Robert Aguilar, LMFT

27955 Smyth Drive Suite 108 - Valencia CA 91355

(661) 347-6137

EFFECTIVE DATE OF THIS NOTICE: This notice went into effect on December 7, 2023.

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

I. MY PLEDGE REGARDING HEALTH INFORMATION:

I understand that health information about you and your health care is personal. I am committed to protecting health information about you. I create a record of the care and services you receive from me. I need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by this mental health care practice. It will tell you about the ways in which I may use and disclose health information about you, your rights to the health information I keep about you, and certain obligations I have regarding the use and disclosure of your health information.

II. HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU:

For Treatment, Payment, or Health Care Operations:

Federal privacy rules allow health care providers with a direct treatment relationship to use or disclose personal health information without written authorization, for their own treatment, payment, or health care operations. For example, if a clinician consults with another health care provider about your condition, your personal health information may be shared to aid in diagnosis and treatment.

III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:

Psychotherapy Notes: Use or disclosure of "psychotherapy notes" requires your Authorization, except in specific situations such as for my use in treating you, for legal proceedings, or as required by law.

Marketing and Sale of PHI: I will not use or disclose your PHI for marketing purposes or sell your PHI.

IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION:

In certain cases, I can use and disclose your PHI without your Authorization for reasons including state or federal law requirements, public health activities, health oversight activities, judicial and administrative proceedings, law enforcement purposes, and research.

V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT:

Disclosures to Family and Others: I may provide your PHI to a family member or friend involved in your care unless you object.

VI. YOUR RIGHTS WITH RESPECT TO YOUR PHI:

You have rights to request limits on uses and disclosures, request restrictions, choose how PHI is sent to you, see and get copies of your PHI, get a list of disclosures, correct or update your PHI, and get a copy of this notice.

Digital Accessibility: This notice is also available in an accessible format on our website at bempoweredfromwithin.com.

Acknowledgement of Receipt of Privacy Notice:

Under HIPAA, you have rights regarding the use and disclosure of your protected health information. By signing below, you acknowledge receipt of this HIPAA Notice of Privacy Practices.

Signature:____________________ Date:____________________