HIPAA Notice

HIPAA NOTICE OF PRIVACY PRACTICES

 

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

 

Effective Date: April 2026

Mind Balance Flow Medical Corporation | 1985 1st St, Ste 205, Livermore, CA 94550

 

OUR USES AND DISCLOSURES OF YOUR HEALTH INFORMATION

 

Treatment: We use and share your health information to provide Ketamine-Assisted Psychotherapy (KAP), integration therapy, medication management, and telemedicine consultations, and to coordinate care with other providers when needed.

 

Payment: We may use your information to process payments for services. Mind Balance Flow is a private-pay practice and does not bill insurance.

 

Healthcare Operations: We may use your health information for quality assurance, clinical supervision, staff training, and administrative functions.

 

Required by Law: We may disclose your health information when required by federal or state law, including DEA inspections, mandatory reporting, and court orders.

 

Emergency Situations: We may share your health information to protect your health or safety in a medical emergency.

 

Authorization: All other uses and disclosures require your written authorization using our Authorization to Disclose Protected Health Information form. You may revoke any authorization at any time unless action has already begun.

 

YOUR RIGHTS

 

• Right to access your medical records
• Right to request corrections
• Right to request restrictions on use or disclosure
• Right to an accounting of disclosures
• Right to receive a paper copy of this Notice
• Right to request confidential communications
• Right to file a complaint

 

OUR DUTIES

 

We are required by law to maintain the privacy of your protected health information, provide you with this Notice, and abide by its terms. We reserve the right to change our privacy practices. Changes will apply to all health information we maintain.

 

COMPLAINTS

 

To file a complaint with us: elyas@mindbalanceflow.com | [INSERT CLINIC PHONE NUMBER]

 

To file a complaint with HHS:

Office for Civil Rights, U.S. Department of Health and Human Services

200 Independence Avenue S.W., Washington D.C. 20201

1-877-696-6775 | www.hhs.gov/ocr/privacy/hipaa/complaints/

 

We will not retaliate against you for filing a complaint.