951-904-6109 In-Person In Temecula & Online Across California
NOTICE OF HEALTH INFORMATION PRIVACY PRACTICES
This Notice of Health Information Privacy Practices or “Notice” describes how Zen Bloom Counseling individual and Family Therapy Corporation may use and disclose your protected health information(PHI) to carry out treatment, payment, health care operations, and for other purposes that are required or permitted by law. It also describes your rights to control and access your protected health information. We are required by law to abide by the terms of this Notice of Privacy Practices. We may change the terms of this Notice of Privacy Practice at any time, and such changes will apply to all information we have about you. The new Notice of Privacy Practice will be available upon request on my website, and in my office. In this Notice, we use terms like “we,” “us” or “our” or “Zen Bloom Counseling” to refer to Zen Bloom Counseling Individual and Family Therapy Corporation. Please review this Notice carefully.
Uses and Discloses of Your Health Information for Treatment, Payment, and
Health Care Operations
Zen Bloom Counseling Individual and Family Therapy Corporation will use and disclose
your health information without your authorization as described in each category listed
below. We have not listed every specific use or disclosure for each category, but rather
provided a representative sample of situations.
1. For Treatment: Zen Bloom Counseling Individual and Family Therapy Corporation may use and disclose your health information without your consent to provide, coordinate, and manage your healthcare and related services. We may share your health information with other healthcare professionals outside of Zen Bloom Counseling (such as your primary care physician, psychiatrist, hospital social worker, nurse, or other healthcare providers). For example, if you are being treated by a physician, nurse, psychiatrist, or another healthcare professional, we may disclose your PHI to them without your consent to help coordinate your care.
2. For Payment: Zen Bloom Counseling Individual and Family Therapy Corporation may use or disclose your protected health information to bill and collect payment for the treatment and services you receive. For example, we may send your Protected Health Information to your insurance company to receive payment for the healthcare services we provided. Additionally, we may send your Protected Health Information to verify your eligibility and obtain authorization for your treatment. Zen Bloom Counseling may also disclose your health information to another healthcare provider so they can bill you for services they provided, such as an ambulance service that transported you to a hospital.
3. For Health Care Operations: Zen Bloom Counseling Individual and Family Therapy Corporation may use and disclose health information about you for our health care operations. These activities may include improvement and quality assessment, post-discharge, follow-up calls, and client satisfaction, contacting you when necessary, contacting you to remind you of your appointment, and general administrative functions. For example, I may need to disclose your protected health information to my attorney to obtain advice about complying with applicable laws.
Certain Uses and Disclosures Do Not Require Your Authorization.
Subject to certain limitations in the state or federal law, we can use and disclose your
protected health information without your verbal or written authorization for the
following situations. These laws do not give you the option to object to these uses
and disclosures.
1.When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.
2. Emergencies: In emergency treatment situations, Zen Bloom Counseling Individual and Family Therapy Corporation may use and disclose your health information. For example, we may provide your health information to an emergency medical technician (EMT) while you're being transported by ambulance.
3. To Prevent a Serious Risk/Threat to Safety or Health: Zen Bloom Counseling Individual and Family Therapy Corporation may use and disclose your protected health information if necessary to prevent an imminent and serious threat to your health or safety, or to the health or safety of others or the public. In these situations, we will only disclose your health information to individuals who can help reduce or prevent the threat.
4. Public Health Activities: Zen Bloom Counseling Individual and Family Therapy Corporation may disclose your health information for public health activities, including but not limited to the following:
● Inform a person who may have been exposed to or is at risk of contracting or spreading a disease or condition;
● Conduct public health investigations or surveillance;
● To control or prevent disease, disability, or injury or;
● Report suspected child, elder, or dependent adult abuse, neglect, child
endangerment, domestic violence, or prevent or reduce a serious threat to
anyone’s safety or;
● Report reaction to medication, adverse events or problems with medications.
5. Health Oversight Activities: Zen Bloom Counseling Individual and Family Therapy Corporation may disclose your health information to a health oversight agency for activities permitted by law. These activities include licensure, investigations, audits, and certification, and involve government agencies that regulate the healthcare system, government benefit programs such as Medi-Cal, other healthcare-related government programs, and civil rights regulations.
6. Disclosures in Legal Proceedings: Zen Bloom Counseling Individual and Family Therapy Corporation may disclose your protected health information to a court or administrative agency upon a judge’s or agency's order. We may also release your health information in legal proceedings without your authorization or without a judge’s order if we are subpoenaed for your health information.
7. Law Enforcement Activities: Zen Bloom Counseling Individual and Family Therapy Corporation may disclose your protected health information without your authorization to a law enforcement official for law enforcement purposes, including reporting crimes that occur on our premises. Additionally, we may disclose your health information without your authorization if required by a subpoena, court order, warrant, summons, or similar legal process signed by a judge.
8. Medical Examiners or Funeral Directors: We may share your health information with a medical examiner to help identify deceased individuals and determine the cause of death in certain situations. Additionally, we may disclose health information to funeral directors as needed to perform their duties.
9. Military and Veterans: If you are a member of the armed forces, we may disclose your health information as required by military command authorities.
