HIPAA NOTICE OF PRIVACY PRACTICES

Kendra Knudsen, PhD
Licensed Clinical Psychologist (PSY36124)
720 Wilshire Blvd #204
Santa Monica, CA 90401
(424) 425-1239
drkendraknudsen@gmail.com

THIS NOTICE DESCRIBES HOW MEDICAL AND MENTAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

I. COMMITMENT TO YOUR PRIVACY

For therapy to be effective, it is important that you feel safe speaking openly about personal matters. Protecting the privacy of your information is a central part of my work.

I am required by law to maintain the privacy of your Protected Health Information (“PHI”) and to provide you with this Notice of my legal duties and privacy practices. I am also required to abide by the terms of this Notice currently in effect.

PHI includes information that identifies you and relates to your past, present, or future physical or mental health, the care you receive, or payment for that care.

I reserve the right to revise this Notice at any time. Any changes will apply to all PHI I maintain, including information created before the change. You may request a copy of this Notice at any time, and the most current version will be available upon request, in my office, and on my website.

II. HOW YOUR INFORMATION MAY BE USED AND DISCLOSED

A. Treatment, Payment, and Health Care Operations

I may use and disclose your PHI without your written authorization for:

Treatment: Providing, coordinating, or managing your care, including consultation with other professionals.

Payment: Obtaining payment for services.

Health Care Operations: Practice management, consultation, supervision, licensing, and quality improvement.

For treatment purposes, providers may need access to your full record. For all other uses, disclosures, and requests, I will make reasonable efforts to limit PHI to the minimum necessary to accomplish the intended purpose.

B. Uses and Disclosures Without Authorization

I may use or disclose your PHI without your authorization in the following circumstances:

  • When required by federal or California law, including reporting to government agencies, law enforcement, or in judicial, administrative, or licensing proceedings

  • For judicial and administrative proceedings, including disclosures in response to court orders, subpoenas, discovery requests, arbitration proceedings, or other lawful processes. Where required by law, I will follow applicable procedures before disclosing information in response to a subpoena, including obtaining authorization, a court order, or providing notice when appropriate

  • When disclosure is compelled by a court, administrative agency, arbitrator, or other tribunal acting within its lawful authority, including by subpoena or similar legal mandate

  • For law enforcement purposes, including when required by a search warrant or to report crimes occurring on the premises

  • To prevent or reduce a serious and imminent threat to health or safety, including when you communicate a specific threat of harm toward yourself or an identifiable person, or when I determine that disclosure is necessary to prevent such harm

  • When required for mandated reporting, including:

    • suspected child abuse or neglect

    • suspected elder or dependent adult abuse

  • If you are in a mental or emotional condition that poses a danger to yourself or others, and disclosure is necessary to prevent harm

  • For public health activities, such as reporting to appropriate authorities or providing information to a coroner or medical examiner in the event of death

  • For health oversight activities, including audits, investigations, inspections, or licensure actions by authorized agencies

  • For research purposes, when permitted under applicable law and subject to required safeguards

  • For specialized government functions, including military, national security, or correctional institution activities

  • For workers’ compensation purposes, to comply with laws relating to work-related injuries or illness

  • For appointment reminders and health-related communications, including information about treatment alternatives or services

  • Emergency Situations:
    If you require emergency treatment and I am unable to obtain your consent (for example, if you are unconscious or otherwise unable to communicate), I may use or disclose your PHI if I determine that you would have consented to such use or disclosure if you were able. I will attempt to obtain your consent as soon as reasonably possible after the emergency has passed

  • When otherwise specifically required or permitted by law

C. Privileged Communications

Your communications with me are generally protected by psychotherapist–patient privilege under California law. This means that, in most situations, I cannot disclose your treatment information in legal proceedings without your authorization.

However, there are important exceptions. In certain circumstances, I may be required or permitted to disclose information without your consent, including:

  • when ordered by a court

  • when required by law

  • when privilege does not apply (such as certain evaluations or legal proceedings)

  • or when necessary to prevent serious harm

When appropriate and feasible, I may assert privilege on your behalf or notify you of a request for your information before disclosure.

D. Uses and Disclosures Requiring Authorization

I will obtain your written authorization before using or disclosing PHI for any purpose not described in this Notice.

You may revoke your authorization in writing at any time, except where action has already been taken in reliance on it.

E. Special Protections for Certain Information

Psychotherapy Notes:
Maintained separately and protected under HIPAA. Disclosure generally requires authorization except in limited circumstances permitted by law, such as for my own use in treatment, for supervision or training, to defend against legal claims, or as required for compliance investigations.

HIV/AIDS Information:
Protected under California law. Specific authorization may be required prior to disclosure.

Substance Use Treatment Information:
May be protected under federal law (42 CFR Part 2) and California law. Specific authorization may be required prior to disclosure.

F. Disclosures with Opportunity to Object

I may share relevant information with family members or others involved in your care or payment unless you object or request a limitation. Emergency disclosures may occur with retroactive consent.

III. YOUR RIGHTS

1. Right to Access and Copies

You have the right to inspect and obtain a copy of your PHI, except for psychotherapy notes and certain legally protected information.

  • Requests must be made in writing

  • I will respond within 30 days

If I deny your request, I will provide a written explanation of the reason for denial and inform you of your right to have the decision reviewed, if applicable.

If access is granted:

  • A reasonable, cost-based fee may apply

  • I may offer a summary if you agree in advance

2. Right to Request Amendment

You may request that I amend your PHI if you believe it is incorrect or incomplete.

  • Requests must be made in writing with a reason

  • I will respond within 60 days

If I deny your request, I will:

  • Provide a written explanation

  • Inform you of your right to submit a written statement of disagreement

  • Allow you to request that your disagreement be included with future disclosures

3. Right to Request Restrictions

You may request restrictions on certain uses or disclosures. I am not required to agree except in the case below:

Out-of-Pocket Payment Restriction:
If you pay in full out-of-pocket, you have the right to request that I not disclose related PHI to your health plan. I am required to honor this request.

4. Right to Confidential Communications

You may request communication by alternative means or at alternative locations. I will accommodate reasonable requests.

5. Right to an Accounting of Disclosures

You have the right to request a list of certain disclosures of your PHI.

  • Applies to disclosures outside of treatment, payment, and operations

  • Covers disclosures made within the past six (6) years

  • I will respond within 60 days

The accounting will include:

  • The date of disclosure

  • The name (and address, if known) of the recipient

  • A brief description of the information disclosed

  • The purpose of the disclosure

The first request in a 12-month period is free; reasonable fees may apply for additional requests.

6. Right to a Copy of This Notice

You may request a paper or electronic copy at any time.

IV. COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with:

California Department of Health Care Services
P.O. Box 997413, MS 0010
Sacramento, CA 95899-7413
(916) 445-4646

U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
1-877-696-6775

I will not retaliate against you for filing a complaint.

V. CONTACT FOR QUESTIONS OR COMPLAINTS

If you have any questions about this Notice, concerns about your privacy, or would like more information about how to file a complaint, you may contact:

Kendra Knudsen, PhD
720 Wilshire Blvd #204
Santa Monica, CA 90401
(424) 425-1239
drkendraknudsen@gmail.com


Notice Effective Date: 4/22/2026