Notice of Privacy Practices

Trinity Holistic Psychiatry 

Effective Date: August 24, 2026 

Your Information. Your Rights. Our Responsibilities. 

This Notice describes how medical information about you may be used and disclosed and how you can access this information. Please review it carefully. 

Your Rights 

You have certain rights regarding your health information. 

Get a Copy of Your Health Record 

You may request to inspect or receive an electronic or paper copy of your medical record and other health information we maintain about you. We will provide a copy or summary as required by law, subject to limited exceptions. 

Request a Correction 

You may ask us to correct health information you believe is inaccurate or incomplete. We may deny your request in certain circumstances, but we will explain the reason in writing. 

Request Confidential Communications 

You may ask us to contact you in a specific way, such as by phone or email, or to send communications to a different address. We will accommodate reasonable requests. 

Ask Us to Limit What We Use or Share 

You may ask us not to use or share certain health information for treatment, payment, or health care operations. We are not required to agree to every request. 

If you pay for a health care service or item in full out of pocket, you may ask us not to share information about that service with your health insurer for payment or health care operations. We will honor that request unless disclosure is required by law. 

Receive a List of Certain Disclosures

You may request an accounting of certain disclosures of your health information made during the six years prior to your request, as permitted by law. 

Get a Copy of This Privacy Notice 

You may request a paper or electronic copy of this Notice at any time. 

Choose Someone to Act for You 

If you have given someone medical power of attorney or another person has legal authority to act on your behalf, that person may exercise your privacy rights as permitted by law. 

File a Complaint 

You may file a complaint with Trinity Holistic Psychiatry if you believe your privacy rights have been violated. 

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

We will not retaliate against you for filing a complaint. 

Your Choices 

For certain health information, you may tell us your preferences about what we share. 

When permitted by law, you may tell us whether you want us to share relevant information with family members, friends, or others involved in your care or payment for your care. 

If you are unable to communicate your preference, we may share information when permitted by law if we believe it is in your best interest or necessary to lessen a serious and imminent threat to health or safety. 

We will obtain your written authorization for uses and disclosures when authorization is required by law. 

How We May Use and Share Your Health Information 

We may use or disclose your protected health information without your written authorization when permitted or required by law, including for the following purposes. 

Treatment

We may use and share your health information with other health care professionals involved in your care for purposes of providing, coordinating, or managing your treatment. 

Payment 

We may use and share your health information to bill and receive payment for services provided to you, including communicating with your health insurance plan when applicable. 

Health Care Operations 

We may use and share your health information for activities necessary to operate our practice, including quality improvement, compliance, administrative activities, and business operations. 

Business Associates 

We may share information with individuals or organizations that perform services on our behalf when appropriate agreements and safeguards are in place to protect your information. 

Public Health and Safety 

We may disclose health information for certain public health activities or when permitted by law to prevent or lessen a serious and imminent threat to the health or safety of you or another person. 

Reporting Abuse or Neglect 

We may disclose health information when required by law to report suspected abuse, neglect, or other circumstances subject to mandatory reporting requirements. 

Health Oversight Activities 

We may disclose information to authorized government agencies for legally permitted oversight activities, including audits, investigations, inspections, and licensing activities. 

Legal Proceedings and Law Enforcement 

We may disclose information in response to certain court orders, subpoenas, administrative proceedings, or lawful law-enforcement requests when permitted or required by law. 

As Required by Law 

We may use or disclose your information when federal or state law requires us to do so. Mental Health and Other Sensitive Information

Because Trinity Holistic Psychiatry provides psychiatric and mental health services, certain information in your record may receive additional protection under federal or California law. 

We will comply with applicable laws that provide greater privacy protections for mental health records and other specially protected health information. When your written authorization is required before information may be disclosed, we will obtain that authorization unless an exception under applicable law applies. 

Psychotherapy notes, when maintained separately from the medical record and meeting the definition of psychotherapy notes under HIPAA, generally require written authorization for disclosure except in limited circumstances permitted by law. 

Certain substance use disorder records may also receive additional protections under federal law, including 42 CFR Part 2 when applicable. We will use and disclose such records only as permitted by applicable law. 

Uses and Disclosures Requiring Your Authorization 

For uses and disclosures not otherwise permitted or required by law, we will obtain your written authorization. 

Certain uses and disclosures, including most uses of psychotherapy notes and certain uses involving marketing or the sale of protected health information, require authorization as provided by law. 

You may revoke an authorization in writing at any time, except to the extent that we have already acted in reliance upon it. 

Our Responsibilities 

Trinity Holistic Psychiatry is required by law to: 

● Maintain the privacy and security of your protected health information. ● Provide you with this Notice describing our legal duties and privacy practices. ● Follow the duties and privacy practices described in the Notice currently in effect. ● Notify you promptly if a breach occurs that may have compromised the privacy or security of your information. 

We will not use or share your information other than as described in this Notice unless you authorize us to do so in writing or another use or disclosure is permitted or required by law. 

Changes to This Notice

We may change the terms of this Notice. Changes may apply to all health information we maintain, including information created or received before the change. 

The current Notice will be available on our website and upon request. 

Questions or Privacy Complaints 

If you have questions about this Notice, wish to exercise your privacy rights, or would like to file a privacy complaint, please contact: 

Trinity Holistic Psychiatry 

Privacy Officer: Kimberly Lewis, PMHNP-BC 

Phone: 916-610-9401 

Email: info@trinityholisticpsychiatry.com 

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

HHS Office for Civil Rights – File a HIPAA Complaint 

You will not be retaliated against for filing a complaint.