OUR UNIQUE VISION & MISSION STATEMENT
OUR UNIQUE VISION & MISSION STATEMENT
We provide counseling within a safe, supportive, caring environment, so you can face your difficulties constructively and confidently; freeing you to enjoy all of the good things life has to offer. If you are struggling with relationship issues, anxiety, depression, or need help healing from abuse or trauma, we can help. Additionally, we are a court mandated parenting group provider.
Therapy can provide a safe place to receive help with problems such as:
- Relationship distress
- Anxiety and panic attacks
- Domestic violence
- Anger management
- Self-Esteem and self-Image
- Parenting and family concerns
- Personal or work stress
- Divorce and parenting
- Trauma and abuse
- San Diego Superior Court Approved Co-Parenting and Parenting Classes
To be your community behavioral healthcare clinic leading the way in client care. Utilizing tools that are FDA approved to improve symptoms of depression, anxiety and sleep. We are inspired by people like John Dupuy the founder of Intergral Recovery, here is a a bio on him. John Dupuy is a native of Texas and grew up in Latin America. John is a veteran of the United States Army, where he served in Europe as a military police investigator. John has a Bachelor’s degree from Texas State University in Modern Languages (German and Spanish) and a Master of Arts degree in Transpersonal Psychology from John F. Kennedy University. John is the founder of Integral Recovery, has published various articles on the subject, and in 2013, his book Integral Recovery: A Revolutionary Approach to the Treatment of Alcoholism and Addiction was published by SUNY Press, later to win the 2013 USA Best Book Award. As stated when John Dupuy describes the CES technology used in his Integral Addiction Recovery Program he states CES is designed to help re-balance the brain. At least 118 clinical studies on effectiveness of CES on anxiety, addiction, depression and sleep restoring healthy brain chemistry, re-balances through bilateral square wave energy field theory.
“Unequivocal Positive Results in Every Case with Negligible Exceptions. Approximately 95% of my private practice patients are in possession of their own personal CES device which I have found to be most effective and beneficial treatments over standard pharmaceutical treatment” according to Brain Earthman, MD, Psychiatrist, Major USAR, Medical Director Electrometrical Products International, Inc.
“Neurological Devices Panel of the Medical Devices Advisory Committee to the FDA on Cranial Electrotherapy Stimulator (CES) Reclassification Meeting on February 10, 2012 indicated that the largest customer for AlphaStim CES is DOD. Military use of Cranial Electrotherapy Stimulation (CES)” according to Dr. Stein’s Testimonial request expedited review of CES reclassification as CES is currently being utilize in Army, Navy and VA hospitals. He stated that Enormous Target Populations, many drug resistant patients, many drug addicted patients would benefit greatly if CES technology could be more widely utilized in the psychiatric community.
Utilize best practices that is result driven for example, Traditional neurofeedback which is similar to weight training, where you work specific muscle groups, in brain you are training one or more specific brain waves in a targeted area of the brain based on operant conditioning to help retrain the brain waves to optimal levels. Within this type of neurofeedback involves low-frequency sounds and involves prepackaged neurofeedback equipment for audio-visual entertainment (AVE), which has blinking lights that can cause seizures.
EEG Neuro-Feedback software and sending CD home with patient with bilateral sounds to assist in increasing symptom reduction. Brainwave Entrainment Meditation, one of the essential practices in an ongoing, lifelong mind and body change.
|MEET OUR CURRENT STAFF|
Walter Patrick Martin, MA, LMFT, CISM-Advance Cert, EAS-C Cert, EMDR Cert, Operations Director and creator of EMDRCarlsbad.com and FamilyCounselingSanDiego.com, in addition Mr. Martin wrote a workbook for couples called “Heat and Soul Toward Intimacy: Couples Guide”. Mr. Martin is part of EMDR International Association and co-facilitated EMDRIA training DeTUR addiction protocol around the country with Dr. AJ Popky. Mr. Martin recently joined the International Employee Assistance Professionals Association and completed Employee Assistant Specialist – Clinic Certification assisting in putting the group as preferred status with EAP Counseling Insurance Panels. Mr. Martin discovered that CES and a unique style of EMDR therapy is actually a method that every therapist dreams about, i.e., it is as efficient as it is time effective. Usually I have been able to see significant positive results in only one session. Give it a try and see the difference. Feel peaceful once again. The proven medical treatment of Cranial Electrical Stimulation (CES) re-balances your brain’s chemistry. Many people report feeling relief from the very first time they use the CES Ultra. Your brain chemistry re-balances while anxiety plummets. And unlike drugs, CES is so safe, you can use it as much as you want. Now you have the power achieve peace of mind and move forward with your life.
Walter Patrick Martin area of focus includes help with self-esteem issues, couples/marriage/family issues, co-parenting, reunification, anger management, complex trauma, Asperger’s, Autism, severe psychosis to manic depression, stress-management, anxiety, depression, and adjusting to life transitions. Walter Patrick Martin also published a workbook for couples called “Heart and Soul into Intimacy.” While working for the County of San Diego for over 12 years Mr. Martin also assist the Red Cross during the Firestorms of 2005, 2006 and Katrina through the County Crisis Team.
Mr. Martin is also proud to be assigned during the 2015/2016 school year for the students and families at Serra High School as the Military Family Life Counselor through MHN Government Services.
Also, Mr. Martin offers Free Counseling for Gambling Addiction in San Diego office. Mr. Martin has received specialized training through a special program by UCLA and the State of California for Gambling Addiction which hides under the radar for many people but it is very real. This is for families, wife’s and the client.
Problem gamblers—those who gamble beyond the limits of recreational entertainment— If you need help right away you can talk to someone right now 24 hours 7 days a week at 1.800.GAMBLER or 1.800.426.2537.
Problem Gambling is participation in any form of gambling to the extent that it creates a negative consequence to the gambler, the gambler’s family, place of employment, or community. This includes patterns of gambling and subsequent related behaviors that compromise, disrupt, or damage personal, family, educational, financial, or vocational interests. The problem gambler does not meet the diagnostic criteria for pathological gambling disorder.
Janet Phillips, LCSW, Clinical Director has years of experience working with a diverse population including children, adolescents, adults and families in both inpatient and outpatient settings. She is current working in an outpatient setting with San Diego County assigned to do Behavioral Health Assessments for Clients with Medicare, and the completion of the Client Plans, and Individual Therapy. Janet received her Masters of Social Work at San Diego State University. She has extensive experience working with children and teens in clinic, school and community venues, assisting them in developing social and anger management skills. Janet also is EMDR trained and has taken extensive classes in Dr. Miller FSP EMDR Protocol for addiction. She is also an equine therapist and continues to ride her horses as often as she can. She is planning on leaving San Diego County toward end of Summer of 2016 at that time we will be adding an additional office space to our practice for her full time need which will also allow any contracted therapist to schedule time in the other office as well. As the group expands Mr. Martin would like to buy or lease a LENS active feedback neuro-feedback unit which has the most positive results in a much quicker timeline.
LaTysa Flowers, Parent Educator/Partner – Skilled and experienced in special education advocacy, mental health support with an emphasis on direct family and children services. Affordable services to support family during difficulty navigating the tools school districts have to offer. As Ms. Flowers is an Educator and Parent Coach she can provide IEP and special education advocate services.
PSYCHOLOGICAL SERVICES: Psychotherapy is not easily described in general statements. It varies depending on the personalities of the psychologist and patient, and the particular problems you bring forward. There are many different methods I may use to deal with the problems that you hope to address. Psychotherapy is not like a medical doctor visit. Instead, it calls for a very active effort on your part. In order for the therapy to be most successful, you will have to work on things we talk about both during our sessions and at home.Psychotherapy can have benefits and risks. Since therapy often involves discussing unpleasant aspects of your life, you may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness, and helplessness. On the other hand, psychotherapy has also been shown to have benefits for people who go through it. Therapy often leads to better relationships, solutions to specific problems, and significant reductions in feelings of distress. But there are no guarantees of what you will experience.
