HIPAA Notice of Privacy Practices

Effective date: January 1, 2025

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.

Your Rights

Right to a copy of your records

You have the right to request a copy of your health and billing records. I will provide a copy or a summary of your health information, usually within 30 days of your request.

Right to request corrections

You can ask me to correct health information about you that you think is incorrect or incomplete. I may say no to your request, but I will tell you why in writing within 60 days.

Right to request confidential communications

You can ask me to contact you in a specific way (for example, home or office phone) or to send mail to a different address. I will say yes to all reasonable requests.

Right to request limits on use

You can ask me not to use or share certain health information for treatment, payment, or operations. I am not required to agree to your request, and I may say no if it would affect your care.

Right to an accounting of disclosures

You have the right to request a list of instances in which your information has been disclosed for purposes other than treatment, payment, or operations.

Right to a copy of this notice

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

Right to file a complaint

If you believe your privacy rights have been violated, you may file a complaint with me or with the U.S. Department of Health and Human Services Office for Civil Rights. I will not retaliate against you for filing a complaint.

How I Use and Share Your Information

For treatment

I may use and share your health information to provide, coordinate, or manage your mental health care. For example, I may share information with a treating physician if medically necessary.

For billing and payment

I may use and share your health information to bill and receive payment from your insurance company or other payers.

For healthcare operations

I may use and share your information as needed to run my practice and ensure quality care, such as for training, quality review, or legal compliance.

Required or permitted disclosures

I may be required or permitted to share your information in the following situations:

• When required by law (for example, mandatory reporting of child abuse or elder abuse)
• To prevent a serious and imminent threat to your safety or the safety of others
• To comply with workers' compensation laws
• To respond to a court order or subpoena
• To public health authorities for disease reporting purposes

Psychotherapy notes

I keep psychotherapy notes separate from the rest of your medical record. These notes receive additional legal protection and will not be shared without your specific written authorization, except as required by law.

My Responsibilities

I am required by law to maintain the privacy and security of your protected health information. I will let you know promptly 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 this notice. I will not use or share your information other than as described here unless you tell me I can in writing.

Changes to This Notice

I can change the terms of this notice, and the changes will apply to all information I have about you. The new notice will be available upon request and posted here.

Questions or Complaints

If you have questions about this notice or wish to file a complaint, contact:

Tina Liu, LMHC
tinaliulmhc@gmail.com

You may also contact the U.S. Department of Health and Human Services Office for Civil Rights at hhs.gov/ocr or by calling 1-800-368-1019.