions.