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Notice of Privacy Practices

THIS NOTICE DESCRIBES: (1) HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, (2) YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION, AND (3) HOW TO FILE A COMPLAINT CONCERNING A VIOLATION OF THE PRIVACY OR SECURITY OF YOUR HEALTH INFORMATION, OR OF YOUR RIGHTS CONCERNING YOUR INFORMATION. YOU HAVE A RIGHT TO A COPY OF THIS NOTICE (IN PAPER OR ELECTRONIC FORM) AND TO DISCUSS IT WITH RUIQI HE, LCSW, PRIVACY CONTACT, AT 626-463-8752 IF YOU HAVE QUESTIONS ABOUT IT. PLEASE REVIEW IT CAREFULLY.

Effective Date: September 18, 2026

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Inly Therapy, Licensed Clinical Social Worker, PC, doing business as Inly Therapy (the “Practice”), is committed to protecting the privacy and security of your health information. This Notice of Privacy Practices (“Notice”) describes how the Practice may use and disclose your Protected Health Information (“PHI”), your rights regarding your health information, and the Practice’s responsibilities under applicable federal and California privacy laws. In this Notice, “therapist” means the licensed clinician who provides your services at the Practice.

YOUR RIGHTS

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When it comes to your health information, you have certain rights. This section explains your rights and some of the Practice’s responsibilities to help you exercise them.

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Get an Electronic or Paper Copy of Your Medical Record

You can ask to see or obtain an electronic or paper copy of your medical record and other health information the Practice maintains about you. If your information is kept electronically, you can ask for it in electronic form. You can also ask the Practice to send a copy of your health information directly to another person or entity that you designate.

The Practice will generally provide a copy or summary within 30 days of your request, or within any shorter time required by California law. A reasonable, cost-based fee may apply as permitted by law. In limited circumstances permitted by law, the Practice may deny or limit access, and if it does, you will be told why in writing and, where the law provides, how to have the decision reviewed.

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Ask Us to Correct or Add to Your Medical Record

You can ask the Practice to correct health information about you that you believe is incorrect or incomplete. The Practice may deny your request in certain circumstances, but if it does, you will receive a written explanation as required by law, and you may submit a written statement of disagreement to be included in your record. Under California law, you may also provide a written addendum about any item or statement in your record that you believe is incomplete or incorrect, and the Practice will attach it to your record.

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Request Confidential Communications

You can ask the Practice to contact you in a specific way, such as at a particular telephone number or email address, or to send mail to a different address. The Practice will accommodate reasonable requests.

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Ask Us to Limit What We Use or Share

You can ask the Practice not to use or share certain health information for treatment, payment, or health care operations. The Practice is not generally required to agree to your request and may deny it, for example, if the restriction could affect your care. If the Practice agrees to a restriction, information may still be disclosed when necessary for emergency treatment or as otherwise permitted or required by law.

If you pay for a health care service out-of-pocket in full, you may ask the Practice not to share information about that service with your health plan for payment or health care operations. The Practice will agree to such a request unless disclosure is required by law.

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Get a List of Certain Disclosures of Your Information

You can ask for an accounting of certain disclosures of your health information made during the six years before your request, including who received the information and why. The accounting will not include certain disclosures, including many disclosures for treatment, payment, and health care operations and disclosures that you specifically authorized or requested. You may receive one accounting during a 12-month period at no charge. A reasonable, cost-based fee may apply if you request additional accountings within the same 12-month period.

 

Be Notified of a Breach

You have the right to be notified if a breach occurs that may have compromised the privacy or security of your health information.

 

Get a Copy of This Notice

You can ask for a paper copy of this Notice at any time, even if you agreed to receive it electronically. This Notice is also available on the Practice’s website.

 

Choose Someone to Act for You

If someone has legal authority to act as your personal representative, such as through a medical power of attorney or legal guardianship, that person may exercise your rights and make choices about your health information as permitted by law. The Practice may verify the person’s authority before taking action. California law gives certain minors the right to consent to some mental health treatment. When a minor lawfully consents to their own treatment, the Practice may limit a parent’s or guardian’s access to that information as permitted by law.

File a Complaint if You Believe Your Privacy Rights Have Been Violated

You may file a complaint with the Practice by using the contact information at the end of this Notice. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights (“OCR”) by:

The Practice will not retaliate against you for filing a complaint or exercising your privacy rights.​​

YOUR CHOICES

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For certain health information, you may tell us your preferences about what information we share. You may tell us whether you want the Practice to:

  • Share information with family members, close friends, or others involved in your care or payment for your care; or

  • Share information in a disaster relief situation.

