Notice of Privacy Practices

Dr. Sasha Faust, PsyD
Licensed Clinical Psychologist (CA)
Phone: 858-598-4009

Effective Date: June 2026

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

I. MY COMMITMENT REGARDING YOUR HEALTH INFORMATION

I understand that information about you and your health care is personal. I am committed to protecting your privacy and maintaining the confidentiality of your protected health information (PHI).

I create a clinical record of the care and services you receive in this practice. This record is necessary to provide high-quality care and to comply with legal and professional obligations.

This Notice applies to all records of your care generated by this practice, whether written, electronic, or verbal.

I am required by law to:

• Maintain the privacy of your protected health information

• Provide you with this Notice describing my legal duties and privacy practices

• Follow the terms of the Notice currently in effect

• Notify you in the event of a breach of unsecured protected health information

I reserve the right to revise this Notice. Any changes will apply to all records I maintain. The updated Notice will be made available upon request and on my website.

II. HOW I MAY USE AND DISCLOSE YOUR HEALTH INFORMATION

The following categories describe ways in which your protected health information may be used or disclosed without your written authorization. Not every use or disclosure is listed, but all permitted uses fall within these categories.

1. Treatment, Payment, and Health Care Operations

Federal privacy regulations allow health care providers with a direct treatment relationship to use and disclose PHI without written authorization for treatment, payment, and health care operations.

• Treatment: Providing, coordinating, or managing your care, including consultation with other health care providers.

• Payment: Obtaining reimbursement for services provided.

• Health Care Operations: Administrative, quality improvement, and business activities necessary to run this practice.

For example, I may consult with another licensed provider regarding your care to support diagnosis or treatment planning.

Note: Uses and disclosures for treatment purposes are not limited to the minimum necessary standard, as full clinical information may be required for safe and effective care.

2. Lawsuits and Legal Proceedings

I may disclose your PHI in response to a valid court or administrative order. I may also disclose information in response to a subpoena, discovery request, or other lawful process when permitted by law, and when appropriate efforts have been made to notify you or obtain protective measures.

III. USES AND DISCLOSURES REQUIRING YOUR AUTHORIZATION

Certain uses and disclosures of your PHI require your written authorization.

Psychotherapy Notes

Psychotherapy notes are kept separately from the clinical record and receive special protections under HIPAA. Disclosure of psychotherapy notes requires your written authorization except in the following limited circumstances:

• Use by me for treatment

• Use for training or supervision purposes

• Use in defense of legal claims brought by you

• Use by the Department of Health and Human Services for compliance investigations

• When required by law

• When necessary to prevent or lessen a serious and imminent threat to health or safety

• As required by a coroner or medical examiner

Marketing and Sale of Information

• I do not use or disclose your PHI for marketing purposes.

• I do not sell your protected health information.

IV. USES AND DISCLOSURES THAT DO NOT REQUIRE AUTHORIZATION

I may use or disclose your PHI without authorization, subject to legal limitations, in the following circumstances:

• When required by federal, state, or local law

• For public health activities (including reporting abuse, neglect, or threats of harm)

• For health oversight activities (audits, investigations, licensing reviews)

• In judicial or administrative proceedings (e.g., court orders)

• For law enforcement purposes, as permitted by law

• To coroners or medical examiners

• For research purposes under specific regulatory conditions

• For specialized government functions (military, national security, correctional institutions)

• For workers’ compensation compliance

• To prevent or lessen a serious and imminent threat to health or safety

I may also use or disclose PHI to contact you regarding:

• Appointment reminders

• Treatment alternatives

• Other health-related benefits or services that may be of interest to you

V. USES AND DISCLOSURES WITH AN OPPORTUNITY TO OBJECT

I may disclose relevant PHI to family members, friends, or others involved in your care or payment for care when you agree or do not object.

In emergency situations, such disclosures may occur if deemed necessary in your best interest.

VI. YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION

You have the following rights:

1. Right to Request Restrictions

You may request limitations on how your PHI is used or disclosed for treatment, payment, or operations. I am not required to agree to all requests.

2. Right to Restrict Disclosures for Self-Paid Services

If you pay out-of-pocket in full for a service, you may request that information about that service not be disclosed to a health plan, and I will comply when required by law.

3. Right to Confidential Communications

You may request that I contact you in a specific way or at a specific location, and I will accommodate reasonable requests.

4. Right to Access Records

You may request access to or copies of your PHI, excluding psychotherapy notes. Requests may be provided in electronic or paper form. A reasonable cost-based fee may apply.

5. Right to an Accounting of Disclosures

You may request a list of certain disclosures of your PHI made in the past six years, excluding those related to treatment, payment, or health care operations.

6. Right to Amend Your Record

You may request corrections to your PHI if you believe it is inaccurate or incomplete. Requests may be denied, but you will receive a written explanation.

7. Right to a Paper or Electronic Copy of This Notice

You may request a copy of this Notice at any time, even if you have agreed to receive it electronically.

VII. QUESTIONS OR COMPLAINTS

If you have questions about this Notice or believe your privacy rights have been violated, you may contact me at:

(858)-598-4009

You may also file a complaint with the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.

ACKNOWLEDGMENT

You may be asked to sign a separate acknowledgment indicating you have received this Notice.

IMPORTANT NOTE

This Notice is effective as of the date listed above and applies to all protected health information maintained by this practice.