Our first few sessions will involve an evaluation of your needs. By the end of the evaluation, I will be able to offer you some first impressions of what our work will include and a treatment plan to follow, if you decide to continue with therapy. You should evaluate this information along with your own opinions of whether you feel comfortable working with me. Therapy involves a large commitment of time, money, and energy, so you should be very careful about the therapist you select. If you have questions about my procedures, we should discuss them whenever they arise. If your doubts persist, I will be happy to help you set up a meeting with another mental health professional for a second opinion.
MEETINGS: I normally conduct an evaluation that will last from 2 to 4 sessions. During this time, we can both decide if I am the best person to provide the services you need in order to meet your treatment goals. If psychotherapy is begun, I will usually schedule one 50-minute session (one appointment hour of 45-50 minutes duration) per week at a time we agree on, although some sessions may be longer or more frequent. Once an appointment hour is scheduled, you will be expected to pay for it unless you provide 48 hours [2 days] advance notice of cancellation [unless we both agree that you were unable to attend due to circumstances beyond your control]. [If it is possible, I will try to find another time to reschedule the appointment.]
CONFIDENTIALITY: All communications between you and your Counselor will be held in strict confidence unless you provide written permission to release information about your treatment. There are exceptions to confidentiality as we utilize Practice Fusion Software and OfficeAlly.com insurance approved clearinghouse. All are HIPPA compliant systems. EXAMPLE OF LIMITS TO HIPPA, therapists are required to report instances of suspected child, elder or dependent adult abuse. Therapists may be required or permitted to break confidentiality when they have determined that a patient presents a serious danger of physical violence to another person or when a patient is dangerous to him or herself. PMI (Protected Medical Information) is taken very seriously. This practice in known for it extreme private needs of active duty military and if requested no information is records for our free hour for active duty Military or DOD contractors to all freedom without concerns of loss of a security clearance. Also all active duty families also afforded only the highest level of privacy as we take privacy very seriously.
COUPLES or FAMILY THERAPY: If you participate in marital or family therapy, your Counselor will not disclose confidential information about your treatment unless all person(s) who participated in the treatment with you provide their written authorization to release such information. Children benefit when they have relationships with both parents WITHOUT NEGATIVITY TOWARD EACH OTHER.This provides a safe place to get to the root of the issues that brought you into treatment. A summary/verification of dates/time of attendance, diagnosis of primary patient is all that will be provided for court purposes. AT THIS LEVEL OF TREATMENT RECORDS ARE NOT RELEASED WITHOUT COURT ORDER EVEN IF ALL PARTIES AGREE if therapist or group legal team feels it would harm the patient.
CO-PARENTING or PARENTING: (San Diego Superior Court Approved) Be flexible and fair. Sometimes, unexpected situations arise that may require some flexibility in how shared parenting is carried out day to day. Be willing to trade some responsibilities or time with the other parent when needed. CO-PARENTING requires commitment of 9 sessions and will sign a contract at office. In addition it is cash or credit only. If you miss appointment or cancel appointment prior to 48 hours you pay $50 and discouraged to change appointment after it is made. Currently at 7:00 PM on Thursday nights we have a group that is open for parents to join.
MINORS and Confidentiality: Communications between therapists and patients who are minors (under the age of 18) are confidential. However, parents and other guardians who provide authorization for their child’s treatment are often involved in their treatment. Consequently, your Counselor, in the exercise of his professional judgment, may discuss the treatment progress of a minor patient with the parent or caretaker. Patients who are minors and their parents are urged to discuss any questions or concerns that they have on this topic with their Counselor. Your Counselor generally requires the consent of both parents prior to providing any services to a minor child. Your Counselor might require that you provide legal documentation, such as a custody order, prior to the commencement of services, if such an order applies.
