Notice of Privacy Practices

This notice describes how health information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.

Calibration Psychotherapy (“we,” “us,” or “our”) is the private psychotherapy practice of Monica Nevarez, LCSW (California License #123944), providing telehealth psychotherapy to adults (18+) throughout California. We are committed to protecting the privacy and security of your protected health information (“PHI”).

1. Our Legal Duties

We are required by law to:

• Maintain the privacy and security of your PHI
• Give you this notice of our legal duties and privacy practices
• Make a good-faith effort to obtain your written acknowledgment that you received this notice
• Follow the terms of the notice that is currently in effect
• Notify you if a breach of your unsecured PHI occurs

We will not use or share your PHI other than as described in this notice unless you give us written authorization. If you do give authorization, you may revoke it in writing at any time, except to the extent we have already acted on it.

2. How We May Use and Disclose Your Health Information

We may use and disclose your PHI for the following purposes without your written authorization:

Treatment

We use your PHI to provide, coordinate, and manage your care. For example, we may use information from your sessions to plan treatment, consult with another professional involved in your care (with your knowledge), or communicate through our secure telehealth platform, scheduling system, and clinical records system. Because our practice is telehealth, your PHI is processed through the secure video and messaging systems we use to deliver care.

Payment

We use your PHI to obtain payment for services — for example, to send you invoices or receipts, process payments, and document the services provided. As a private-pay practice, we do not bill insurance; if you choose to submit a superbill to your insurer for possible reimbursement, that submission is made by you.

Health Care Operations

We may use your PHI for the business operations of the practice — for example, to maintain and secure our records systems, to review the quality of services, for licensing and compliance activities, and to train staff or business associates who support the practice under confidentiality agreements.

3. Other Uses and Disclosures We May Make Without Your Authorization

Federal and California law permit or require us to use or disclose your PHI in certain circumstances, including:

• Appointment reminders and communications. We may contact you to remind you of appointments or to follow up on scheduling, by phone, text message, or email you have provided.
• Business associates. We may share PHI with service providers that help operate the practice (for example, our telehealth platform, records system, billing or accounting services). These providers are required by contract to safeguard your information.
• Individuals involved in your care. We may share relevant PHI with a family member or other person you identify as involved in your care or in payment for your care, when you are present or available to object and do not object.
• Emergencies. If you are incapacitated or there is an emergency, we may disclose PHI as needed to provide or arrange care.
• As required by law. We must disclose PHI when required by federal, state, or local law.
• To avert a serious threat. We may disclose PHI when, in our professional judgment, disclosure is necessary to prevent a serious and imminent threat to your health or safety or to the health or safety of another person or the public. This includes disclosures required or permitted by California law regarding threats of serious harm.
• Health oversight. We may disclose PHI to health oversight agencies, such as the California Board of Behavioral Sciences, for audits, investigations, inspections, and licensing activities.
• Judicial and administrative proceedings. We may disclose PHI in response to a court order, and, as permitted by law, in response to a subpoena or other lawful process.
• Law enforcement. We may disclose PHI to law enforcement as required or permitted by law.
• Public health. We may disclose PHI for public health activities as required by law.
• Coroners, medical examiners, and funeral directors. We may disclose PHI as permitted by law following a death.
• Workers’ compensation. We may disclose PHI as authorized by workers’ compensation laws.
• Military, veterans, and national security. We may disclose PHI as required for military command authorities and authorized national security activities.

Under California law, additional limits apply to the disclosure of certain information, including information related to mental health treatment, and we follow those requirements as well.

4. Psychotherapy Notes

Psychotherapy notes — notes recorded by your therapist documenting or analyzing the contents of a counseling session and kept separate from the rest of your clinical record — receive special protection. We will not use or disclose psychotherapy notes without your written authorization, except in limited circumstances permitted by law (such as to defend ourselves in a legal proceeding you bring, as required by law, or to avert a serious threat to health or safety).

5. Uses and Disclosures That Require Your Written Authorization

The following uses and disclosures require your written authorization, and you may revoke that authorization in writing at any time:

• Most uses and disclosures of psychotherapy notes
• Uses and disclosures of PHI for marketing purposes
• Disclosures that constitute a sale of your PHI
• Any other use or disclosure not described in this notice

6. Your Rights Regarding Your Health Information

You have the following rights concerning your PHI. To exercise any of these rights, contact us using the information in Section 10. We may ask you to make requests in writing.

• Request restrictions. You may ask us to limit how we use or disclose your PHI for treatment, payment, or health care operations. We are not required to agree to your request, except that we must agree to restrict disclosure to a health plan for services you have paid for in full out of pocket (which applies to our private-pay practice), if you request it.
• Confidential communications. You may ask us to contact you in a particular way or at a particular location — for example, only at a specific phone number. We will accommodate reasonable requests.
• Inspect and copy. You may inspect and obtain a copy of PHI in your clinical record, with limited exceptions under California law (for example, psychotherapy notes and certain information your therapist determines could be harmful to you). We may charge a reasonable, cost-based fee for copies.
• Request an amendment. If you believe PHI in your record is inaccurate or incomplete, you may ask us to amend it. We may deny the request in certain circumstances, but we will explain why in writing.
• Accounting of disclosures. You may request a list of certain disclosures of your PHI made during the six years before your request (or a shorter period you specify), excluding disclosures for treatment, payment, health care operations, and certain other disclosures. The first list in any 12-month period is free; we may charge a reasonable fee for additional lists.
• Paper copy of this notice. You may request a paper copy of this notice at any time, even if you agreed to receive it electronically.
• Breach notification. You have the right to be notified if we discover a breach of your unsecured PHI.

7. Acknowledgment of Receipt

When you begin care, we will ask you to sign a written acknowledgment that you received (or were offered and declined) a copy of this notice. You are not required to sign it to receive care — if you decline or we cannot obtain your signature, we will document our good-faith effort. A sample of the acknowledgment is below; your signed copy is kept in your clinical record.

8. Changes to This Notice

We reserve the right to change this notice and our privacy practices at any time. Any change will apply to PHI we already hold as well as PHI we receive in the future. When we make a material change, we will post the revised notice on this page, update the effective date, and make the new notice available to current clients. The notice in effect at the time of each use or disclosure governs that use or disclosure.

9. Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services. To file a complaint with us, contact Monica Nevarez using the information in Section 10. To file with the federal government, contact the Office for Civil Rights, U.S. Department of Health and Human Services. You will not be retaliated against for filing a complaint.

10. Contact Us

Questions about this notice, your rights, or our privacy practices are welcome:

Calibration Psychotherapy
Monica Nevarez, LCSW · California License #123944
Telehealth · Clients throughout California
Phone: (424) 283-3653
Or through the contact form on our home page.