Notice of Privacy Practices
Effective: May 2026
Privacy Officer: NAME
Phone: (805) 373-1222
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Ohana Health is required by law to maintain the privacy and confidentiality of your protected health information (PHI), to provide you with notice of our legal duties and privacy practices, and to notify you in the event of a breach of your unsecured protected health information. When we use or disclose your protected health information, we are required to abide by the terms of this notice.
I. Uses and Disclosures of Your Health Information Without Written Authorization
We may use or disclose your protected health information without your written authorization for the following purposes:
Treatment and Health Care Operations
- Treatment: We may use your information to provide care and consult with other healthcare providers as needed. We may also refer you to other treatments, services, or providers.
- Health Care Operations: We may use your information for internal operations such as administration, planning, and improving the quality of care. If Ohana Health merges with another organization, your records may become the property of the new entity.
Emergencies
We may disclose your health information to notify or assist in notifying a family member or another person responsible for your care during an emergency.
Disclosure to Family and Others Involved in Your Care
We may share your information with individuals present with you at the time of service if we reasonably believe you do not object.
As Required by Law
We may disclose your health information when required by federal, state, or local law.
Public Health
We may disclose your information for public health purposes such as preventing disease, reporting abuse or neglect, reporting reactions to medications, and controlling health risks.
Health Oversight Activities
We may disclose your information to agencies overseeing healthcare systems or government programs.
Judicial and Administrative Proceedings
We may disclose your information in response to court orders, subpoenas, or legal processes.
Law Enforcement
We may disclose your information to law enforcement officials as required by law or for investigative purposes.
Victims of Abuse, Neglect, or Domestic Violence
We may disclose information to appropriate authorities if we believe you may be a victim of abuse or to prevent serious harm.
Research and Organ Donation
We may disclose information for approved research purposes or to organizations involved in organ and tissue donation.
Fundraising
We may contact you regarding fundraising efforts. You may opt out at any time.
Deceased Persons
We may disclose information to coroners or medical examiners.
Public Safety
We may disclose information to prevent a serious threat to health or safety.
Specialized Government Functions
We may disclose information for workers’ compensation, military, national security, or correctional institution purposes.
II. Uses and Disclosures With Written Authorization
Marketing
We will obtain your written authorization before using your information for marketing purposes, except for face-to-face communications or small promotional items.
Sale of Information
We will not sell your protected health information without your written authorization.
Psychotherapy Notes
We will not use or disclose psychotherapy notes without your written authorization except as permitted by law.
Highly Confidential Information
Certain information, such as substance use treatment records, HIV/AIDS status, and genetic information, requires special protection. We will obtain your authorization before disclosing such information.
All other uses and disclosures not described in this notice will be made only with your written authorization.
III. Your Health Information Rights
- You have the right to request restrictions on certain uses and disclosures (though we may not be required to agree).
- You have the right to request confidential communications by alternative means or locations.
- You have the right to inspect and obtain a copy of your health information.
- You have the right to request corrections to your health information.
- You have the right to receive an accounting of disclosures.
- You have the right to receive a copy of this notice at any time.
Changes to This Notice
Ohana Health reserves the right to update this Notice at any time. Updated versions will apply to all information we maintain and will be available upon request at our office and on our website.
Contact Information
Ohana Health
80 East Hillcrest Drive, Suite 130
Thousand Oaks, CA 91360
Phone: (805) 373-1222
Email: info@ohanahealthclinic.com
If you have questions about this notice or your privacy rights, please contact our Privacy Officer at (805) 373-1222. You may also request an appointment to discuss your concerns.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
This notice is effective as of May 2026.
Acknowledgment of Receipt
I have read and understand this Notice of Privacy Practices. By signing below, I authorize Ohana Health to use and disclose my protected health information as described in this notice.
Patient/Client Signature: ________________________________
Date: ________________________________
