Updated October 2026

Your medical record contains personal information about your health. This personal information is Protected Health Information (PHI). PHI may identify you and relate to your past, present or future physical or mental health condition and related healthcare services. This notice of privacy practices describes how we may use and disclose your PHI in accordance with applicable law. It also describes your rights regarding how you may gain access to and control your PHI. We are required by law to maintain the privacy of your health information and provide you with and abide by the terms of this notice. As required by law, we will make disclosures of your PHI available to you upon your request.

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU

Treatment and Payment:

We use your health information to provide you with care or treatment of your health condition.  We may disclose health information to our employees and other professional staff.  Your PHI may be used and disclosed to any parties that are involved in providing care outside of Hollywood Mental Health which would not require your written authorization. For example, we may share your PHI with a pharmacy if required to dispense a prescription; a laboratory facility to perform a test requested by your provider; your insurer in order to collect payment for services rendered, as part of an audit, or as part of a quality assurance review. 

Business Operations:

We may use or disclose, as needed, your PHI to protect our business activities including, but not limited to, documentation quality assessment and employee review activities. We may also disclose PHI while providing appointment reminders, relaying test results, or communicating via voicemail or email. We may share your PHI with third parties that perform various business activities (e.g. Information technology services, provided we have a written contract with the business that requires it to safeguard the privacy of your PHI.)

Written Authorization:

Federal and state law require your written consent to release mental health/health information. This written authorization is known as a Release of Information (ROI) form. The consent will specify who is to receive the information, the purpose of the ROI, and the time period for which it is valid. You may modify or revoke the consent in writing at any time. The revocation will not affect health information that we used or disclosed prior to your revocation.  With your verbal permission, we may use or disclosure your PHI to anyone you authorize. 

AS REQUIRED BY LAW

As required by law, we will use and disclose your health information, but we will limit our use or disclosure to the relevant requirements of the law.  When the law requires us to report abuse, neglect, or domestic violence, or respond to judicial or administrative proceedings, or to law enforcement officials, we will further comply with the requirement set forth below concerning those activities. 

Judicial and Administrative Proceedings: 

We may, and are sometimes required by law, to disclose your health information in the course of any administrative or judicial proceeding to the extent expressly authorized by a court or administrative order.  Except in the case of mental health records or substance abuse records (see below), we may also disclose information about you in response to a subpoena, discovery request or other lawful process if reasonable efforts have been made to notify you of the request and you have not objected, or if your objections have been resolved by a court or administrative order. Unlike other medical records, in order for us to release mental health records or substance abuse records under a subpoena, the subpoena must be accompanied by a court order authorizing the issuance of the subpoena. 

Law Enforcement Activities:

We may, and are sometimes required by law, to disclose your health information to law enforcement officials for purposes such as identifying or locating a suspect, fugitive, material witness, or missing person, complying with a court order, warrant, grand jury subpoena and other law enforcement purposes.

Public Health and Safety:

We may, and are sometimes required by law, to disclose your health information to public health authorities for such reasons as preventing or controlling diseases, infections, or responding to a public emergency; helping with product recalls; reporting adverse reactions to medications; and to prevent or lessen serious and imminent threat to the health or safety of the general public or a particular person, including when we suspect abuse, neglect, or domestic violence. When we report suspected abuse, neglect, or domestic violence, we will inform you or your personal representative promptly unless, in our best professional judgment, we believe the notification would place you at risk of serious harm, or would require informing a personal representative we believe is responsible for the abuse or harm. We may disclose your health information to prevent or reduce a threat to anyone’s health or safety.

Oversight Activities, Government Functions and Workers’ Compensation:

We may disclose your health information to certain government agencies during the course of audits, investigations, inspections, licensure and other proceedings, subject to compliance with the law. We may disclose your health information for military or national security purposes or to correctional institutions or law enforcement officers that have you in their lawful custody. We may disclose your health information as necessary to comply with workers’ compensation laws, including reporting cases of occupational injury or illness to your employer, as required by law.  

Medical Examiner and Organ Donation:

We may, and are often required by law, to disclose your health information to coroners in connection with their investigations of deaths. We may also share your health information with organ and tissue procurement organizations.

Notification and Communication with Family Members:

We may disclose your health information to notify or assist in notifying a family member, your personal representative or another person responsible for your care about your location, your general condition or, unless you had instructed us otherwise, in the event of your death.  In the event of a disaster, we may disclose information to a relief organization so that they may coordinate these notification efforts.  We may also disclose information to someone who is involved with your care or helps pay for your care (please note we have specific policies regarding disclosure of health information to the parents of a patient who is a minor).  If you are able and available to agree or object, we will give you the opportunity to object prior to making these disclosures. We may disclose this information in a disaster over your objection, if we believe it is necessary to respond to the emergency circumstances. If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communication with your family and others.

YOUR RIGHTS

Receiving a Copy of Your Health Information:

You may request a copy of  your health information, with limited exceptions.  To access your health information, you must submit a written request detailing what information you want access to and your preferred format (i.e. electronic copy or paper copy) We will provide a copy of your health information within the time period required by law, and in your requested format. If your preferred format is not able to be readily produced, we will work with you to find an alternative method. We will also send a copy to any other person you designate in writing. We will charge a reasonable fee which covers our costs for labor, supplies, postage, and if requested and agreed to in advance, the cost of preparing an explanation or summary. We may deny your request under limited circumstances. If we deny your request to access your child's records or the records of an incapacitated adult you are representing because we believe allowing access would be reasonably likely to cause substantial harm to the patient, you will have a right to appeal our decision.  If we deny your request to access your psychotherapy notes, you will have the right to have them transferred to another mental health professional.

Correct Your Health Information:

You may request that we amend your health information.  You must make a request to amend in writing and include the reasons you believe the information is inaccurate or incomplete.  We will review the request although we are not required to amend your health information.  Your request may be denied if; 1) we do not have the information, 2) we did not create the information, 3) the person or entity that created the information is no longer available to make the amendment, 4) the information is deemed to be accurate and complete as is.  If we deny your request, you may submit a written statement of your disagreement, and we will, in turn, prepare a written response. All information related to any request to amend will be maintained and disclosed in conjunction with any subsequent disclosure of the disputed information. Further information about how to make a privacy act request can be found at: https://www.hhs.gov/privacy/how-make-privacy-act-request.html#amendment

Request Confidential Communication:

You may request in writing that we provide you with your health information in a specific way or at a specific location. For example, you may request that we contact you at a home or office phone number, or to send the health information to a different address. We will comply with all reasonable, written requests.

Limit What We Use or Share:

You may request in writing that we do not use or share your health information for treatment, payment, or our healthcare operations. However, we are not required to agree and may deny your request if it affects your care. If you pay for a service out-of-pocket in full, you may request in writing that we do not share that information for the purpose of payment or our healthcare operations with your insurer. We will comply with reasonable, written requests unless we are required to disclose the information for treatment or legal reasons. 

In certain cases, you have both the right and choice to ask us to share your health information with family, close friends, or others involved in your care. If you cannot tell us your preference, for example if you are unconscious, we may share your health information if we believe it is in your best interest. We may also share your health information when needed to lessen a serious and imminent threat to health or safety or in a disaster relief situation.

Obtain a List of Those Persons or Entities with Whom We Have Shared Your Health Information:

You may request in writing a list (accounting) of the times we’ve shared your health information, with whom we shared your health information and why. The accounting will identify such information for 6 years prior to the date you ask. We will include all disclosures except for those about treatment, payment or our healthcare operations, disclosures provided to you or pursuant to your written authorization, and certain other disclosures. We will provide you with one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another accounting within 12 months.

Choose Someone to Act for You:

If you have given someone medical power of attorney or if someone is your legal guardian, that person may exercise your rights and make choices about your health information. We will make sure the person has the authority and can act for you before we take any action.

PSYCHOTHERAPY NOTES

We will not use or disclose your psychotherapy notes without your prior written authorization except for the following: 1) use by the originator of the notes for your treatment, 2) for training our staff, students and other trainees, 3) to defend ourselves if you sue us or bring some other legal proceeding, 4) if the law requires us to disclose the information to you or the Secretary of Health and Human Services or for some other reason, 5) in response to health oversight activities concerning your psychotherapist, 6) to avert a serious and imminent threat to health or safety, 7) in the case of an audit from your insurance company, or 8) to the coroner or medical examiner after you die. To the extent you revoke an authorization to use or disclose your psychotherapy notes, we will stop using or disclosing these notes.

WEBSITE PRIVACY

Any personal information you provide Hollywood Mental Health via our website will never be sold or rented to any third party without your express permission. If you provide us with any personal or contact information in order to receive anything from us, we may collect and store that personal data. We do not automatically collect your personal email address simply because you visit our website. Our website may contain links to other outside websites. We cannot take responsibility for the privacy policies and practices of these websites and encourage you to check the privacy practices of all Internet sites you visit. While we make every effort to ensure that all the information provided on our website is correct and accurate, we make no warranty, express or implied, as to the accuracy, completeness, or timeliness, of the information available on our site. We are not liable to anyone for any loss, claim or damages caused in whole or in part, by any of the information provided on our site. Any changes to this privacy policy will be made public on our website.

CHANGES TO THIS NOTICE

We reserve the right to change the terms of our notice of privacy practices at any time. Any updates to this notice of privacy practices will be effective for all PHI that we maintain at that time. Any revisions made to this notice will be posted on our website and your patient portal. You may request an updated copy in person or via mail.

BREACHES

You will be notified immediately if we receive information that there has been a breach involving your PHI.

COMPLAINTS

Complaints about this Notice or how we have handled your health information should be directed to our Privacy Officer. If you are not satisfied with the manner in which we handle a complaint, you may submit a formal complaint to the Department of Health and Human Services Office of Civil Rights. Further information about how and where to file a complaint may be found at: https://www.hhs.gov/hipaa/filing-a-complaint/complaint-process/index.html

If you have questions and would like additional information, you may contact us at (503) 477-4969 or frontdesk@hmhpdx.com.