BILLING AND PAYMENTS: You will be expected to pay for each session at the time it is held, unless we agree otherwise or unless you have insurance coverage which requires another arrangement. Payment schedules for other professional services will be agreed to when they are requested. [In circumstances of unusual financial hardship, I may be willing to negotiate a fee adjustment or payment installment plan.]
If your account has not been paid for more than 60 days and arrangements for payment have not been agreed upon, I have the option of using legal means to secure the payment. This may involve hiring a collection agency or going through small claims court. [If such legal action is necessary, its costs will be included in the claim.] In most collection situations, the only information I release regarding a patient’s treatment is his/her name, the nature of services provided, and the amount due.
INSURANCE: WE HONOR AND THANK OUR MILITARY so there is no cost for any active duty service and retired military on first session as we are a proud member of “GIVE AN HOUR” program. We are a STAR CIVILIAN PROVIDER. Our clinic is a contracted provider with many insurance companies. If however we can not take your insurance, we will work with you, provide a monthly statement (Superbill) which can be provided for you to submit to your insurance company for reimbursement of what you have paid. If you are on Medi-Cal the card is required to be on file to be seen at our office and a credit card on file.
INSURANCE REIMBURSEMENT (Important)
In order for us to set realistic treatment goals and priorities, it is important to evaluate what resources you have available to pay for your treatment. If you have a health insurance policy, it will usually provide some coverage for mental health treatment. I will fill out forms and provide you with whatever assistance I can in helping you receive the benefits to which you are entitled; however, you (not your insurance company) are responsible for full payment of my fees. It is very important that you find out exactly what mental health services your insurance policy covers.
You should carefully read the section in your insurance coverage booklet that describes mental health services. If you have questions about the coverage, call your plan administrator. Of course I will provide you with whatever information I can based on my experience and will be happy to help you in understanding the information you receive from your insurance company. If it is necessary to clear confusion, I will be willing to call the company on your behalf.
Due to the rising costs of health care, insurance benefits have increasingly become more complex. It is sometimes difficult to determine exactly how much mental health coverage is available. “Managed Health Care” plans such as HMOs and PPOs often require authorization before they provide reimbursement for mental health services. These plans are often limited to short-term treatment approaches designed to work out specific problems that interfere with a person’s usual level of functioning. It may be necessary to seek approval for more therapy after a certain number of sessions. While a lot can be accomplished in short-term therapy, some patients feel that they need more services after insurance benefits end. [Some managed-care plans will not allow me to provide services to you once your benefits end. If this is the case, I will do my best to find another provider who will help you continue your psychotherapy.]
You should also be aware that most insurance companies require you to allow me to provide them with a clinical diagnosis. Sometimes I have to provide additional clinical information such as treatment plans or summaries, or copies of the entire record (in rare cases). This information will become part of the insurance company files and will probably be stored in a computer. Though all insurance companies claim to keep such information confidential, I have no control over what they do with it once it is in their hands. In some cases, they may share the information with a national medical information databank. I will provide you with a copy of any report I submit, if you request it. I understand that by using your insurance I am aware that such information may be provided to them. I will try to keep that information limited to the minimum necessary.
Once we have all of the information about your insurance coverage, we will discuss what we can expect to accomplish with the benefits that are available and what will happen if they walkout before you feel ready to end our sessions. It is important to remember that you always have the right to pay for my services yourself to avoid the problems described above [unless prohibited by contract].
CANCELLATION POLICY: ALL scheduling in ONLINE. Sessions are typically scheduled one time per week at the same time and day but Neuro-Programming Session are twice a week for 25 weeks. Your Counselor may suggest a different amount of therapy depending on the nature and severity of your concerns. Your consistent attendance greatly contributes to a successful outcome. In order to cancel or reschedule an appointment, you are expected to notify your Counselor at least 48 hrs. in advance of your appointment, by phone. If you do not provide your Counselor with at least 48 hours notice in advance, you are responsible for $50 missed session fee. If you or your partner walks out of treatment $50 will be charged.
