Your rights and how this practice handles information

When it comes to your health information, you have certain rights.

Get an electronic or paper copy of your medical record

You may ask to see or obtain an electronic or paper copy of your medical record and other health information I maintain about you.

I will provide a copy or summary of your health information within the time required by law. I may charge a reasonable, cost-based fee as permitted by law.

California law provides special protections concerning access to mental health records. In limited circumstances, I may decline to provide mental health records directly to you if I determine that there is a substantial risk of significant adverse or detrimental consequences to you from seeing or receiving the records. If this occurs, I will comply with California law regarding documentation and notification, and you may designate an appropriately licensed health professional to inspect or receive the records on your behalf.

Ask me to correct your medical record

You may ask me to correct health information about you that you believe is incorrect or incomplete.

I may deny your request in certain circumstances, but I will explain the reason in writing when required by law.

Request confidential communications

You may ask me to contact you in a specific way — for example, by telephone rather than email — or to send communications to a different address.

I will accommodate reasonable requests.

Ask me to limit what I use or disclose

You may ask me not to use or disclose certain health information for treatment, payment, or health care operations. I am not generally required to agree to your request, and I may decline if, for example, the restriction could affect your care.

If you pay for a health care service out of pocket in full, you may ask me not to disclose information about that service to your health plan for payment or health care operations. I will honor that request unless the law requires me to disclose the information.

Get a list of certain disclosures

You may ask for an accounting of certain disclosures of your health information made during the six years before the date of your request, including who received the information and why.

The accounting will not include certain disclosures, such as disclosures for treatment, payment, and health care operations and certain disclosures that you specifically authorized or requested.

I will provide one accounting in any 12-month period without charge. I may charge a reasonable, cost-based fee for additional requests during the same 12-month period.

Get a copy of this notice

You may request a paper copy of this notice at any time, even if you have agreed to receive it electronically.

Choose someone to act for you

If you have given someone medical power of attorney or another person has legal authority to act on your behalf, that person may exercise your rights and make choices about your health information to the extent permitted by law.

I will verify that the person has appropriate authority before taking action.

File a complaint

If you believe your privacy rights have been violated, you may contact me using the information at the end of this notice.

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights.

I will not retaliate against you for filing a complaint.

For certain health information, you may tell me your preferences about what I disclose.

For example, you may tell me whether you want me to share relevant information with a family member, close friend, or other person involved in your care or payment for your care.

If you are unable to tell me your preference — for example, because of an emergency — I may disclose relevant information if I determine that doing so is in your best interest and is permitted by law.

I will not sell your protected health information.

I will not use or disclose your protected health information for marketing purposes when your authorization is required by law unless you give me written authorization.

Most uses and disclosures of psychotherapy notes, as that term is defined by HIPAA, require your written authorization.

Treatment

I may use your health information and disclose it to other health care professionals for purposes of providing, coordinating, or managing your treatment when permitted by applicable law.

Example: I may communicate with another physician involved in your care about your diagnoses, medications, laboratory results, or treatment.

Health care operations

I may use and disclose your health information as necessary to operate my practice, improve the quality of care, conduct administrative activities, and contact you when necessary.

Example: I may use health information to evaluate and improve the services provided by my practice.

Payment

I may use and disclose your health information as necessary to bill and obtain payment for services.

Example: If you ask me to provide information necessary for reimbursement from a health plan, I may provide information as permitted by law.

Federal and California law permit or require me to disclose health information in certain circumstances. These may include:

• public health and safety activities;
• reporting suspected child abuse or neglect;
• reporting certain suspected abuse or neglect of an elder or dependent adult;
• preventing or reducing a serious threat to someone's health or safety when disclosure is authorized or required by law;
• health oversight activities;
• workers' compensation matters;
• certain law-enforcement or governmental requests;
• responding to certain court orders, subpoenas, lawsuits, or other legal proceedings;
• research when applicable legal requirements are satisfied;
• responding to organ and tissue donation requests when applicable;
• communicating with medical examiners or funeral directors as permitted by law; and
• other disclosures required or specifically permitted by law.

I will comply with applicable federal and California requirements before making such disclosures.

California law provides additional privacy protections for certain mental health information. When California law provides greater privacy protection than federal law, I will follow the applicable California requirements.

In general, I will not disclose mental health treatment information without your written authorization unless the disclosure is otherwise permitted or required by law.

California law also imposes additional requirements on certain requests for information that specifically relates to a patient's participation in outpatient treatment with a psychotherapist. When those requirements apply, the person or entity requesting the information must provide the documentation required by California law.

Psychotherapy notes, as defined by HIPAA, receive additional protection and generally will not be used or disclosed without your written authorization except as permitted or required by law.

Certain substance use disorder records are subject to additional federal protections under 42 CFR Part 2.

To the extent that I create or maintain substance use disorder patient records that are subject to 42 CFR Part 2, those records will be used and disclosed only as permitted by applicable law.

Part 2 records generally may not be used or disclosed in civil, criminal, administrative, or legislative proceedings against you without your written consent or a court order accompanied by a subpoena or other legal requirement as required by applicable law.

For uses and disclosures not described in this notice or otherwise permitted or required by law, I will obtain your written authorization.

Your written authorization generally is required for:

• most uses and disclosures of psychotherapy notes;
• uses and disclosures for marketing when authorization is required by law;
• the sale of protected health information; and
• other uses or disclosures for which authorization is required by federal or California law.

If you authorize me to use or disclose your health information, you may revoke that authorization in writing at any time. Your revocation will not affect uses or disclosures already made in reliance on your authorization.

I use SimplePractice, a secure, HIPAA-compliant electronic health record system.

Communication by unencrypted email or text message may carry privacy risks. By initiating contact through either channel, you consent to those risks. You may ask at any time that I not contact you by email or text, and that preference will be recorded in your chart.

I am required by law to maintain the privacy and security of your protected health information.

I will notify you as required by law if a breach occurs that may have compromised the privacy or security of your information.

I must follow the duties and privacy practices described in the notice currently in effect.

I will not use or disclose your information other than as described in this notice unless you authorize me to do so in writing or the use or disclosure is otherwise permitted or required by law.

I may change the terms of this notice. Changes may apply to all health information I maintain about you, including information created or received before the change.

If I materially change this notice, the revised notice will be available on my website and upon request.

If you have questions about this notice, would like to exercise any of your privacy rights, or believe your privacy rights have been violated, please contact:

Daniel Bernstein, MD · Bernstein Psychiatry
Telephone: (650) 395-9192
Email: dbernstein@bernsteinpsych.com

You may also file a complaint with:

U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Telephone: 1-877-696-6775
HHS Office for Civil Rights complaint information

You will not be retaliated against for filing a complaint.