Unfold Psychology: A Heafey Practice, P.C.
R. Austin Heafey, Psy.D., Clinical Psychologist, CA License #30807
Associate Clinicians, Therapists, and Executive Function Specialists

1955 Mountain Blvd., Suite 101
Oakland, CA 94611
Tel. 650.993.9321

THIS NOTICE DESCRIBES HOW PROTECTED HEALTH INFORMATION (PHI) MAY BE USED AND DISCLOSED AND HOW YOU CAN REQUEST AND RECEIVE ACCESS TO YOUR PHI. PLEASE REVIEW IT CAREFULLY.

I. Unfold Psychology’s Pledge Regarding Health Information

The psychologists, therapists, clinicians, staff and other health care providers at Unfold Psychology: A Heafey Practice, P.C., (“Unfold Psychology”) understand that health information about you and your health care is personal. We are committed to protecting Protected Health Information (“PHI”). To provide you with quality care and to comply with certain legal requirements, we maintain a record of the care and services you receive from our clinicians and staff. This Notice of Privacy Practices applies to all of the records of your care generated by this mental health care practice.

This Notice of Privacy Practices explains how we may use and disclose your PHI for purposes of treatment, payment, and health care operations, as well as for other purposes permitted or required by law. It describes certain obligations we have regarding the use and disclosure of your PHI and also outlines your rights regarding access to and control over your PHI. “Protected Health Information” refers to any health-related information, including demographic details, that can be used to identify you and that pertains to your past, present, or future physical or mental health condition, the provision of health care services to you, or payment for such services.

We are required by law to abide by the terms of this Notice of Privacy Practices (NPP). We reserve the right to change the terms of this Notice at any time, without prior notice. Any revised Notice will apply to all protected health information that we maintain, regardless of when it was created or received. If we make material changes, we will make the updated Notice available to you upon request, and will make the same available at our offices. You may obtain a copy of the revised Notice by accessing our website, calling our office to request a mailed copy, or asking for one in person at your next appointment.

We are required by law to:

• Make sure that any PHI that identifies you is kept private.
• Give you this Notice of our legal duties and privacy practices with respect to health information.
• Follow the terms of the Notice that is currently in effect.

II. How We May Use and Disclose Health Information About You

Your PHI may be used and disclosed by your physician, our office staff, and other individuals or entities involved in your care and treatment in order to provide you with health care services. We may also use and disclose your PHI for purposes related to payment of your health care bills and to support the day-to-day operations of your physician’s practice. The following categories describe the various permissible uses and disclosures of your PHI. For each category, we provide a general explanation and, where appropriate, illustrative examples. While not every specific use or disclosure is listed, all permitted uses and disclosures fall within one of these categories.

Treatment: We may use and disclose your protected health information (PHI) to provide, coordinate, or manage your health care and related services. This includes disclosing information to other health care providers involved in your care, such as specialists, laboratories, or home health agencies, in order to ensure continuity and quality of treatment.

Under federal privacy regulations, health care providers with a direct treatment relationship to a patient/client are permitted to use or disclose the patient/client’s PHI for treatment purposes without the patient/client’s written authorization. For example, a clinician may consult with another licensed health care provider about your condition to assist in diagnosing or treating you. Similarly, if you are referred to another physician or specialist, we may disclose relevant PHI so that the physician has the necessary information to diagnose or treat you.

Disclosures made for treatment purposes are not limited to the minimum necessary standard. This is because your therapists, clinicians and other health care providers may require access to your full health record in order to provide you with effective and quality care. The term “treatment” includes, among other things, the coordination and management of health care among providers, consultations between health care providers, and referrals of a patient from one health care provider to another.

Payment: We may use and disclose your PHI as necessary to obtain payment for the health care services provided to you, either by us or by another provider. This may include certain activities that your health insurance plan may undertake before it approves or reimburses for the health care services we recommend for you, such as: making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, obtaining approval for a treatment or service may require that your relevant PHI be disclosed to the health plan to obtain approval for the treatment or service.

Health Care Operations: We may use or disclose your PHI as necessary to support the business activities of your clinician’s practice. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, and conducting or arranging for other business activities.

We may share your PHI with third party “business associates” who perform essential functions on behalf of our practice, such as billing or transcription services. Whenever an arrangement between our office and a business associate involves the use or disclosure of your PHI, we will require these business associates to enter into a written agreement that contains safeguards to protect the privacy and security of your PHI, as required by law.

