HIPAA Notice of Privacy Practices

Refreshing Mental Health is committed to protecting the privacy of your health information. We are required by law to maintain the privacy of your protected health information (PHI), to provide you with this notice of our legal duties and privacy practices, and to abide by the terms of this notice.

Treatment: We may use and disclose your health information to provide, coordinate, or manage your healthcare and related services. For example, we may share your information with other healthcare providers involved in your treatment.

Payment: We may use and disclose your health information to obtain payment for services we provide. This may include sharing information with your insurance company to verify coverage and process claims.

Healthcare Operations: We may use and disclose your health information for healthcare operations, including quality assessment, staff training, accreditation, licensing, and other activities necessary to run our practice.

As Required by Law: We will disclose your health information when required to do so by federal, state, or local law, including mandatory reporting requirements.

Abuse or Neglect: We may disclose information to appropriate authorities if we believe a patient has been the victim of abuse, neglect, or domestic violence.

Public Health Activities: We may disclose health information to public health authorities for activities such as disease surveillance, reporting, and control.

Serious Threats to Health or Safety: We may use or disclose health information when necessary to prevent a serious threat to your health or safety or the health or safety of the public.

Other uses and disclosures of your health information not described in this notice will only be made with your written authorization, including most uses of psychotherapy notes, uses of your information for marketing purposes, and sales of your information. You may revoke your authorization at any time in writing, except to the extent we have already taken action in reliance on your authorization.

Special protections: California law provides additional protections for mental health information, HIV/AIDS information, substance abuse records, and genetic information. These categories of information will not be disclosed without your specific written authorization except as required by law or in emergencies.

Right to inspect and copy: You have the right to inspect and obtain a copy of your health information. We may charge a reasonable fee for copies.

Right to request amendment: If you believe information in your record is incorrect or incomplete, you may request that we amend the information.

Right to an accounting of disclosures: You have the right to request a list of disclosures we have made of your health information, with certain exceptions.

Right to request restrictions: You have the right to request restrictions on certain uses or disclosures of your health information. We are not required to agree to all requested restrictions.

Right to confidential communications: You have the right to request that we communicate with you in a specific way or at a specific location.

Right to a paper copy of this notice: You have the right to receive a paper copy of this notice upon request.

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

We reserve the right to change this notice at any time. We reserve the right to make the revised or changed notice effective for health information we already have as well as any new information we receive. The current notice will be posted at our offices and on our website.

To exercise any of the rights described in this notice, or if you have questions about our privacy practices, please contact us:

Refreshing Mental Health — Privacy Officer
473 E Carnegie Dr., Suite 200, San Bernardino, CA 92408
Phone: 1-888-502-8244
Email: info@wwwrefreshingmentalhealth.com

To 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
1-877-696-6775 | www.hhs.gov/ocr