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If you are unable to communicate your preference, the Practice may share information when permitted by law if doing so is believed to be in your best interest or is necessary to reduce a serious and imminent threat to health or safety.

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Fundraising

The Practice may contact you for fundraising efforts, but you may tell us not to contact you again. To opt out, contact our Privacy Contact using the information at the end of this Notice.

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Uses Requiring Written Authorization

Except as otherwise permitted by law, the Practice will obtain your written authorization before using or disclosing your health information for:

  • Marketing purposes;

  • The sale of your health information (the Practice does not sell your health information);

  • Most uses and disclosures of psychotherapy notes; or

  • Any other purpose not described in this Notice.

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Psychotherapy notes are a therapist’s separate notes analyzing or documenting the contents of counseling sessions that are kept apart from the rest of your record. They are different from your general clinical record, which may include items such as your diagnosis, treatment plan, session times, and progress summaries. Psychotherapy notes receive special protection, and only limited uses and disclosures are permitted without your authorization, as allowed or required by law.

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If you provide written authorization, you may revoke it in writing at any time. Revocation will not affect information that has already been used or disclosed in reliance on your authorization.

OUR USES AND DISCLOSURES
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How Do We Typically Use or Share Your Health Information?

The Practice may use and disclose your health information without your written authorization for the purposes below, as permitted by law and subject to the more protective rules described later in this Notice.

 

Treatment

The Practice may use your health information and share it with other health care professionals involved in your treatment when permitted by law. For example, your therapist may communicate with your physician or psychiatrist to coordinate your care.

 

Health Care Operations

The Practice may use and share your health information to run the Practice, manage your treatment and services, improve the quality of care, and perform other health care operations permitted by law. For example, the Practice may use your information for scheduling, appointment reminders, quality improvement, administrative activities, and management of your care. You may tell us how you prefer to receive reminders and other communications.

 

Payment

The Practice may use and disclose your health information to bill and obtain payment from health plans or other entities. For example, if you use health insurance, the Practice may give your health plan information about your services for claims processing, authorization, or payment.

OTHER USES AND DISCLOSURES PERMITTED OR REQUIRED BY LAW
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The Practice may also use or disclose your health information without your written authorization in the circumstances below when permitted or required by law. Where California law is more protective than federal law, the Practice will follow California law.

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Public Health and Safety

The Practice may disclose health information for certain public health and safety purposes, including preventing or controlling disease and reporting adverse reactions or product safety concerns.

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Reporting Abuse and Neglect

As a mandated reporter under California law, the Practice must report known or reasonably suspected child abuse or neglect, and abuse or neglect of elders and dependent adults, to the appropriate authorities. The Practice may also report suspected domestic violence when permitted or required by law.

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Serious Threats to Health or Safety

If you communicate a serious threat of physical violence against a reasonably identifiable person, or if the Practice believes you present a serious and imminent danger to yourself or others, the Practice may disclose information as permitted or required by law to prevent or reduce the threat. This may include notifying the person at risk, law enforcement, or others who can help, and seeking emergency evaluation as permitted by law.

 

Health Oversight

The Practice may disclose health information to health oversight agencies for activities authorized by law, including audits, investigations, inspections, licensing, and regulatory activities.

 

Comply With the Law

The Practice will disclose health information when required by applicable federal or state law, including to the U.S. Department of Health and Human Services when necessary to determine compliance with federal privacy requirements.

 

Research

The Practice may use or disclose health information for research when the requirements of applicable law have been satisfied.

 

Coroners, Medical Examiners, and Funeral Directors

The Practice may disclose health information to a coroner, medical examiner, or funeral director as permitted by law.

 

Organ and Tissue Donation

The Practice may disclose health information to organ procurement organizations as permitted by law.

Workers’ Compensation, Law Enforcement, and Government Requests

The Practice may use or disclose health information as permitted or required by law:

  • For workers’ compensation claims;

  • For certain law enforcement purposes, only as permitted by California and federal law; or

  • For certain specialized government functions, including military, national security, and protective services.

 

Judicial and Administrative Proceedings

Communications between you and your therapist may be protected by the California psychotherapist–patient privilege and other California confidentiality laws. The Practice will not disclose your mental health records in response to a subpoena or discovery request alone. The Practice will disclose them only with your written authorization, in response to a court order, or as otherwise permitted or required by law, and will assert privilege on your behalf where the law allows.

