Website Privacy Policy
Information Collected When You Visit My Website
When you visit my website, certain personal and non-personal information may be collected depending on how you interact with the site. For example, if you choose to fill out a form, send a message, or schedule an appointment, you may provide information such as your name, email address, or phone number. Any personal information you share will only be used for the specific purpose for which it was provided (e.g., responding to your inquiry or scheduling an appointment).
Other non-personal information may also be collected, such as the date and time you visit the site or the website that referred you here. This information helps me understand how visitors use the site and improve its functionality and content to better serve you.
Cookies
A cookie is a small data file stored on your device when you visit a website. Cookies are commonly used to enhance website functionality and improve the user experience. For example, cookies can remember your preferences, login details, or which pages you visited. They also help website owners understand which parts of their site are most popular.
My website may use cookies to verify user information and improve your browsing experience. Most internet browsers are set to accept cookies by default, but you can adjust your browser settings to refuse cookies or alert you when cookies are being created. Please note that disabling cookies might limit your ability to access certain features or sections of the site.
Contact Forms
My website features a contact form specifically designed to help you begin the process of working with me. You’ll find it under the “Contact” option in the menu, and it may also appear on select pages. I do not accept unscheduled phone calls and do not share my direct number or email address. The contact form offers clear instructions for submitting inquiries or requests, making communication simple and efficient.
Current clients are provided with direct contact information, but for my privacy and safety, I do not share phone numbers, a physical office address, or similar details publicly.
Clinical Privacy Policy
This notice describes how your medical information may be used and disclosed and outlines your rights regarding this information. Please review it carefully.
I am committed to maintaining the privacy and confidentiality of your medical information. Records of the care provided are used to deliver quality care, facilitate payment for services, and ensure compliance with professional and legal obligations. As required by law, this notice explains how your protected health information (PHI) may be used and disclosed and outlines your rights under HIPAA and applicable state laws.
Medical Information Use & Disclosure
Protected Health Information (PHI) refers to any information that identifies you and relates to your past, present, or future physical or mental health, health care services, or payment for those services. Your PHI may be used or disclosed in the following ways:
Treatment: Your PHI may be used or shared with other healthcare providers involved in your care, such as consulting with another provider to coordinate services. However, in my practice, this happens very rarely for most clients.
Payment: Your PHI may be used to bill and collect payment for services rendered.
Health Care Operations: PHI may be used for practice management, quality improvement, and compliance with legal or professional requirements.
Required by Law: PHI will be disclosed as mandated by federal, state, or local laws, including reporting abuse or neglect, responding to legal proceedings, or addressing public health concerns.
Other Uses & Disclosures
Your PHI may also be disclosed in specific situations, including but not limited to:
Public Health and Safety: To protect public health or safety or to prevent a serious threat to the health or safety of others.
Judicial or Administrative Proceedings: When required by a valid court order, subpoena, or other lawful processes.
Health Oversight Activities: For audits, inspections, or licensure reviews.
Workers’ Compensation: To comply with workers’ compensation laws.
Business Associates: PHI may be shared with entities performing administrative functions on my behalf under written agreements requiring confidentiality.
Your Health Information Rights
You have the following rights regarding your PHI:
Right to Request Restrictions: You have the right to request limitations on how your PHI is used or disclosed. While not all requests can be granted, I always honor requests to withhold information from your health plan if you pay for services out of pocket in full. In my view, their involvement ends where your payment begins. Since I do not accept insurance, I also do not provide unpaid administrative support for their benefit.
Right to Confidential Communications: You may request that PHI be sent to an alternate address or communicated in a specific manner.
Right to Inspect and Copy: You can request access to your PHI or obtain a copy of your records. Reasonable fees may apply as allowed by law.
Right to Amend: You may request an amendment to your PHI if you believe it is incomplete or inaccurate.
Right to an Accounting of Disclosures: You may request a record of certain disclosures of your PHI made in the last six years, excluding those for treatment, payment, or healthcare operations.
Right to an Electronic Copy of Records: If your records are maintained electronically, you may request access in a specified electronic format.
Right to Notice of Breach: You have the right to be informed if a breach occurs that compromises the privacy or security of your PHI.
Right to a Paper Copy of this Notice: A paper copy of this notice is available upon request.
Changes to this Notice of Privacy Practices
I reserve the right to update this notice as needed to reflect changes in privacy practices or legal requirements. Updated versions will apply to all PHI, regardless of when it was created.
Complaints
Complaints about this Privacy Policy or how this medical practice handles your health information should be directed to my office.
Alexandra Gulbis, LCSW
PO Box 531
Isleton, CA 95641
If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to:
U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
You will not face retaliation or penalties for filing a complaint.