Additionally, we may use or disclose your PHI, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you. If you prefer not to receive such communications, you may contact our Privacy Officer to opt out.

Other Permitted and Required Uses and Disclosures That Require Providing You the Opportunity to Agree or Object: You have the opportunity to agree or object to the use or disclosure of all or part of your PHI. If you are not present or able to agree or object to the use or disclosure of the protected health information, then your therapists, clinicians, staff and other health care providers may, using professional judgment, determine whether the disclosure is in your best interest.

Others Involved in Your Care or Payment for Your Care: Unless you object, we may disclose your PHI to a member of your family, a relative, a close friend or any other person you identify, but only if the information is directly relevant to that person’s involvement in your care or payment for your care. If you are unable to agree or object to such a disclosure (such as in an emergency), we may make such disclosures if, in our professional judgement, we determine that it is in your best interest. We may also use or disclose your PHI to notify, or assist in notifying, a family member, personal representative or any other person that is responsible for your care about your location, general condition, or death. Finally, we may use or disclose your PHI to authorized public or private entities to assist in disaster relief efforts and to coordinate communication with those involved in your care.

Lawsuits and Disputes: If you are involved in a lawsuit or legal procedure, we may disclose your PHI in response to a court or administrative order. We may also disclose PHI in response to a subpoena, discovery request, or other lawful process issued by a party involved in the dispute, but only if reasonable efforts have been made to notify you of the request or to obtain a protective order to safeguard the information.

III. Certain Uses and Disclosures Require Your Authorization

We will not use or disclose your PHI for the purposes described below without your prior written authorization:

• Psychotherapy Notes. We do keep “psychotherapy notes” as that term is defined in Code of Federal Regulations 45 CFR § 164.501, and any use or disclosure of such notes requires your authorization unless the use or disclosure is:
  
  1. For our use in treating you.
  2. For our use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy.
  3. For our use in defending Unfold Psychology therapists, clinicians, staff and other mental health providers in legal proceedings initiated by you.
  4. For use by the Secretary of Health and Human Services to investigate our compliance with HIPAA.
  5. Required by law, and the use or disclosure is limited to the requirements of such law.
  6. For certain health oversight activities pertaining to the originator of the psychotherapy notes, as required by law.
  7. Required by a coroner or medical examiner who is performing duties authorized by law.
  8. Required to help prevent or lessen a serious threat to the health and safety of a person or the public.
• Marketing Purposes. As psychotherapists, we will not use or disclose your PHI for marketing purposes.
• Sale of PHI. As psychotherapists, we will not sell your PHI in the regular course of our business.

IV. Certain Uses and Disclosures Do Not Require Your Authorization

Subject to certain limitations in the law, we can use and disclose your PHI without your Authorization for the following reasons:

• When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.
• For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.
• For health oversight activities, including audits and investigations.
• For judicial and administrative proceedings, including responding to a court or administrative order, although our preference is to obtain an Authorization from you before doing so.
• For law enforcement purposes, including reporting crimes occurring on our premises.
• To coroners or medical examiners, when such individuals are performing duties authorized by law.
• For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy for the same condition.
• Specialized government functions, including ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counterintelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.
• For workers’ compensation purposes. Although our preference is to obtain an Authorization from you, we may provide your PHI in order to comply with workers’ compensation laws.
• Appointment reminders and health related benefits or services. We may use and disclose your PHI to contact you to remind you that you have an appointment with us. We may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that we offer.

V. Certain Uses and Disclosures Require You to Have the Opportunity to Object

• Disclosures to Family, Friends, or Others Involved in Your Care: We may disclose your PHI to a family member, friend, or other person that you indicate is involved in your care or in the payment for your care, unless you object to such disclosure, in whole or in part. If you are not present or are unable to agree or object, we may use our professional judgment to determine whether a disclosure is in your best interest. The opportunity to consent may be obtained retroactively in emergency situations.

VI. Uses and Disclosures of Protected Health Information Based Upon Your Written Authorization

• Other uses and disclosures of your PHI that are not described in this Notice will be made only with your prior written authorization, unless otherwise permitted or required by law. You may revoke this authorization in writing at any time. If you revoke your authorization, we will no longer use or disclose your protected health information for the reasons covered by your written authorization. Please understand that we cannot undo any disclosures made before we receive your revocation, and that we are required to retain records of the care that we provided to you.

