HIPAA NOTICE OF PRIVACY PRACTICES

Effective Date: June 16, 2026

Our commitment to your privacy

ESTELLE Child & Family Therapy Inc. is required by law to maintain the privacy of your protected health information (PHI), to provide you with this Notice of Privacy Practices, and to abide by the terms of this notice. We are committed to protecting your health information.

How we may use and disclose your PHI

For treatment:

We may use and share your health information to provide, coordinate, or manage your mental health care. For example, your therapist may share information with other treating providers (e.g., physicians, psychiatrists, psychologists, counselors, and other licensed health care providers) with your consent to coordinate care.

For payment:

We may use and disclose your PHI to bill and receive payment for services rendered. This may include sharing information with your insurance company for payment for the healthcare services provided to the client. We may also provide your information to business associates, including billing companies, credit card companies, claims processing companies, and others that process healthcare claims.

For healthcare operations:

We may use your PHI for internal business operations, including quality improvement, training, licensing, and administrative functions, such as those performed by accountants, attorneys, consultants, and others, to ensure we comply with applicable laws.

Other uses permitted without authorization (e.g., emergencies):

We may disclose your information:

  • As required by law (e.g., mandatory reporting of child abuse, elder, or dependent adult abuse)

  • To avert a serious threat to your safety or the safety of others

  • In response to a court order or lawful subpoena

  • For public health activities as required by law

  • If you are unable to give your consent (e.g., if you are unconscious or in severe pain)

  • Appointment reminders and health-related benefits or services (e.g., treatment alternatives information)

Uses requiring your written authorization

All other uses and disclosures of your PHI – including psychotherapy notes, marketing, and the sale of PHI – require your written consent. You may revoke authorization at any time, in writing, except where we have already acted in reliance on it.

Your rights regarding your PHI

You have the right to:

  • See and get a copy of your health records: This request must be made in writing, and we have up to 15 days after receiving the written request to provide you with your PHI. In certain cases, we may deny your request and will inform you in writing. You will then have the right to have this denial reviewed by another psychotherapist. The requested copies of your PHI will cost no more than $0.25 for each page. We may also provide you with a summary or explanation of your PHI if agreed in advance.

  • Request amendments to your records if you believe information is incorrect or incomplete

  • Request restrictions on how we use or disclose your information: We will consider all requests, though we are not legally required to accept them.

  • Request confidential communications (e.g., only contact you at a specific phone number or address)

  • Request and receive an accounting of disclosures we have made of your PHI in the past six years unless you request a shorter time frame.

  • Receive this notice by email: We’ll provide you with this notice by email upon request.

  • File a complaint: If you believe your privacy rights have been violated, or you disagree with a decision made about access to your PHI, you may file a complaint.

Filing a complaint

If you have any questions about this notice or if you want to file a complaint about our privacy practices, or would like to know how to file a complaint, you can contact the Department of Consumer Affairs’ Board of Behavioral Sciences at https://www.bbs.ca.gov/consumers/consumer_complaints.html or by mail at Board of Behavioral Sciences, 1625 North Market Blvd, Suite S200, Sacramento, CA 95834, or by calling +1 (916)574-7830

Contact us

You may contact us:

Changes to this notice

We reserve the right to change this Notice at any time. The revised notice will apply to all PHI we maintain. Current notices will be posted on our website.