EMERGENCY ISSUE: Your Counselor is unable to provide 24-hour crisis service but call 760-513-6587 as we an operator to answer our calls 24 hours a day. In the event that you are feeling unsafe or require immediate medical or psychiatric assistance, you should call 911, or National Hopeline Network (800) 784-2433.. Our Counselors are unfortunately unable to use emails except for non-clinical uses. If an email correspondence is particularly important to your therapy, please be sure to print out and bring a copy of the email to your next session so Counselor can read at that time.
TERMINATION OF TREATMENT: The length of your treatment and the timing of the eventual termination of your treatment depend on the specifics of your treatment plan and the progress you achieve. It is a good idea to plan for your termination, in collaboration with your Counselor. Your Counselor will discuss a plan for termination with you as you approach the completion of your treatment goals. You may discontinue therapy at any time. If you or your Counselor determines that you are not benefiting from treatment, either of you may elect to initiate a discussion of your treatment alternatives. Treatment alternatives may include, among other possibilities, referral, changing your treatment plan, or terminating your therapy.
NEUROFEEDBACK (BRAIN RETAINING): (“EEG-biofeedback”) is a comparatively new and emerging treatment modality that is currently applied to a wide variety of disorders. Neurofeedback for attention deficit/hyperactivity disorder (ADHD), substance addiction, depression, anxiety, and post-traumatic stress disorder (PTSD) have a reasonably good research basis for clinical application. However, neurofeedback for these disorders and many others may be considered “experimental” by some insurance providers, health care practitioners, or others. Other psychological, neurological, and behavioral disorders, including tinnitus and tremors, have limited published neurofeedback research available, and neurofeedback treatment of these conditions is currently considered to be “experimental.”
ASSIGNMENT OF INSURANCE BENEFITS: I hereby authorize billing my insurance company or other third party payers for any covered services received and authorize my insurance company to make direct payment for said services. I understand that if payment for the services I receive here is not made, the therapist may stop my treatment. I further understand that portions of my clinical record may be disclosed to my insurance company or other third party payers for reimbursement purposes.
ACKNOWLEDGEMENT: I acknowledge that I have read the Agreement give Informed Consent to treatment as well as agree to the policies set forth in the Agreement. I acknowledge that I have the opportunity to read the separate Privacy Practices/HIPAA disclosure (On website – FamilyCounselingSanDiego.com). (If a minor child), I as parent/guardian give consent, has been offered and agreement to services for my child as set forth in this Agreement.
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at FCSD. We need this record to provide you with quality care and to comply with certain legal requirements. This notice will tell you about the ways in which we may use and share your protected health information (“PHI”). It also describes your rights and certain actions we must take when using or sharing your PHI with other people or organizations. We are required by law to: make sure that PHI linked to you is kept private and confidential (with some exceptions as listed below); give you this notice about our responsibilities and privacy practices about your PHI; and follow the terms of the notice that is currently in effect. Except as outlined below, we will not use or share your PHI unless you have signed an authorization form that gives us permission to do so. You have the right to cancel the permission by telling us in writing, except if we have already used or shared your PHI when you first gave us permission.
HOW WE MAY USE AND SHARE PROTECTED HEALTH INFORMATION
The following sections describe different ways that we use and share (disclose) your PHI. We will describe each category of uses and disclosures, and give some examples. The law limits how we can use and disclose some PHI related to treatment of drug and alcohol abuse, HIV infection, and mental illness. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the following categories.
We may use your PHI to provide you with treatment or services. We may share it with doctors, nurses, technologists, medical students, or other healthcare personnel who are involved in your care, with your signed permission.
We may use and share your PHI to bill for the services we provide to you and to collect payment for the services billed, from you, your insurance company or a third party. We may also share PHI with another provider so that provider can bill and collect for services you received. For example, we may share your PHI with your health plan so that it can list services received by you on your itemized bill. We may also tell your health plan about a treatment you need so we can care for you, or ask if your plan will pay us for the treatment.