VII. You Have the Following Rights With Respect to Your PHI

You have the following rights regarding your PHI that we maintain:

The Right to Request Restriction on Uses and Disclosures: You have the right to ask us not to use or disclose certain PHI for treatment, payment, or health care operations purposes. You may also request that we do not disclose PHI to family members or friends who may be involved in your care. Your request must be in writing and must specify the restriction and the individuals to whom it applies. While we will consider all requests, we are not required to agree, including if we believe it would affect your care. If your therapist, clinician or health care provider does agree to the requested restriction, we may not use or disclose your PHI in violation of that restriction, unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with your physician.

The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full: You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the services in questions have been paid for out-of-pocket in full.

The Right to Choose How We Send PHI to You: You have the right to request to receive confidential communications from us by alternative means or at an alternative location. You have the right to ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request. Please make this request in writing to our Privacy Officer.

The Right to Request Access and Copies of Your PHI: You have the right to inspect and obtain a copy of your PHI maintained in our records, including medical and billing information used to make decisions about your care. You may obtain your medical record that contains medical and billing records and any other records that your therapist, clinician, or health care provider and the practice uses for making decisions about you. We will provide you with a copy of your record, or a summary of it (if you agree to receive a summary) within 30 days of receiving your written request. As permitted by federal or state law, we may charge you a reasonable copy fee for a copy of your records. Certain records, such as psychotherapy notes, information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and laboratory results, may not be accessible under federal law. If we deny access, we will explain the reason and inform you whether you have a right to have the denial reviewed. Please contact our Privacy Officer if you have questions about access to your medical record.

The Right to an Accounting of Disclosures Made: You have the right to request a list of disclosures of your PHI for purposes other than treatment, payment, or health care operations, or for which you provided us with an authorization. We will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list we will give you will include disclosures made in the last six years unless you request a shorter time. You first request in a 12-month period will be at no charge, and each additional request within the same 12-month period may be subject to a reasonable fee. The list of disclosures excludes disclosures we may have made to you if you authorized us to make the disclosure, for a facility directory, to family members or friends involved in your care, or for notification purposes, for national security or intelligence, to law enforcement (as provided in the privacy rule) or correctional facilities, as part of a limited data set disclosure. The right to receive this information is subject to certain exceptions, restrictions and limitations.

The Right to Correct or Update Your PHI: You have the right to request amendments to any inaccurate or incomplete information for so long as we maintain this information. In certain cases, we may deny your request if the information is accurate and complete, not part of our records, or not subject to inspection under the law. If we do so, we will provide you with written explanation within 60 days of receiving your request and inform you of your right to submit a statement of disagreement. We may respond with a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact our Privacy Officer if you have questions about amending your medical record.

Right to Revoke Consent: You have the right to revoke your consent to any use and disclosure of your PHI at any time, in writing, by submitting a request to our Privacy Officer. Revoking your consent will not affect the legality of any use or disclose made by us prior to the revocation.

The Right to Get a Paper or Electronic Copy of This Notice: You have the right to receive a copy of this Notice, either on paper or electronically by email. Even if you have agreed to receive this Notice via email, you also have the right to request a paper copy of it at any time.

VIII. Duration of Consent; Data Retention and Destruction

Your consent to the use and disclosure of your PHI pursuant to this Notice will remain in effect for the duration of the services we provide to you, unless and until you revoke your consent in writing.

We will retain your PHI for as long as necessary to provide care to you and to comply with applicable legal and regulatory requirements. When your PHI is no longer needed, it will be securely destroyed in accordance with applicable privacy laws and industry standards.

Audiovisual materials recorded and stored by the practice are subject to Unfold Psychology’s separate Consent to Record Audio policy. The practice may condition the provision of services upon your execution of that separate policy.

IX. Complaints

If you believe your privacy rights have been violated, you have the right to file a complaint with us or with the the Secretary of Health and Human Services. To file a complaint with us, please contact our Privacy Officer directly. We will not retaliate against you in any way for filing a complaint. If you have questions about our privacy practices or wish to discuss your concerns, you may also speak with therapist, clinician, or health care provider.

X. Effective Date of This Notice

This HIPAA Notice of Privacy Practices went into effect on 08/01/2023 and was last updated on 05/08/2025. Your acknowledgement of this policy is dated as of the date indicated on your SimplePractice intake and consent.

For further information, please contact the offices of Unfold Psychology: A Heafey Practice, P.C. at (650) 993-9321 or email CareTeam@unfoldpsychology.com. You may revoke an authorization by emailing your contact information and request to CareTeam@unfoldpsychology.com.