I. THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
II. OUR LEGAL DUTY TO PROTECT YOUR HEALTH INFORMATION
Em Scott Therapy is legally required to protect the privacy of your Protected Health Information (PHI), which includes information that identifies you and relates to your past, present, or future physical or mental health or condition, the provision of health care to you, or payment for that care.
This Notice outlines our legal duties, your rights, and how we may use and disclose your PHI. We are required to follow the privacy practices described in this Notice and will notify you promptly if a breach occurs that may compromise the privacy or security of your information.
We may change the terms of this Notice at any time. Changes will apply to all the information we maintain. The updated Notice will be available in our office and at [www.emscotttherapy.com].
III. HOW WE MAY USE AND DISCLOSE YOUR PHI
A. Uses and Disclosures That Do Not Require Your Written Authorization
We may use and disclose your PHI without your consent for:
- Treatment
To provide, coordinate, or manage your mental health care and related services. This includes consultation between providers within Em Scott Therapy or with other health care professionals involved in your treatment. - Payment
To bill and receive payment for services. This includes sharing information with third-party payers or business associates that assist with billing. - Health Care Operations
For administrative, training, and quality improvement purposes to ensure you receive high-quality care. - Emergencies or Patient Incapacitation
When you are unable to provide consent due to emergency circumstances or incapacity, and disclosure is believed to be in your best interest.
B. Other Uses and Disclosures Permitted by Law
We may also use or disclose your PHI without your consent when required by law or for the following:
- Reporting abuse or neglect
- Court or administrative orders
- Law enforcement purposes
- Public health activities
- Health oversight agencies
- To prevent a serious threat to health or safety
- National security or military operations
- Appointment reminders or health-related benefits/services
C. Uses and Disclosures That Require an Opportunity to Object
We may share your PHI with individuals involved in your care or payment for your care, such as family or close friends, unless you object.
D. Uses and Disclosures That Require Your Written Authorization
For all other situations not covered above, we will obtain your written authorization before using or disclosing your PHI. You may revoke your authorization at any time in writing.
IV. YOUR RIGHTS REGARDING YOUR PHI
You have the following rights:
- Request Restrictions
You may request limitations on how your PHI is used or disclosed. While we are not required to agree to all requests, we will comply with any agreed-upon restrictions. - Confidential Communications
You may request to receive communications in a specific way (e.g., via email) or at a specific location. - Inspect and Copy Your PHI
You may request access to your records. Requests must be in writing, and a fee may apply for copies. - Amend Your PHI
If you believe your PHI is inaccurate or incomplete, you may request an amendment in writing. - Receive an Accounting of Disclosures
You may request a list of disclosures of your PHI made by Em Scott Therapy, excluding those made for treatment, payment, or operations. - Appoint a Personal Representative
If you’ve designated someone through medical power of attorney, they may exercise your rights on your behalf. - Receive a Paper Copy of This Notice
Even if you agree to receive it electronically, you have the right to a paper copy.
V. HOW TO FILE A COMPLAINT
If you believe your privacy rights have been violated, you may file a complaint with:
- California Department of Health Services:
P.O. Box 997413, MS 0010, Sacramento, CA 95899-7413
Phone: (916) 445-4646 or (877) 735-2929 (TTY) - U.S. Department of Health and Human Services:
Office for Civil Rights, 90 7th Street, Suite 4-100, San Francisco, CA 94103
Phone: (415) 437-8310 or (415) 437-8311 (TDD)
You will not be retaliated against for filing a complaint.
VI. CONTACT INFORMATION
If you have questions about this Notice or your rights, please contact:
Em Scott Therapy
Los Angeles Emotional Wellness Group
1910 Hillhurst Ave
Los Angeles, CA 90027
emscotttherapy@gmail.com
(626) 344-2030
www.emscotttherapy.com
Em Scott Therapy 