Notice of Privacy Practices

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.

About this notice

This notice applies to Nationwide IOP Center [VERIFY: full legal entity name and type, e.g. LLC or Inc.], 1544 Canada Blvd, Glendale, CA 91208, and to everyone on our team who works with your information: clinicians, care coordinators, staff and the service providers who help us.

"Health information" means information that identifies you and relates to your past, present or future health, your care, or payment for your care.

Our duties

• We are required by law to keep your health information private and to give you this notice of our duties and practices.
• We must follow the notice that is currently in effect.
• We will tell you promptly if a breach happens that may have put your information at risk.
• We will not use or share your information in ways other than those described here unless you tell us we may, in writing. You can change your mind at any time, in writing.

Treatment, payment and operations

Treatment

We use your information to provide your care, and we share it with others who treat you. Example: your therapist shares notes with your group clinician, or with your primary doctor if you ask us to coordinate.

Payment

We use and share information to bill and get paid by your health plan or others. Example: we give your insurance plan the information it needs to check your benefits or pay for a session.

Health care operations

We use and share information to run our program, improve care and train staff. Example: we review records to check the quality of our groups.

Reminders and options

We may contact you about appointments, and about treatment options or services that may interest you.

Family and people involved in your care

You can tell us who we may talk to about your care, such as a family member or friend who helps you. If you are not able to tell us, for example in an emergency, we may share information we believe is in your best interest. You have the right to tell us not to share with someone.

Other uses the law allows

The law allows or requires us to share information without your permission in these situations, within the limits the law sets:

• When the law requires it, including when the U.S. Department of Health and Human Services checks that we comply with privacy law.
• To prevent a serious threat to someone's health or safety, only to a person who can help prevent it.
• Abuse, neglect or domestic violence: reports to the authorities, as California law requires (for example suspected child, elder or dependent adult abuse).
• Public health and safety, such as preventing disease or reporting adverse reactions to medications.
• Health oversight, such as audits, inspections and licensing.
• Lawsuits and legal actions, in response to a court order, or a subpoena when the law's protections are met.
• Law enforcement, in limited cases, such as responding to a court-ordered warrant.
• Coroners, medical examiners and funeral directors, and organ and tissue donation organizations.
• Research, only when approved under privacy rules that protect you.
• Special government functions, such as military, national security and protective services.
• Workers' compensation, as the law allows.

Uses that need your written permission

• Psychotherapy notes. Most uses and sharing of a therapist's separate session notes.
• Marketing. We never use your information for marketing without your written permission.
• Sale of information. We never sell your information.
• Testimonials and reviews. We never share that you are or were a patient, including in a review or on social media, without your written permission.
• Anything not described in this notice.

We do not do fundraising.

Your rights

See and get a copy of your records

You can ask to see or get a paper or electronic copy of your health information. We will respond within the time the law sets, and may charge a reasonable, cost-based fee.

Ask us to correct your records

If you think something is wrong or missing, ask us to correct it. We may say no, but we will tell you why in writing, within 60 days.

Ask for confidential communications

You can ask us to reach you a certain way (for example only on your mobile) or at a different address. We will say yes to all reasonable requests.

Ask us to limit what we use or share

You can ask us not to use or share certain information. We are not required to agree, except one case: if you pay for a service in full yourself, you can ask us not to share it with your health plan, and we will say yes unless the law requires us to share it.

Get a list of who we shared information with

You can ask for a list (an "accounting") of the times we shared your information in the six years before your request, who we shared it with and why. It will not include sharing for treatment, payment, operations, or sharing you asked for. One list a year is free.

Get a copy of this notice

You can ask for a paper copy at any time, even if you agreed to get it electronically.

Choose someone to act for you

If someone is your legal guardian or holds your medical power of attorney, they can use your rights. We will check before we act.

California law

California's Confidentiality of Medical Information Act and other state laws sometimes protect your information more than federal law does, for example for mental health records. When state law gives you more protection, we follow it.

Questions and complaints

To use any of these rights, ask a question, or complain, contact our Privacy Officer:

[VERIFY: Privacy Officer name or title]
1544 Canada Blvd, Glendale, CA 91208
Phone: (747) 599-0059
Email: [VERIFY: privacy contact email]

You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights: 200 Independence Avenue SW, Washington, D.C. 20201, 1-800-368-1019 (TDD 1-800-537-7697), or online at hhs.gov/ocr/complaints.

We will not retaliate against you for filing a complaint.

Changes to this notice

We can change this notice, and the changes will apply to all information we have about you. The new notice will be on this page, available at our office, and given to you on request.