Privacy Policy

The Services outlined on this Site are mental health and behavioral health counseling or psychotherapy services provided by professionals who are licensed or registered with the California Board of Behavioral Sciences (BBS). Our business within the scope of practice abides by the Code of Ethics for Social Workers, Marriage and Family Therapists, and Professional Counselors, BBS, including confidentiality and HIPAA rules, for the Users of this Website as well as our clients who sign the consent forms in writing to commence counseling services and telehealth services.

Notice of Privacy Practices (HIPAA)

REVIEW THIS NOTICE CAREFULLY. THIS NOTICE DESCRIBES HOW PROTECTED HEALTH INFORMATION (PHI) ABOUT YOU (THE CLIENT OF THIS PRACTICE) MAY BE USED AND DISCLOSED AND HOW YOU CAN GAIN ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION. 

Required of WALTZ Trauma Care and Therapy by the Privacy Regulations created by Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Our practice must give you, the client, this Notice before initiating services and upon request at any time. This Notice outlines clients’ rights and therapists’ duties when engaging in a professional relationship for behavioral health and mental health practices.

What is HIPAA?

HIPAA stands for the Health Insurance Portability and Accountability Act of 1996. It is a federal law that establishes security and privacy standards for the use and disclosure of your Protected Health Information (PHI) for the purpose of treatment, payment, and health care operations. 

IF YOU HAVE QUESTIONS ABOUT THIS NOTICE PLEASE CONTACT: 

Ah Hyun “Ashley” Lee, LCSW

WALTZ Trauma Care and Therapy

2211 Post St #300

Mailbox 11116

San Francisco, CA 94115

(415) 489-0693

Uses and Disclosures of Your Protected Health Information

for Treatment: 

An authorization is required in writing to speak with your primary care physician, psychiatrist, other care providers, or anyone else (i.e., family member) to discuss your care. Without an authorization, your PHI and clinical records will remain strictly confidential. This means, if someone were to reach out to our practice and ask about you, your appointment schedules, etc., stating that they know you are in therapy, clinicians cannot acknowledge that you are seeing them at all. However, there are limits to confidentiality to share your PHI without your consent as required by the law in the mental health profession. As mandated reporters, clinicians at our practice may be required to disclose your PHI to law enforcement and/or appropriate government agencies when there is a reasonable suspicion of abuse or neglect to a child, the elderly, or a dependent adult. When there is an immediate danger to Others, your clinician may disclose your PHI to law enforcement officers or other persons who might prevent or lessen that threat. When there is an immediate danger to Self, your clinician may contact 911, an ambulance, a hospital, or other persons who might prevent or lessen that threat. Our practice is required to respond upon a receipt of a legitimate court order (not from an attorney or a lawyer).

for Payment:  

Our practice will make uses and disclosures of your protected health information as necessary for payment purposes. Our practice may also use your information to prepare a bill to send to you, to the person responsible for your payment, or to your insurance company if you are using your insurance benefits to cover the cost of the services rendered. 

for Health Care Operations:  

Our practice will make uses and disclosures of your protected health information as necessary, and as permitted by law, for health care operations, which may include clinical improvement, professional peer review, business management, accreditation and licensing, etc.  For instance, our practice may use and disclose your protected health information for purposes of improving clinical treatment and care. 

Minimum Necessary Requirement

For the use and disclosure of your PHI,  it is a requirement for information to be shared at the minimum necessary and limited to those who need to know, whenever possible, as permitted by the law. 

The HIPAA Privacy Rule:  

  • Establishes conditions under which PHI can be used within the clinical practice and disclosed to others outside it; 

  • Grants individuals (clients who receive clinical services) certain rights regarding their PHI; 

  • Requires that the clinical practice maintains the privacy and security of PHI.    

The HIPAA Security Rule: 

  • Establishes administrative, technical, and physical standards for the security of electronic protected health information (ePHI); 

  • Requires that the clinical practice maintains the availability, integrity, and confidentiality of electronic health information. 

The Client’s Rights:

Right to Treatment: You have the right to ethical treatment without discrimination regarding race, ethnicity, gender identity, sexual orientation, religion, disability status, age, or any other protected category.
Right to Confidentiality: You have the right to have your health care information protected. If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. Our practice will agree to such unless a law requires us to share that information.

Right to Request Restrictions: You have the right to request restrictions on certain uses and disclosures of protected health information about you. However, our practice is not required to agree to a restriction you request.

Right to Receive Confidential Communications by Alternative Means and at alternative Locations: You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations.

Right to Inspect and Copy: You have the right to inspect or obtain a copy (or both) of PHI. Records must be requested in writing and release of information must be completed. Furthermore, there is a copying fee charge of $1.00 per page. Please make your request well in advance and allow 2 weeks to receive the copies. If our practice refuses your request for access to your records, you have a right of review, which our practice will discuss with you upon request.

Right to Amend: If you believe the information in your records is incorrect and/or missing important information, you can ask our practice to make certain changes, also known as amending, to your health information. You have to make this request in writing. You must tell us the reasons you want to make these changes, and our practice will decide if it is and if we refuse to do so, we will tell you why within 60 days.

Right to a Copy of This Notice: If you received the paperwork electronically, you have a copy in your email. To obtain a paper copy of this notice, contact your clinician. You will receive a physical copy in the mail.

Right to Choose Someone to Act for You: If someone is your legal guardian, that person can exercise your rights and make choices about your health information; Our practice will make sure the person has this authority and can act for you before we take any action.

Right to Choose: You have the right to decide not to receive services with me. If you wish, our practice will provide you with names of other qualified professionals.

Right to Terminate: You have the right to terminate therapeutic services with our practice at any time without any legal or financial obligations other than those already accrued. Our practice asks that you discuss your decision with your clinician in session before terminating or at least contact your clinician or a manager at our practice by phone letting us know you are terminating services.

Right to Release Information with Written Consent: With your written consent, any part of your record can be released to any person or agency you designate. Together, you and your clinician will discuss whether or not releasing the information in question to that person or agency might be harmful to you.

Right to File a Complaint:  If you are concerned that your clinician and our practice has violated your privacy rights, or you disagree with a decision our practice made about access to your records, you may contact your clinician, a manager at our practice, the State of California Department of Health, or the Secretary of the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.

Breach of PHI 

You, as the client, have a right to be notified in cases where your PHI has been inappropriately accessed, used, or disclosed in violation of the Privacy Rule.  Potential breaches include lost paper records, lost smartphones or laptops containing PHI, misdirected mail, email or faxes etc. 

Refer to U.S. Department of Health and Human Services at https://www.hhs.gov and Health Information Privacy at https://www.hhs.gov/hipaa/for-individuals/index.html