Notice of privacy practice

Effective Date: December 26, 2025

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THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION.

 

PLEASE REVIEW IT CAREFULLY.

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I. MY PLEDGE REGARDING YOUR HEALTH INFORMATION

I understand that information about you and your health care is personal. I am committed to protecting your health information.

 

I create and maintain records of the care and services you receive from this practice. These records are necessary to provide quality care and to comply with legal requirements. This Notice applies to all records of your care created by this practice.

 

I am required by law to:
- Maintain the privacy of your protected health information (“PHI”)
- Provide you with this Notice of my legal duties and privacy practices
- Follow the terms of this Notice currently in effect
- Notify you if a breach of your unsecured PHI occurs

 

I reserve the right to change this Notice. Any changes will apply to all PHI I maintain. The updated Notice will be available upon request, in my office, and on my website.

 

II. HOW I MAY USE AND DISCLOSE YOUR HEALTH INFORMATION

 

I may use or disclose your PHI without your written authorization for treatment, payment, and health care operations, including coordination of care, billing, and administrative activities.

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III. USES AND DISCLOSURES THAT REQUIRE YOUR WRITTEN AUTHORIZATION

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Session Notes:
I maintain clinical session notes as part of providing speech-language pathology services. Any use or disclosure outside treatment, payment, or operations requires authorization unless required by law.

 

IV. USES AND DISCLOSURES THAT DO NOT REQUIRE YOUR AUTHORIZATION

 

I may disclose PHI as required by law, for public health activities, health oversight, law enforcement, workers’ compensation, and appointment reminders.

 

V. YOUR RIGHTS

 

You have the right to request restrictions, request confidential communications, inspect and obtain copies of records, request amendments, receive an accounting of disclosures, and obtain a copy of this Notice.

 

VI. COMPLAINTS

 

Privacy Contact:
Cynthia Heryanto
Email: cynthia@communicationhorizons.com
Phone: 310-895-9955

You may also file a complaint with:
U.S. Department of Health and Human Services
Office for Civil Rights