We will use PHI to schedule an appointment, or to remind you that you have an appointment for treatment. Treatment Alternatives. We will use PHI to tell you about possible treatment options that may interest you.
Health-Related Products and Services. We will use PHI to tell you about our health-related products or services that may interest you. Individuals involved in your care or payment for your care. We may share your PHI with a family member, friend, personal representative, or anyone else you want to be involved in your care. Only with legal signed consent. We may share your PHI with anyone who helps pay for your care if requested, with your signed consent.
As Required By Law
We will use and share your PHI when required to do so by federal, state or local law. To Avert a Serious Threat to Health or Safety. We may use and share your PHI when necessary to prevent or lessen a serious threat to your health and safety, or to that of others. However, we will share your PHI only with a responsible person who is able to help prevent the threat.
Military Service and Veterans
If you are or have been a member of the Armed Forces, we will not share your PHI unless required by the appropriate military command authorities with a federal court order.
We may share your PHI as permitted by law for workers’ compensation or similar programs when necessary to provide you with treatment, services, or benefits for work-related injuries or illness.
Public Health Risks
We may use and share your PHI for public health purposes. In general, these activities include, but are not limited the following: to prevent or control disease (such as cancer or tuberculosis), injury or disability;
to report births and deaths; to report the abuse or neglect of children, elders and dependent adults; to report reactions to medications, or problems with healthcare products; to notify patients of recalls, repairs, or replacement of products they may be using; to notify a person who may have been exposed to a disease or may be at risk for getting or spreading a disease or condition; to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will share your PHI only if you agree or when it is required or authorized by law.
Health Oversight Activities
We may use and share your PHI with a healthcare oversight agency as authorized or required by law. These oversight activities include, for example: audits, investigations, inspections, accreditation and licensure surveys. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes
We may share your PHI in response to a court or administrative order, a subpoena, discovery request, warrant, summons, or other lawful process. We will do so only after we make efforts to tell you about the request, (which may include a written notice to you) or to obtain an order protecting the information requested.
We may use and disclose PHI if asked to do so by a law enforcement official: in compliance with a court order, subpoena, warrant, summons, grand jury subpoena or similar process; to identify or locate a suspect, fugitive, material witness, or missing person; about a victim or a crime, if, under some limited circumstances, we are unable to obtain the permission directly from the victim of a crime; about a death we believe may be the result of criminal conduct; about criminal conduct in any of our facilities; and in emergency circumstances to report: a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
Coroners, Medical Examiners and Funeral Directors
We may use and share your PHI to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release your PHI to funeral directors when necessary for them to carry out their duties.
National Security and Intelligence Activities
We may use and share your PHI to federal officials for intelligence, counterintelligence, and other national security activities as authorized or required by law.
Protective Services for the President and Other Persons
As authorized or required by law, we may use and share your PHI to authorized federal officials so they can protect the President, the President’s family, other designated persons or foreign heads of state, or conduct special investigations.
If you are in a correctional institution or under the custody of law enforcement officials, we may use and share your PHI with the correctional institution or law enforcement officials if they tell us that it is necessary: (1) to provide the healthcare services you need, (2) to protect your health and safety or that of others, or (3) for the safety and security of the correctional institution.
OTHER USES OF PROTECTED HEALTH INFORMATION
Other uses and disclosures of PHI not covered by this notice, or by the laws that apply to us will be made only with your written permission. If you allow us to use or share your PHI, you may cancel that permission, in writing, at any time. If you cancel your permission, we will stop any further use or disclosure of your PHI for the purposes covered by your written permission. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required by law to keep records of the services or treatment we provided to you.
YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
You have the following rights regarding your PHI that we maintain in our facilities.
