Your rights under CMIA and HIPAA:

 

As a patient, you have the right to:

• Request limits on how your protected health information (PHI) is used or shared for treatment, payment, or healthcare operations.

• Receive confidential communication by alternative means or at alternate locations upon request.

• Access and obtain copies of your medical and billing records.

• Request corrections to your PHI if you believe it is inaccurate or incomplete.

• Receive a list of disclosures of your PHI that were not authorized by you.

• Receive notification if your PHI is affected by a breach.

• Receive a paper copy of this Notice at any time upon request.

 

How your information may be used:

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We may use or disclose your PHI without additional written authorization for the following purposes:

• Treatment – To coordinate care with other professionals involved in your treatment.

• Payment – To bill and receive reimbursement for services.

• Healthcare Operations – For quality assurance, administrative audits, and practice improvement.

• Legal and safety purposes – To comply with mandated reporting laws, court orders, or if there is a serious threat to your safety or that of others.

• Public health and oversight – To report as required to public health authorities or licensing boards. Additional disclosures may be required by California law, such as in cases of suspected child, elder, or dependent adult abuse.

 

When written authorization is required:

We will not disclose your PHI for purposes such as marketing, sale of information, or other non treatment activities without your explicit written consent. You may revoke your authorization at any time in writing.

 

Our duties to you:

 

 We are required by law to:

• Maintain the privacy of your PHI.

• Provide you with this notice.

• Abide by the terms of this notice.

• Inform you promptly if a breach of unsecured PHI occurs.

• Update you in writing if our policies change.

 

I use SimplePractice, a secure, HIPAA-compliant electronic health record system. Communication via unencrypted email may carry privacy risks. By initiating email contact, you consent to those risks.

 

How to file a complaint:

 

If you believe your privacy rights have been violated, you may:

• Contact Dr. Ryan Pate directly.

• File a complaint with the U.S. Department of Health and Human Services:

 

Office for Civil Rights U.S. Department of Health and Human Services

200 Independence Avenue, S.W. Washington, D.C. 20201

Toll-Free: 1-877-696-6775

Website: www.hhs.gov/ocr/privacy

 

There will be no retaliation for filing a complaint.