Tiffany D. Irving, LMFT
California LMFT #111106 · Nevada MFT #4011-R
Effective date: October 13, 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.
My duties
I am required by law to keep your protected health information (PHI) private, to give you this Notice of my legal duties and privacy practices, to follow the Notice currently in effect, and to notify you if a breach of your unsecured PHI occurs. When California or Nevada law gives you more privacy protection than federal law, I follow the stricter law.
How I may use and share your information without your written permission
- Treatment: to provide and coordinate your care, for example consulting with another health care provider involved in your care.
- Payment: to bill and receive payment, for example sending information to your insurance plan or to a billing platform such as Headway.
- Health care operations: to run my practice, for example quality review, record-keeping, or working with service providers (“business associates”) who sign agreements to protect your information.
I may also use or share information without your permission when the law allows or requires it, including:
- To prevent a serious threat to health or safety: if I believe disclosure is necessary to prevent serious harm to you or someone else, including a duty to warn when someone communicates a serious threat of violence against a reasonably identifiable victim.
- To report suspected abuse or neglect of a child, elder, or dependent adult, as required by law.
- When required by law, including in response to a court order, a valid subpoena that meets legal requirements, or a request from a health oversight agency such as a licensing board.
- For public health activities, law enforcement purposes allowed by law, coroners and medical examiners, workers’ compensation, and specialized government functions, as permitted by law.
Uses that require your written authorization
- Psychotherapy notes, if I keep them separately from your record
- Marketing, and any sale of your health information (I do not sell health information)
- Any other use or disclosure not described in this Notice
You may revoke an authorization in writing at any time, except to the extent I have already acted on it.
Your rights
- See and get a copy of your records, paper or electronic. I may charge a reasonable, cost-based fee.
- Ask me to correct your records if you believe they are incorrect or incomplete.
- Ask for confidential communications, for example to be contacted at a different phone number or address.
- Ask me to limit what I use or share. I’m not required to agree in most cases, but if you pay in full out of pocket for a service, you can ask me not to share that information with your health plan, and I will agree unless the law requires sharing.
- Get a list of certain disclosures I’ve made in the past six years.
- Get a paper copy of this Notice at any time, even if you received it electronically.
- Choose someone to act for you, such as a legal guardian or someone with medical power of attorney.
Telehealth
I provide therapy by secure video. Please join sessions from a private location. At the start of each session I will confirm your name and the address where you are located.
Questions and complaints
If you believe your privacy rights have been violated, you may contact me (details below) or file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, at www.hhs.gov/ocr/privacy/hipaa/complaints/ or 1-800-368-1019. You may also contact the California Board of Behavioral Sciences or the Nevada Board of Examiners for Marriage and Family Therapists and Clinical Professional Counselors. I will not retaliate against you for filing a complaint.
Changes to this Notice
I may change this Notice, and the changes will apply to all information I have about you. The current Notice will be posted on my website and available on request.
Contact (Privacy Officer)
Tiffany D. Irving, LMFT
info@diversehorizonslifesolutions.com · (650) 690-2608