Notice of Privacy Practices

This notice describes how medical and mental health information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.

Healing Collective Therapy is the solo practice of Tina Marie Del Rosario, LCSW. In this notice, “I” and “me” refer to Tina Marie Del Rosario and the practice. I’m required by law to protect the privacy of your health information and to give you this notice.

Your rights

When it comes to your health information, you have certain rights.

Get a copy of your health and claims records

You can ask to see or get a copy of your records. I’ll provide a copy or a summary, usually within 30 days of your request, and may charge a reasonable, cost-based fee. In limited circumstances allowed by law, a request may be denied, and you’ll be told why in writing.

Ask me to correct your records

You can ask me to correct information you think is incorrect or incomplete. I may say no, but I’ll tell you why in writing within 60 days.

Request confidential communications

You can ask me to contact you in a specific way (for example, a cell phone instead of a home phone) or at a different address. I’ll say yes to all reasonable requests.

Ask me to limit what I use or share

You can ask me not to use or share certain information for treatment, payment or operations. I’m not required to agree if it would affect your care. If you pay for a service in full out of pocket, you can ask me not to share that information with your health insurer, and I’ll agree unless a law requires me to share it.

Get a list of those I’ve shared information with

You can ask for a list (an accounting) of the times I’ve shared your health information for six years before the date you ask, who I shared it with, and why. It will include all disclosures except those about treatment, payment and operations, and certain others, such as any you asked me to make. One accounting a year is free; I may charge a reasonable, cost-based fee for additional requests 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’ve agreed to receive it electronically.

Choose someone to act for you

If you’ve given someone medical power of attorney, or someone is your legal guardian, that person can exercise your rights and make choices about your health information. I’ll make sure the person has this authority before taking any action.

File a complaint if you feel your rights are violated

You can complain to me using the contact information at the end of this notice. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. I won’t retaliate against you for filing a complaint.

Your choices

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

You have both the right and the choice to tell me whether to share information with your family, close friends or others involved in your care, and whether to share information in a disaster relief situation. If you aren’t able to tell me your preference, for example if you’re unconscious, I may share your information if I believe it’s in your best interest. I may also share information when needed to lessen a serious and imminent threat to health or safety.

I will never share your information for marketing purposes or sell your information unless you give me written permission.

Psychotherapy notes

Psychotherapy notes, if kept, are my personal notes about the content of our sessions, kept separate from the rest of your record. They receive extra protection under federal law and generally can’t be shared without your written authorization, except in limited circumstances the law allows.

Couples, family and group sessions

When more than one person attends sessions together, the record of joint work is shared. I don’t keep individual secrets from the joint work. Each person’s right to access records is subject to the law and to protecting the privacy of the other participants. I’ll explain how this works before we begin.

How I typically use or share your health information

To treat you

I can use your health information and share it with other professionals who are treating you, with your consent where California law requires it.

To run my practice

I can use and share your health information to run my practice, improve your care, and contact you when necessary, for example for scheduling.

To bill for your services

I don’t bill insurance directly. If you ask for a superbill to submit to your insurer, it will include the information needed for reimbursement, such as dates of service and diagnosis and service codes.

How else I can use or share your health information

I’m allowed or required to share your information in other ways, usually in ways that contribute to the public good. I have to meet many conditions in the law before I can share your information for these purposes.

• Preventing harm: I’m required by California law to report suspected child abuse or neglect, and suspected elder or dependent adult abuse. If you communicate a serious threat of physical violence against a reasonably identifiable person, I may be required to warn that person and notify law enforcement.
• Health and safety: I can share information to prevent or lessen a serious and imminent threat to anyone’s health or safety.
• Complying with the law: I’ll share information if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that I’m complying with federal privacy law.
• Health oversight and licensing: I can share information with health oversight agencies, such as my licensing board, for activities authorized by law.
• Lawsuits and legal actions: I can share information in response to a court or administrative order, or in response to a subpoena, as the law allows.
• Government requests and workers’ compensation: I can share information for workers’ compensation claims, for law enforcement purposes or with a law enforcement official as the law allows, and for special government functions such as military or national security when required.
• Coroners and medical examiners: I can share information with a coroner or medical examiner when an individual dies.

California law, including the Confidentiality of Medical Information Act, may give you more protection than federal law. Where it does, I follow the stricter rule.

My responsibilities

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

Changes to this notice

I can change the terms of this notice, and the changes will apply to all information I have about you. The new notice will be available on request, in my office, and on this website.

Contact

Privacy Officer: Tina Marie Del Rosario, LCSW
Healing Collective Therapy
5317 N Figueroa St, Los Angeles, CA 90042
(323) 607-7329

Effective date: October 23, 2026