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.
Effective Date: November 2024
Please review this notice carefully. Your privacy is important to us.
Our Commitment to Your Privacy
The Affair Recovery Center of San Diego is committed to protecting the privacy of your health information. We are required by law to maintain the privacy of Protected Health Information (PHI) and to provide you with this Notice of Privacy Practices.
This notice explains how we may use and disclose your PHI and describes your rights regarding this information. We are required to follow the terms of this notice while it is in effect.
What is Protected Health Information (PHI)?
PHI is information about you, including demographic information, that may identify you and relates to your past, present, or future physical or mental health condition, the provision of health care to you, or the payment for that care.
Examples of PHI include your name, address, phone number, Social Security number, dates of service, diagnoses, treatment plans, and session notes.
How We May Use and Disclose Your PHI
For Treatment
We may use your PHI to provide, coordinate, or manage your mental health care. For example, we may share information with another health care provider to whom you have been referred for consultation or coordination of care.
For Payment
We may use and disclose your PHI to bill and collect payment for your treatment. For example, we may send claims to your health insurance company with diagnostic and procedure codes.
For Health Care Operations
We may use your PHI for our healthcare operations, such as quality assessment, case management, and administrative activities.
With Your Written Authorization
Other uses and disclosures of your PHI require your written authorization. You may revoke an authorization at any time by providing written notice.
Disclosures Without Your Authorization
We may use or disclose your PHI without your authorization in limited circumstances, including:
- As required by law: When required by federal, state, or local law
- To prevent serious harm: When necessary to prevent a serious threat to your health and safety or the health and safety of others
- Child abuse or neglect: When we reasonably believe a child is a victim of abuse or neglect
- Elder abuse: When we reasonably believe an elderly or dependent adult is a victim of abuse or neglect
- Judicial proceedings: In response to a court order or subpoena
- Law enforcement: For certain law enforcement purposes as permitted by law
- Coroners and medical examiners: For identification purposes and determining cause of death
Psychotherapy Notes
Psychotherapy notes receive special protection under HIPAA. These are notes recorded by a mental health professional documenting the contents of a counseling session. We generally will not disclose psychotherapy notes without your written authorization.
Exceptions include situations where disclosure is necessary to defend ourselves in a legal action, to avert a serious threat to health or safety, for supervision purposes, or as required by law.
Your Rights Regarding Your PHI
Right to Inspect and Copy
You have the right to inspect and obtain a copy of your PHI that we maintain. Requests must be made in writing. We may charge a reasonable fee for copies.
Right to Amend
You have the right to request that we amend your PHI if you believe it is incorrect or incomplete. We may deny the request in certain circumstances.
Right to an Accounting of Disclosures
You have the right to request a list of certain disclosures we have made of your PHI. This does not include disclosures for treatment, payment, or health care operations.
Right to Request Restrictions
You have the right to request restrictions on how we use or disclose your PHI. We are not required to agree to your request, except in certain circumstances involving payment from your own funds.
Right to Request Confidential Communications
You have the right to request that we communicate with you about health matters in a certain way or at a certain location.
Right to a Paper Copy
You have the right to obtain a paper copy of this Notice of Privacy Practices upon request.
Changes to This Notice
We reserve the right to change this notice and make the new notice provisions effective for all PHI we maintain. If we make significant changes, we will post the revised notice on our website and make copies available upon request.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services. You will not be penalized or retaliated against for filing a complaint.
To file a complaint with HHS, visit: www.hhs.gov/hipaa/filing-a-complaint
Privacy Officer Contact
For questions about this notice, to request access to your health information, or to file a complaint, please contact:
Privacy Officer
Affair Recovery Center of San Diego
Jordan Zipkin, LMFT
Carmel Valley, San Diego, CA 92130
Questions About Privacy?
Your confidentiality is our priority. Reach out if you have any concerns.
Contact Us