Right to Inspect and Copy
Except for information related to treatment of mental illness, or information gathered in a civil, criminal or administrative action or proceeding, or some PHI subject to the Clinical Laboratory Improvements Amendments of 1988, you have the right to ask to inspect and copy your PHI. To inspect and copy your PHI, you must send a specific, detailed request in writing to the Custodian of Medical Records addressed as follows:
Patrick Martin, MA, LMFT, PO BOX 487, BONSALL, CA 92003
You may ask for a review if we deny a request to inspect and copy except: 1) in circumstances listed above; 2) you are an inmate and the copies would jeopardize your health safety, security, custody, or rehabilitation or that of others; 3) if the PHI is obtained as part of a research study, your right to access your PHI is suspended during the research; 4) if the PHI is controlled by the Privacy Act and access is not permitted by law; or 5) if the PHI was obtained from someone other than a healthcare provider under a promise of confidentiality and access to the PHI would reveal who that person is.
You must ask for a review in writing addressed as follows:
Patrick Martin, MA, LMFT, PO BOX 487, BONSALL, CA 92003
A mental health care provider other than the person who denied your request will review the denial. We will provide or deny access in accordance with the decision of the provider who reviewed the denial.
Right to Amend
If you feel that your PHI in our custody is incorrect or incomplete, you may ask us to correct or amend the PHI. You have the right to request a change for as long as we keep your PHI. To ask for a change, you must write to our Custodian of Medical Records with a reason that supports your request at the following address: Patrick Martin, MA, LMFT, PO BOX 487, BONSALL, CA 92003. We will not change your PHI unless you write us, or do not include a reason to support your request. In addition, we may deny your request if you ask us to change information that: was not created by us; is not part of the information kept by or for us; is not part of the information which you are permitted by law to inspect and copy; or is accurate and complete. If we deny your request to change your PHI, you have the right to submit a written correction about any item or statement in your medical record you believe is incomplete or incorrect. The correction cannot exceed 250 words for each item you feel is incorrect or incomplete.
Right to an Accounting of Disclosures
You have the right to request a list that shows how we use or share your PHI other than disclosures made: 1) to you or authorized by you; 2) for national security or intelligence purposes; 3) to correctional institutions or law enforcement; 4) as part of a limited data set as permitted by law; or 5) for treatment, payment and healthcare operations (as described above). To request this list, you must write to our Custodian of Medical Records at the following address: Patrick Martin, MA, LMFT, PO BOX 487, BONSALL, CA 92003. Your request must state a time period, which cannot be more than six years, and cannot include dates before April 14, 2003. Your request should describe the type of list you would like (for example, on paper or electronically). The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Right to Request Restrictions
You have the right to ask that we limit how we use or share your PHI for treatment, payment or healthcare operations. You also have the right to ask us to limit what we share about you to someone who is involved in your care or in the payment for your care, such as a family member or friend. For example, you can tell us not to use or share information about a surgery that you had done at SCVMC, or about a treatment you received at one of our other facilities. We are not required to agree to your request. If we do agree, we will comply with your request, unless the information is needed to provide emergency treatment to you. To request restrictions, you must write to our Custodian of Medical Records at the following address:
Patrick Martin, MA, LMFT
PO BOX 487, BONSALL, CA 92003
In your request, you must tell us: (1) what information you do not want us to use or share; (2) whether you want to limit our use, sharing of your PHI or both; and (3) to whom you want the limits to apply, for example, sharing with your spouse or a family member.
Right to Request Confidential Communications
You have the right to ask that we communicate with you about your PHI in a certain way or at a certain location. For example, you can ask that we contact you only at work or by U.S. mail. To request confidential communications, you must write to:
Patrick Martin, MA, LMFT
PO BOX 487, BONSALL, CA 92003
We will not ask you the reason for your request, and we will try to accommodate all reasonable requests. You must tell us how or where you want to be contacted.
Right to a Paper Copy of This Notice
You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time in person, or by writing to:
Patrick Martin, MA, LMFT
PO BOX 487, BONSALL, CA 92003