HIPAA Notice of Privacy Practices

Effective Date: October 2025 PBA Psychology Group, Inc. 9350 Wilshire Blvd, Suite 212 • Beverly Hills, CA 90212 Tel: (310) 271-2275 • pbapsychology.com

Your Privacy Matters

This Notice describes how your medical and mental health information may be used and disclosed—and how you can access that information. We are committed to protecting your privacy and complying with all federal and state privacy laws, including the Health Insurance Portability and Accountability Act (HIPAA), the HITECH Act, and the California Consumer Privacy Act (CCPA).

Our Responsibilities

PBA Psychology Group is legally required to protect your Protected Health Information (PHI) and to notify you of our privacy practices. We must:

· Maintain the confidentiality and security of your PHI.

· Notify you promptly if a privacy or security breach occurs.

· Use or disclose only the minimum amount of information necessary for each purpose.

· Follow the terms of this Notice until it is replaced or updated.

How We May Use and Share Your Information

A. Treatment, Payment, and Health Care Operations

We may use or disclose your PHI without additional authorization for:

· Treatment: Coordinating or managing your care with other healthcare providers (e.g., psychiatrists, primary care doctors).

· Payment: Billing and collecting payment for services provided.

· Operations: Quality assurance, compliance, or staff training purposes.

We may also contact you to remind you of appointments or inform you about treatment alternatives or related services.

B. Uses and Disclosures Required or Permitted by Law

Your PHI may be disclosed without your consent when required or authorized by law, such as:

· Reporting child, elder, or dependent adult abuse or neglect.

· Responding to a court order, subpoena, or legal process.

· Preventing or addressing a serious threat to health or safety.

· Participating in public health and oversight activities.

· Compliance with Workers’ Compensation or other government-mandated programs.

· Certain research activities approved by an oversight body.

· National security, law enforcement, or health oversight investigations.

C. Electronic Communications & Telehealth

We may use telehealth or secure electronic communication (email, text, or online platforms) as part of your care. We use reasonable safeguards to protect your information, but electronic communication carries some risk. You may request alternative methods of communication at any time.

D. Disclosures Requiring Your Authorization

Any use or disclosure not described above will require your written authorization. You may revoke your authorization in writing at any time, except for disclosures already made in reliance on it.

Your Rights

You have the right to:

· Access and Copies: Review or receive a copy of your PHI (reasonable fees may apply).

· Request Corrections: Ask for corrections if you believe your information is inaccurate or incomplete.

· Request Restrictions: Ask us to limit how we use or share your information. While we may not always be able to agree, we will consider your request.

· Confidential Communications: Request to be contacted at a different address, by a specific method, or via alternate communication channels.

· Accounting of Disclosures: Request a record of certain disclosures made in the past six years.

· Paper or Electronic Copy: Receive this Notice by email or paper.

· Breach Notification: Be notified if a breach occurs that may have compromised your information.

California Consumer Privacy Act (CCPA) Notice

If you are a California resident, you may have additional privacy rights under the CCPA. While most health information regulated by HIPAA is exempt from the CCPA, other data collected through our website or business operations—such as contact forms, email addresses, or website usage—may be covered.

Under the CCPA, you have the right to:

· Know what personal information we collect and how it’s used.

· Request deletion of certain data (subject to legal retention rules).

· Opt out of the sale or sharing of personal data (we do not sell your information).

You can exercise these rights by contacting us directly.

Complaints or Questions

If you believe your privacy rights have been violated, you may file a complaint with:

PBA Psychology Group, Inc. 9350 Wilshire Blvd, Suite 212 Beverly Hills, CA 90212 Tel: (310) 271-2275

Or with the: U.S. Department of Health and Human Services (HHS) Office for Civil Rights 200 Independence Avenue, S.W. Washington, D.C. 20201 Submit a Complaint Online →

We will not retaliate against you for filing a complaint.

Effective Date and Updates

This Notice is effective October 2025 and replaces prior versions. We reserve the right to revise our privacy practices and will post updated notices in our office and on our website.