Notice of Privacy Practices(Effective: December 18, 2024)This notice describes how medical information about you may be used and disclosed, and howyou can access this information. Please review it carefully.I am committed to protecting your privacy in compliance with the California Confidentiality ofMedical Information Act (CMIA). If applicable, I also comply with the Health InsurancePortability and Accountability Act (HIPAA).My Legal Duty to Safeguard Your InformationI am legally required to protect the confidentiality of your medical information, which includesany information that can identify you and relates to your past, present, or future health, the careyou receive, or the payment for that care.I reserve the right to revise this Notice. Any changes will apply to all information already on file.The updated Notice will always be available in my office and on my website.How I May Use and Disclose Your InformationWithout Your Authorization Treatment: I may share your information with other licensed healthcare providersinvolved in your care. Payment: I may use or disclose your information to obtain payment for services,including billing and claims processing. Practice Operations: I may use information to improve the quality of care I provide orto comply with legal and administrative requirements. When Required by Law: Examples include reporting abuse, complying with courtorders, or fulfilling public health requirements. To Prevent Serious Harm: If there is a significant threat to your safety or the safety ofothers, I may share information with appropriate authorities. Legal and Administrative Purposes: I may disclose information in response to validsubpoenas, audits, or oversight by government agencies.With Your Authorization Any other use or disclosure not listed above requires your explicit, written authorization. This includes sharing psychotherapy notes or using information for marketing. You may revoke your authorization at any time by submitting a written request.Family and FriendsI may share information with individuals involved in your care or payment only if you providewritten consent or do not object when given the opportunity.Your Rights Right to Access Records: You may request to inspect or obtain copies of yourinformation. Requests must be in writing, and I will respond within 15 days. Reasonablecopying fees may apply. Right to Request Amendments: You may ask me to correct or add to your records. Iwill respond within 60 days. Right to Confidential Communication: You may request specific ways I communicatewith you (e.g., via email or alternate address). Right to an Accounting of Disclosures: You may request a list of certain disclosuresmade in the past six years. Right to Breach Notification: If a breach of your information occurs, I will notify youpromptly as required by law.SafeguardsI maintain strict physical, electronic, and procedural safeguards to protect your information fromunauthorized access or disclosure.Contact InformationIf you have questions about this Notice, please contact me:Diya Sen, LMFT #125796Let’s Just Listen15814 Winchester Blvd, #105Los Gatos, CA 95030831-288-2212www.letsjustlisten.com