Notice of Privacy Practices
Effective Date: June 07, 2024
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.
Mind Bloom La Jolla / Ana Lopez Hopkins, MSN, PMHNP-BC (“we,” “us,” “our”) is required by law to maintain the privacy of your protected health information (“PHI”), provide you with this Notice of our legal duties and privacy practices, and abide by the terms of the Notice currently in effect.
How We May Use and Disclose Your Health Information
Treatment
We may use and disclose your PHI to provide, coordinate, or manage your mental health care and related services, including consulting with other treating providers about your care.
Payment
We may use and disclose your PHI to obtain payment for services, including billing your insurance carrier, verifying coverage, and processing claims.
Health Care Operations
We may use and disclose your PHI for operations such as quality assessment, staff review, licensing, and business planning.
Other permitted or required uses include:
- As required by law
- To avert a serious threat to health or safety
- For public health activities
- For health oversight activities
- In response to a court or administrative order, subpoena, or discovery request
- For law enforcement purposes, in limited circumstances
- To coroners, medical examiners, or funeral directors, as necessary
- For workers’ compensation purposes
Psychotherapy notes, if maintained separately from your medical record, receive additional protection and generally require your specific written authorization before disclosure, except in limited circumstances required by law.
Any other use or disclosure of your PHI not described above will only be made with your written authorization, which you may revoke at any time in writing.
Your Rights Regarding Your Health Information
You have the right to:
- Request restrictions on certain uses and disclosures of your PHI (we are not required to agree, except where you paid out-of-pocket in full for a service and request that we not disclose it to your health plan).
- Request confidential communications by alternative means or at alternative locations.
- Inspect and obtain a copy of your PHI, with limited exceptions.
- Request an amendment to your PHI if you believe it is incorrect or incomplete.
- Receive an accounting of disclosures we have made of your PHI, with certain exceptions.
- Obtain a paper copy of this Notice upon request, even if you agreed to receive it electronically.
- File a complaint if you believe your privacy rights have been violated, either with us directly or with the U.S. Department of Health and Human Services, Office for Civil Rights, without fear of retaliation.
Our Responsibilities
We are required by law to maintain the privacy of your PHI, provide you with this Notice, and follow the terms currently in effect. We reserve the right to change this Notice and to make the revised Notice effective for PHI we already have, as well as any information we receive in the future. A copy of the current Notice will always be available on our website and at our office.
Contact Us
If you have questions about this Notice or wish to exercise any of the rights described above, please contact:Mind Bloom La Jolla
1120 Silverado St. Suite 203, La Jolla, CA 92037
Phone: (858) 412-5141
Email: anahopkins@mindbloomlajolla.com
You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, at www.hhs.gov/ocr/privacy/hipaa/complaints.