Notice of Privacy Policies
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW
Hannah Caratti, LMFT (the “Practice”) is committed to protecting your
privacy. The Practice is required by federal law to maintain the privacy
of Protected Health Information (“PHI”), which is information that
identifies or could be used to identify you. The Practice is required to
provide you with this Notice of Privacy Practices (this “Notice”), which
explains the Practice’s legal duties and privacy practices and your
rights regarding PHI that we collect and maintain.
Your rights regarding PHI are explained below. To exercise these rights,
please submit a written request to the Practice at the address noted below.
To inspect and copy PHI.
• You can ask for an electronic or paper copy of PHI. The Practice
may charge you a reasonable fee.
• The Practice may deny your request if it believes the disclosure
will endanger your life or another person’s life. You may have a right
to have this decision reviewed.
To amend PHI.
• You can ask to correct PHI you believe is incorrect or incomplete.
The Practice may require you to make your request in writing and provide
a reason for the request.
• The Practice may deny your request. The Practice will send a
written explanation for the denial and allow you to submit a written
statement of disagreement.
To request confidential communications.
• You can ask the Practice to contact you in a specific way. The
Practice will say “yes” to all reasonable requests.
To limit what is used or shared.
• You can ask the Practice not to use or share PHI for treatment,
payment, or business operations. The Practice is not required to agree
if it would affect your care.
• If you pay for a service or health care item out-of-pocket in full,
you can ask the Practice not to share PHI with your health insurer.
• You can ask for the Practice not to share your PHI with family
members or friends by stating the specific restriction requested and to
whom you want the restriction to apply.
To obtain a list of those with whom your PHI has been shared.
• You can ask for a list, called an accounting, of the times your
health information has been shared. You can receive one accounting
every 12 months at no charge, but you may be charged a reasonable fee if
you ask for one more frequently.
To receive a copy of this Notice.
• You can ask for a paper copy of this Notice, even if you agreed to
receive the Notice electronically.
To choose someone to act for you.
• If you have given someone medical power of attorney or if someone
is your legal guardian, that person can exercise your rights.
To file a complaint if you feel your rights are violated.
• You can file a complaint by contacting the Practice using the
Hannah Caratti, LMFT
2420 Grace Drive, Santa Rosa, CA 95404
Hannah Caratti, LMFT (privacy officer and licensed MFT)
• You can file a complaint with the U.S. Department of Health and
Human Services Office for Civil Rights by sending a letter to 200
Independence Avenue, S.W., Washington, D.C. 20201, calling
1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
• The Practice will not retaliate against you for filing a complaint.
OUR USES AND DISCLOSURES
1. Routine Uses and Disclosures of PHI
The Practice is permitted under federal law to use and disclose PHI,
without your written authorization, for certain routine uses and
disclosures, such as those made for treatment, payment, and the
operation of our business. The Practice typically uses or shares your
health information in the following ways:
To treat you.
• The Practice can use and share PHI with other professionals who are
• Example: Your primary care doctor asks about your mental health
To run the health care operations.
• The Practice can use and share PHI to run the business, improve
your care, and contact you.
• Example: The Practice uses PHI to send you appointment reminders if
To bill for your services.
• The Practice can use and share PHI to bill and get payment from
health plans or other entities.
• Example: The Practice gives PHI to your health insurance plan so it
will pay for your services.
2. Uses and Disclosures of PHI That May Be Made Without Your
Authorization or Opportunity to Object
The Practice may use or disclose PHI without your authorization or an
opportunity for you to object, including:
To help with public health and safety issues
• Public health: To prevent the spread of disease, assist in product
recalls, and report adverse reactions to medication.
• Required by the Secretary of Health and Human Services: We may be
required to disclose your PHI to the Secretary of Health and Human
Services to investigate or determine our compliance with the
requirements of the final rule on Standards for Privacy of Individually
Identifiable Health Information.
• Health oversight: For audits, investigations, and inspections by
government agencies that oversee the health care system, government
benefit programs, other government regulatory programs, and civil rights
• Serious threat to health or safety: To prevent a serious and
• Abuse or Neglect: To report abuse, neglect, or domestic violence.
To comply with law, law enforcement, or other government requests
• Required by law: If required by federal, state or local law.
• Judicial and administrative proceedings: To respond to a court
order, subpoena, or discovery request.
• Law enforcement: For law locate and identify you or disclose
information about a victim of a crime.
• Specialized Government Functions: For military or national
security concerns, including intelligence, protective services for heads
of state, or your security clearance.
• National security and intelligence activities: For intelligence,
counterintelligence, protection of the President, other authorized
persons or foreign heads of state, for purpose of determining your own
security clearance and other national security activities authorized by law.
• Workers’ Compensation: To comply with workers’ compensation laws
or support claims.
To comply with other requests
• Coroners and Funeral Directors: To perform their legally authorized
• Organ Donation: For organ donation or transplantation.
• Research: For research that has been approved by an institutional
• Inmates: The Practice created or received your PHI in the course
of providing care.
• Business Associates: To organizations that perform functions,
activities or services on our behalf.
3. Uses and Disclosures of PHI That May Be Made With Your Authorization
or Opportunity to Object
Unless you object, the Practice may disclose PHI:
To your family, friends, or others if PHI directly relates to that
person’s involvement in your care.
If it is in your best interest because you are unable to state your
4. Uses and Disclosures of PHI Based Upon Your Written Authorization
The Practice must obtain your written authorization to use and/or
disclose PHI for the following purposes:
Marketing, sale of PHI, and psychotherapy notes.
You may revoke your authorization, at any time, by contacting the
Practice in writing, using the information above. The Practice will not
use or share PHI other than as described in Notice unless you give your
permission in writing.
• The Practice is required by law to maintain the privacy and security
• The Practice is required to abide by the terms of this Notice
currently in effect. Where more stringent state or federal law governs
PHI, the Practice will abide by the more stringent law.
• The Practice reserves the right to amend Notice. All changes are
applicable to PHI collected and maintained by the Practice. Should the
Practice make changes, you may obtain a revised Notice by requesting a
copy from the Practice, using the information above, or by viewing a
copy on the website [www.counselingyogameditation.com].
• The Practice will inform you if PHI is compromised in a breach.
This Notice is effective on March 9th, 2022