10.National Security and Protective Services for the President and Others: We may disclose medical information about you to authorized federal officials for intelligence, counter-intelligence, and other national security activities authorized by law. We may also disclose health information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or so they may conduct special investigations.
11. For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who receive another form of therapy for the same condition.
12.Specialized government functions, including, ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counter-intelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.
13.For workers' compensation purposes. Although our preference is to obtain an Authorization from you, we may provide your PHI in order to comply with workers' compensation laws.
14.Appointment reminders and health related benefits or services. We may use and disclose your PHI to contact you to remind you that you have an appointment with us. We may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that we offer.
15.Inmates: If you are an inmate in a correctional facility or under the custody of law enforcement, we may disclose your health information to the correctional institution or the law enforcement official responsible for your care.
16.Food and Drug Administration: We may disclose your health information to a person or organization as required by the Food and Drug Administration (FDA) for the following purposes: (i) to facilitate product recalls; (ii)to report adverse events, product defects, issues, biologic product deviations, or track products;
(iii) to carry out repairs or replacements; or (iv) to conduct post-marketing surveillance, as mandated.
As Required By Law: Zen Bloom Counseling Individual and Family Therapy Corporation will disclose your health information when required to do so by state, federal, or local law.
Uses and Disclosures That May be Made without Your Authorization, but for
which You Will Have an Opportunity to Object
Persons Involved in Your Care or Payment of Your Care: With prior notice and the opportunity for you to approve, restrict, or refuse the disclosure or use, Zen Bloom Counseling Individual and Family Therapy Corporation may use or disclose your health information:
1. To assist or inform a family member, close personal friend, personal
representative, or another person involved in your care about your general
condition, location, or death, or to help with the payment of your healthcare;
2. To disaster relief organizations to aid in disaster relief efforts.
Uses and Disclosures of Your Health Information which Require Your Permission
Uses and disclosures not covered in this Notice of Privacy Practices typically require
your written consent, known as an “authorization.” You have the right to revoke this
authorization in certain cases. Authorization is also needed for the use or disclosure of
protected health information for marketing purposes or the sale of such information.
While Zen Bloom Counseling Individual and Family Therapy Corporation is a behavioral
health provider, we do not create psychotherapy notes for your medical records.
However, if we did create such notes, their use or disclosure would require
authorization. If you pay for your services out of pocket, you can restrict certain
disclosures. The disclosure of genetic information for underwriting purposes is
prohibited.
Your Rights Regarding Your Health Information
Right to a copy of this notice: You can request a copy by calling 000-000-0000 or by asking for one whenever you visit our office. It is also available on Zen Bloom Counseling Individual and Family Therapy Corporation’s website at
https://zenbloomcounseling.com/policies/privacy-policy.
Right to copy and inspect your health record used to make decisions about your
payment and treatment: Your request to inspect or obtain a copy of your health information must be submitted in writing to Zen Bloom Counseling Individual and Family Therapy Corporation. A fee may apply for copies. In certain limited situations, we may deny your request. If we do deny your request, you can have the denial reviewed by a licensed Zen Bloom Counseling Individual and Family Therapy Corporation healthcare professional. We will abide by the decision made by the licensed healthcare professional.
Right to amend your health record if you believe the information is incorrect or
incomplete: You must submit a written request to Zen Bloom Counseling Individual and Family Therapy Corporation explaining why the information is incorrect or incomplete. If we accept your request, please note that we are not required to remove any information from your record. We may deny your request if you ask us to amend health information that: was not created by us, is not part of the information you are allowed to inspect or copy, is not part of the health or billing information we use to make decisions about your care, or is complete and accurate. If Zen Bloom Counseling Individual and Family Therapy Corporation denies your request to amend, we will provide you with a written notice explaining the reason for the denial and offer you the opportunity to submit a written statement of disagreement with the denial.
Right to request an accounting of disclosures to others of your health information:
You have the right to request a list of instances in which we have disclosed your PHI for purposes other than treatment, payment, or health care operations, those excluded by law, or for which you provided me with an Authorization. We will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list we will give you will include disclosures made in the last six years unless you request a shorter time. We will provide the list to you at no charge, but if you make more than one request in the same year, we will charge you a reasonable cost based fee for each additional request.
Right to request restrictions on certain uses and disclosures: You must request the restriction in writing addressed to Zen Bloom Counseling Individual and Family Therapy Corporation. We will ask you to sign a request for a restriction form, which you should complete and return to us. We are not required to agree to any restrictions you request. If we do agree, we will honor your request unless the restricted health information is needed to provide you with emergency treatment.
The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.
Marketing Purposes. As a psychotherapist, we will not use or disclose your PHI for marketing purposes.
Sale of PHI. As a psychotherapist, we will not sell your PHI in the regular course of my business.
Breach: Affected individuals have the right to be notified of a breach of their healthcare information.
Complaints: If you think we may have violated your privacy rights, you may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services. To file a complaint with us, you may contact our Privacy Officer in writing at 29645 Rancho California Road Ste 238 Temecula, CA 92591. The Privacy Office will assist you with writing your complaint if you request such assistance. Zen Bloom Counseling Individual and Family Therapy Corporation will not retaliate against you for submitting a complaint.
Phone: 951-904-6109
Email: leena@zenbloomcounseling.com