Please Read Carefully
Your health record contains personal information about you and your health. State and federal law protects the confidentiality of this information. Protected Health Information (PHI) includes details about your past, present, or future physical or mental health conditions and the care you receive. The confidentiality of alcohol and drug abuse patient records is specifically protected by federal law and regulations. SD Wellness Center is required to comply with these additional restrictions, which include a prohibition—except in very limited circumstances—on disclosing that you are receiving treatment or sharing any information that identifies you as someone seeking care for substance use. Any violation of these laws is considered a crime, and if you suspect a breach, you may file a report to the appropriate authorities as outlined in federal regulations.
•For Treatment – We may use medical and clinical information about you to provide treatment or services.
•For Payment – With your authorization, we may use and disclose medical information to obtain payment for the treatment services provided to you.
•For Health Care Operations – We may use and disclose your PHI as necessary for the operation of our program.
•Without Authorization – Certain laws allow us to disclose information about you without authorization in limited situations, such as when required by a court order. More details on these exceptions are available upon request.
•With Authorization – We must obtain written authorization from you before using or disclosing your PHI for any purpose not otherwise permitted by law.
•Right to Access, Inspect, and Copy – You have the right, subject to certain limitations, to inspect and obtain copies of your PHI used in making decisions about your care. Reasonable, cost-based fees may apply for copies.
•Right to Amend – If you believe the PHI we have is incorrect or incomplete, you may request an amendment. While we are not obligated to approve all requests, we will review them accordingly.
•Right to an Accounting of Disclosures – You may request a record of certain disclosures of your PHI.
•Right to Request Restrictions – You can request limitations on the use of your PHI for treatment, payment, or health care operations. However, we are not required to agree to such requests.
•Right to Request Confidential Communication – You may ask us to communicate with you about medical matters in a specific manner or at a specific location.
•Right to a Copy of This Notice – You have the right to receive a copy of this Notice of Privacy Practices at any time.
You may file a complaint in writing to us or the U.S. Secretary of Health and Human Services if you believe we have violated your privacy rights. We will not retaliate against you for filing a complaint.
If you have any questions about this Notice of Privacy Practices, please contact us at:
Email: Info@sd-wellness.com
Phone: 949-463-9406
This Notice of Privacy Practices describes how we may use and disclose your PHI in accordance with applicable laws. It also explains your rights regarding access to and control of your PHI. We are legally required to maintain the privacy of PHI and to provide you with this notice. We reserve the right to amend this Notice of Privacy Practices at any time. If we make changes, the revised notice will apply to all PHI we maintain. A copy of any updated notice will be available on our website, by mail upon request, or at your next appointment.
Complaints
If you believe your privacy rights have been violated, you may file a complaint by contacting us at:
Email: Info@sd-wellness.com
Phone: 949-463-9406
We will not retaliate against you for filing a complaint. You may also file a complaint with the U.S. Secretary of Health and Human Services. You may also file a complaint with the U.S. Secretary of Health and Human Services:
200 Independence Avenue, S.W.
Washington, D.C. 20201
(855) 977-6335
862 license number: 370237BP
860 license number: 370237AP
Effective Date: 10/01/2024
Expiration Date: 09/30/2026