 

Sensitive Services and Out-of-State Requests

California law provides additional protection for certain sensitive health information, including information about mental and behavioral health, reproductive health care, and gender-affirming care. The Practice will follow California law that limits disclosure of this information in response to requests, subpoenas, or investigations from outside California.

 

Business Associates

The Practice may share health information with business associates that perform services on behalf of the Practice, such as electronic health record, telehealth, billing, technology, or other service providers. Business associates that receive PHI are required to protect that information in accordance with applicable law and contractual requirements.

SUBSTANCE USE DISORDER RECORDS (42 CFR PART 2)

 

Substance use disorder (“SUD”) treatment records from programs covered by the federal confidentiality rule at 42

CFR Part 2 (“Part 2”) receive additional protection beyond HIPAA. To the extent the Practice creates, receives, or maintains such records, Part 2 applies. The uses and disclosures described in this Notice are limited by Part 2 and by other laws that are more protective than HIPAA, and where those laws apply, the Practice’s uses and disclosures will follow the more protective requirement.

 

Use in Legal Proceedings

SUD treatment records received from programs subject to 42 CFR part 2, or testimony relaying the content of such records, shall not be used or disclosed in civil, criminal, administrative, or legislative proceedings against you unless based on your written consent, or a court order after notice and an opportunity to be heard is provided to you or the holder of the record, as provided in 42 CFR part 2. A court order authorizing use or disclosure must be accompanied by a subpoena or other legal requirement compelling disclosure before the requested record is used or disclosed.

 

Consent

You may give a single written consent for all future uses and disclosures of your Part 2 records for treatment, payment, and health care operations. Your Part 2 consent for other purposes, and any separate consent required for SUD counseling notes, will be obtained as Part 2 requires. You may revoke a Part 2 consent in writing at any time, but revocation does not affect disclosures already made in reliance on it.

 

Redisclosure

Once health information is disclosed as permitted by HIPAA, the person or organization that receives it may redisclose it, and it may no longer be protected by the HIPAA Privacy Rule.

 

Fundraising

The Practice will not use or disclose Part 2 records for fundraising. If that changes, you will first receive a clear and conspicuous opportunity to choose not to receive fundraising communications.

 

Your Rights and Breach Notification

You have the rights described in this Notice with respect to your Part 2 records, including the right to request restrictions, to receive an accounting of certain disclosures, and to file a complaint with the Practice or with the U.S. Department of Health and Human Services. The Practice will notify you of any breach of your Part 2 records as required by law.

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CALIFORNIA PRIVACY PROTECTIONS

 

California law, including the Confidentiality of Medical Information Act (California Civil Code § 56 and following), provides privacy protections for health and mental health information that are, in some respects, stronger than federal law. Under California law, the Practice generally may not disclose your medical or mental health information without your written authorization except in limited circumstances the law specifically allows. When California law is more protective than HIPAA, the Practice will follow California law. Nothing in this Notice limits any greater privacy rights you have under California law.

 

 
OUR RESPONSIBILITIES
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  • The Practice is required by law to maintain the privacy and security of your Protected Health Information.

  • The Practice will notify you as required by law if a breach occurs that may have compromised the privacy or security of your information.

  • The Practice must follow the duties and privacy practices described in the Notice currently in effect and give you a copy of it.

  • The Practice will not use or disclose your health information other than as described in this Notice unless you authorize the use or disclosure in writing or the use or disclosure is otherwise permitted or required by law.

  • If you provide written authorization, you may revoke it in writing at any time, subject to applicable legal limitations.

 

 

CHANGES TO THIS NOTICE
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The Practice may change the terms of this Notice. Any changes may apply to health information the Practice already maintains as well as information received in the future. If this Notice is materially revised, the revised Notice will be posted on the Practice’s website and made available upon request. You may request a copy of the current Notice at any time.

 

 
QUESTIONS, COMPLAINTS, OR REQUESTS REGARDING YOUR PRIVACY RIGHTS
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To ask questions about this Notice, exercise your privacy rights, or file a privacy complaint, please contact:

 

Inly Therapy

Privacy Contact: Ruiqi He, LCSW

Address: 1055 E Colorado Blvd 5th Floor PMB COL-5247, Pasadena, CA 91106

Phone: 626-463-8752

Email: info@inlytherapy.com

Website: https://www.inlytherapy.com

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