Last updated: December 22, 2024

Your Information. Your Rights. Our Responsibilities.

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.

Contact Information

Legal Business Name: Healing Haven, Licensed Clinical Social Worker, SPC

Fictitious Business Name: Healing Haven Mental Health

Phone: 650-264-9618 ext. 650

Fax: 650-264-9619

Email: info@healinghavenmh.com

315 East Esplanade #89 San Jacinto, CA. 92583Your Rights

You have the right to:

Get a copy of your paper or electronic medical record

Correct your paper or electronic medical record

Request confidential communication

Ask us to limit the information we share

Get a list of those with whom we’ve shared your information

Get a copy of this privacy notice

Choose someone to act for you

File a complaint if you believe your privacy rights have been violated

Your Choices

You have some choices in the way that we use and share information as we:

Tell family and friends about your condition

Provide disaster relief

Include you in a hospital directory

Provide mental health care

Market our services and sell your information

Raise funds

Our Uses and Disclosures

We may use and share your information as we:

Treat you

Run our organization

Bill for your services

Help with public health and safety issues

Do research

Comply with the law

Respond to organ and tissue donation requests

Work with a medical examiner or funeral director

Address workers’ compensation, law enforcement, and government requests

Respond to lawsuits and legal actions

Detailed Explanation of Your Rights

Get an electronic or paper copy of your medical record

You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you.

We will provide a copy or summary, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your medical record

You can ask us to correct information you think is incomplete or incorrect.

We may deny your request, but we will explain our decision in writing within 60 days.

Request confidential communications

You can ask us to contact you in a specific way (for example, home or office phone) or send mail to a different address.

We will say “yes” to all reasonable requests.

Ask us to limit what we use or share

You may request that we not use or share certain information for treatment, payment, or operations. We are not required to agree, but will comply when possible.

If you pay out-of-pocket in full for a service, you can ask us not to share information with your health insurer for that service unless required by law.

Get a list of those with whom we’ve shared information

You may request an accounting of disclosures made over the past six years, except those related to treatment, payment, operations, and certain other exceptions.

One list per year is free; additional requests may incur a reasonable fee.

Get a copy of this notice

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

Choose someone to act for you

If someone has medical power of attorney or is your legal guardian, they may act for you.

We will ensure documentation is valid before granting access.

File a complaint if you feel your rights are violated

You can file a complaint with us using the contact information above.

You may also file with the U.S. Department of Health & Human Services:

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

200 Independence Avenue, S.W.

Washington, D.C. 20201

Phone: 1-877-696-6775

www.hhs.gov/ocr/privacy/hipaa/complaints/

We will not retaliate against you for filing a complaint.

For certain situations, you have the right to tell us how we share your information.

You may tell us whether to:

Share information with family, friends, or others involved in your care

Share information in a disaster relief situation

Include your information in a directory

If you cannot express your preference, we may share information if necessary for your care or safety.

We will never share your information for:

Marketing

Selling your information

Most sharing of psychotherapy notes

Fundraising communications may occur, but you can opt out at any time.

Our Uses & Disclosures

Treat you

We can use your health information and share it with other professionals involved in your care.

Run our organization

We use health information to manage and improve care and services.

Bill for your services

We may share information with health plans or entities to obtain payment.

Other Uses Allowed by Law

We may share your information to support:

Public health and safety

Product recalls

Reporting abuse or neglect

Preventing or reducing a serious threat

Health research

Compliance with federal or state laws

We may also disclose information for:

Organ/tissue donation

Coroner or funeral director services

Workers’ compensation, law enforcement, or national security

Legal proceedings

Our Responsibilities

We are required by law to maintain privacy and security of protected health information.

We will notify you promptly if a breach occurs.

We must follow this notice and provide you a copy upon request.

We will not use or share your information without your written permission unless allowed by law.

You may revoke permission at any time in writing.

For more details, visit:

www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html

Changes to This Notice

We may change this notice at any time.

Changes will apply to all information we maintain.

The revised notice will be available on our website and upon request.

Special Notes

We will never sell personal information.

We will never share substance-use treatment information without written authorization (if applicable).

Contact Us

If you have any questions about this Privacy Policy, you may contact us:

Phone: 650-264-9618 ext. 650

Fax: 650-264-9619

Email: info@healinghavenmh.com

315 East Esplanade #89 San Jacinto, CA. 92583