Insightful Connections Marriage and Family Therapy, P.C.
Kayleen Ramirez-Garcia, LMFT #141883
Effective Date: August 8, 2026
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Our Commitment to Your Privacy
Insightful Connections Marriage and Family Therapy, P.C. ("the Practice," "we," "our") is required by law to protect the privacy of your protected health information (PHI), to give you this Notice explaining our legal duties and privacy practices, and to follow the terms of the Notice currently in effect.
PHI is information about you — including demographic information — that may identify you and that relates to your past, present, or future mental or physical health, the care you receive, or payment for that care.
We are also required to notify you if a breach of your unsecured PHI occurs.
How We May Use and Disclose Your Information Without Your Written Authorization
Treatment. We may use your information to provide, coordinate, or manage your care. For example, with your consent we may consult with your physician, psychiatrist, or a prior treating provider about your treatment.
Payment. We may use and disclose your information to obtain payment for services. For example, we may submit claims, verify benefits, or provide a diagnosis and dates of service to your health plan.
Health Care Operations. We may use your information for activities necessary to operate the Practice, such as quality review, clinical consultation, licensure and accreditation, and business management. When we consult with other professionals about your care, we make reasonable efforts to limit what is shared.
Business Associates. We contract with outside vendors — for example, our electronic health record and telehealth platform, and our billing services — who may encounter your information in the course of their work. Each is bound by a written agreement requiring them to protect your information to the same standard we do.
Appointment Reminders and Related Contacts. We may contact you to remind you of appointments, discuss scheduling, or share information about treatment alternatives. You may request that we contact you only in a particular way or at a particular location.
Uses and Disclosures Required or Permitted by Law
We may use or disclose your information without your authorization in the following circumstances:
- When required by law, including by court order or valid subpoena.
- Suspected abuse or neglect. As a licensed therapist, Kayleen Ramirez-Garcia is a mandated reporter under California law and must report reasonable suspicion of child abuse or neglect, and abuse or neglect of an elder or dependent adult, to the appropriate authorities.
- Serious and imminent threat to health or safety. If you communicate a serious threat of physical violence against a reasonably identifiable victim, California law requires us to take protective action, which may include notifying the potential victim and law enforcement.
- Risk of serious self-harm. If we believe you are at imminent risk of harming yourself, we may disclose information necessary to protect your safety.
- Public health and health oversight activities, including disclosures to agencies authorized to license, audit, or investigate health care providers.
- Judicial and administrative proceedings, law enforcement purposes, coroners and medical examiners, workers' compensation, and specialized government functions, each to the extent permitted by law.
- Research, only when an authorized review board has approved the study and appropriate privacy protections are in place.
Uses and Disclosures That Require Your Written Authorization
Your written authorization is required for:
- Psychotherapy notes. These are notes documenting or analyzing the contents of a session, kept separate from the rest of your record. Most uses and disclosures of psychotherapy notes require your specific authorization.
- Marketing communications.
- Any sale of your protected health information.
- Most other uses and disclosures not described in this Notice.
You may revoke an authorization in writing at any time. Revocation does not apply to disclosures we have already made in reliance on it.
We do not sell your protected health information, and we do not use it for marketing or fundraising.
Special Protections for Substance Use Disorder Records
If we receive records protected under 42 CFR Part 2 — the federal regulations governing the confidentiality of substance use disorder (SUD) treatment records — those records carry protections that are more restrictive than HIPAA. Certain uses and disclosures that HIPAA would otherwise permit are materially limited when the information is Part 2 information.
In particular:
- Part 2 information may not be used or disclosed in any civil, criminal, administrative, or legislative proceeding against you except with your written consent that specifically permits such use, or pursuant to a court order meeting Part 2 requirements.
- Part 2 information may not be used to investigate or prosecute you without appropriate authorization.
- You have the right to revoke consent for the disclosure of Part 2 information, and to obtain an accounting of certain disclosures made with your consent.
Notice of Potential Redisclosure
Once your information has been disclosed to someone who is not a health care provider, health plan, or health care clearinghouse — for example, an employer, a school, or a court — that recipient may not be bound by the HIPAA Privacy Rule, and your information may be redisclosed and no longer protected by federal privacy law.
Your Rights Regarding Your Health Information
Right to inspect and copy. You may request access to and a copy of your record, including an electronic copy where we maintain it electronically. We may charge a reasonable, cost-based fee. In limited circumstances, we may deny access; where required, you may request review of that denial. Under California law, a therapist may, in certain circumstances, provide a summary rather than the full record where release would be detrimental to your wellbeing.
Right to request an amendment. If you believe information in your record is incorrect or incomplete, you may request in writing that we amend it. We may deny the request, and if we do we will explain why in writing and you may submit a statement of disagreement to be kept with your record.
Right to an accounting of disclosures. You may request a list of certain disclosures we have made of your information, other than those made for treatment, payment, or health care operations, or those you authorized.
Right to request restrictions. You may ask us to limit how we use or disclose your information. We are not required to agree, with one exception: if you pay for a service in full, out of pocket, you may require that we not disclose information about that service to your health plan, and we must honor that request.
Right to confidential communications. You may ask us to contact you at a specific phone number, address, or email, or to communicate only in a particular way. We will accommodate reasonable requests.
Right to a paper or electronic copy of this Notice. You may request a copy at any time, even if you have agreed to receive it electronically.
Right to be notified of a breach of your unsecured protected health information.
Right to revoke authorization in writing at any time, as described above.
To exercise any of these rights, contact us using the information below. Most requests must be submitted in writing.
Telehealth
We provide services by secure video. While we use a HIPAA-compliant platform and take reasonable safeguards, no electronic transmission can be guaranteed to be completely secure. Additional detail about the risks, benefits, and limitations of telehealth is provided in our Telehealth Consent form. California law requires us to verify and document your physical location at the start of each telehealth session.
Our Legal Duties
We are required by law to maintain the privacy of your PHI, to provide you with this Notice, and to abide by the terms of the Notice currently in effect. We reserve the right to change this Notice and to make the revised Notice effective for all information we maintain. If we make a material change, we will post the updated Notice on this website and make copies available at our office and on request.
In addition to HIPAA, your information is protected under the California Confidentiality of Medical Information Act (Civil Code § 56 et seq.) and the psychotherapist–patient privilege. Where California law provides greater protection than federal law, California law applies.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with us using the contact information below. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights:
Office for Civil Rights, U.S. Department of Health and Human Services
200 Independence Avenue SW, Washington, D.C. 20201
1-800-368-1019 · TDD 1-800-537-7697 · https://www.hhs.gov/ocr/privacy/hipaa/complaints
Concerns about the professional conduct of a licensed therapist may also be directed to the California Board of Behavioral Sciences, 1625 North Market Blvd., Suite S-200, Sacramento, CA 95834 · (916) 574-7830 · https://www.bbs.ca.gov
You will not be retaliated against, and your care will not be affected, for filing a complaint.
Contact — Privacy Officer
Kayleen Ramirez-Garcia, LMFT #141883
Insightful Connections Marriage and Family Therapy, P.C.
2108 N St #8909, Sacramento, CA 95816
In-person office: 1833 West March Lane, Suite 6, Stockton, CA 95207
kayleen@icmft.com · 209-486-1742