Your information. Your rights. Our responsibilities.

Summary

This notice applies to KLW Consulting, LLC and to William Wong, PharmD, for care provided in person and by telehealth. "We" and "us" refer to KLW Consulting.

You have the right to

• Get a copy of your paper or electronic medical record
• Correct your paper or electronic medical record
• Request confidential communications
• Ask us to limit the information we share
• Get a list of those with whom we've shared your information
• Get a copy of this notice
• Choose someone to act for you
• File a complaint if you believe your privacy rights have been violated

We may use and share your information to

• Treat you and coordinate care with your other providers
• Run our practice
• Bill for your services
• Help with public health and safety issues, and comply with the law
• Respond to lawsuits, legal actions, and government requests as the law allows

Your rights

When it comes to your health information, you have certain rights. To use any of them, contact our Privacy Officer using the details in Contact us.

Get an electronic or paper copy of your medical record

You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Under California law, we will let you inspect your records within 5 working days and send copies within 15 days of receiving your request. We may charge a reasonable, cost-based fee as the law allows.

Ask us to correct your medical record

You can ask us to correct health information about you that you think is incorrect or incomplete. We may say "no" to your request, but we will tell you why in writing within 60 days.

Request confidential communications

You can ask us to contact you in a specific way (for example, by cell phone rather than home phone) or to send mail to a different address. We will say "yes" to all reasonable requests.

Ask us to limit what we use or share

You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree, and we may say "no" if it could affect your care. If we agree, we may still share the information if you need emergency treatment.

If you pay for a service or item out of pocket in full, you can ask us not to share that information with your health insurer for payment or our operations. We will say "yes" unless a law requires us to share it.

Get a list of those with whom we've shared information

You can ask for a list (accounting) of the times we've shared your health information for up to six years before the date you ask, who we shared it with, and why. The list will include all disclosures except those for treatment, payment, and health care operations, and certain others (such as any you asked us to make). We will provide one list a year for free and may charge a reasonable, cost-based fee for another within 12 months.

Get a copy of this notice

You can ask for a paper copy of this notice at any time, even if you have agreed to receive it electronically. We will provide it promptly.

Choose someone to act for you

If someone is your legal personal representative, such as a person with your health care power of attorney or your legal guardian, that person can exercise your rights and make choices about your health information. We will confirm the person has this authority before we act. Where California law allows a minor to consent to their own care, the minor generally controls the related health information.

File a complaint if you feel your rights are violated

You can complain to us using the details in Contact us. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by writing to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting hhs.gov/hipaa/filing-a-complaint.

We will not retaliate against you for filing a complaint.

Your choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations below, talk to us and we will follow your instructions.

You have both the right and the choice to tell us whether to share information with family, close friends, or others involved in your care or in paying for your care, and whether to share information in a disaster relief situation. If you are unable to tell us your preference, for example if you are unconscious, we may share your information if we believe it is in your best interest. We may also share it when needed to lessen a serious and imminent threat to health or safety.

We never share your information for the following without your written permission:

• Marketing purposes
• Sale of your information
• Most sharing of psychotherapy notes

We do not sell health information, and we do not conduct fundraising.

How we use and share your information

We typically use or share your health information in the following ways.

Treat you

We use your health information and share it with other professionals who are treating you. For example, California law requires us to notify your primary care physician when we start, adjust, or stop a medication, and we send prescriptions to the pharmacy you choose.

Run our practice

We use and share your health information to run our practice, improve your care, and contact you when necessary, such as for appointment reminders. For example, we use secure scheduling, records, and telehealth services from vendors ("business associates") who must protect your information under a written agreement with us.

Bill for your services

We use and share your health information to bill and get payment from health plans or other entities. For example, if we bill your insurance, we give it information about your visit so it will pay for your services.

Other ways we may share it

We are allowed or required to share your information in other ways, usually in ways that contribute to the public good, such as public health and research. We must meet many conditions in the law before we can share your information for these purposes.

Help with public health and safety issues

• Preventing disease
• Helping with product recalls
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone's health or safety

Do research

We can use or share your information for health research, subject to the conditions the law sets.

Comply with the law

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to confirm we're complying with federal privacy law.

Respond to organ and tissue donation requests, and work with a medical examiner or funeral director

We can share health information with organ procurement organizations, and with a coroner, medical examiner, or funeral director when an individual dies.

Address workers' compensation, law enforcement, and other government requests

• For workers' compensation claims
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies, such as licensing boards, for activities authorized by law
• For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions

We can share health information about you in response to a court or administrative order, or in response to a subpoena, as the law allows.

Substance use disorder records

If we have substance use disorder patient records about you that are covered by federal law (42 CFR Part 2), we will not use or share information in those records in civil, criminal, administrative, or legislative investigations or proceedings against you without (1) your written consent or (2) a court order and a subpoena.

California protections

California law gives you some protections that go further than federal law. When California law is more protective, we follow it.

• Under the California Confidentiality of Medical Information Act (Civil Code § 56 and following), we generally need your written authorization to share your medical information, except as that law permits or requires.
• Certain sensitive information, such as HIV test results, mental health records, and substance use disorder records, has additional protections under California and federal law and is shared only as those laws allow.
• We will not release information about abortion or gender-affirming care in response to an out-of-state subpoena or request based on another state's laws that interfere with rights protected in California, as provided in Civil Code §§ 56.108 and 56.109.
• You may inspect your records within 5 working days and receive copies within 15 days of your request, as provided in Health and Safety Code § 123110.

Our responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you give us permission, you may change your mind at any time by letting us know in writing.

For more information, see the HHS guide to notices of privacy practices.

Changes to this notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be posted on this page, available in our office, and provided on request.

Contact us

For questions about this notice, to use any of your rights, or to file a complaint with us, contact: