Policies
Last updated: May 7, 2025 9:56 AM
Good Faith Estimate
You have the right to receive a “Good Faith Estimate” explaining how much your medical and mental health care will cost.
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the expected charges for medical services, including psychotherapy services.
You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency healthcare services, including psychotherapy services.
You can ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule a service.
If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.
HIPAA Notice of Privacy Practices
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 OBLIGATIONS
We are required by law to:
Maintain the privacy of protected health information (PHI)
Give you this notice of our legal duties and privacy practices regarding your health information
Follow the terms of our notice that is currently in effect
Notify you if a breach of your unsecured PHI occurs
HOW WE MAY USE AND DISCLOSE YOUR PHI
The following categories describe ways that Earl Andrew B. De Guzman MD, APC. (hereinafter referred to as “The Practice,” “we,” “us,” and “our”) may use and disclose your protected health information without your written authorization.
For Treatment
We may use your health information to provide you with psychiatric treatment or services. We may disclose your health information to others who are involved in your care, such as physicians, therapists, or pharmacists, but only with your written consent except in emergencies.
For Payment
We may use and disclose your health information so that he can bill and receive payment for treatment and services provided to you. For example, we may provide information to create superbills for you to submit to your insurance for reimbursement.
For Health Care Operations
We may use and disclose your health information for healthcare operations purposes. These uses and disclosures help run the practice and ensure quality care. For example, we may use your information for internal quality assessment or to review the qualifications and performance of healthcare providers in the practice.
Appointment Reminders, Treatment Alternatives, and Health-Related Benefits
We may use your information to contact you with appointment reminders or to tell you about treatment alternatives or health-related benefits and services that may be of interest to you, based on your explicit consent in the Communication Consent Form.
SPECIAL SITUATIONS THAT DO NOT REQUIRE YOUR AUTHORIZATION
As Required by Law
We will disclose 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 disclose your PHI when necessary to prevent or lessen a serious threat to your health and safety or the health and safety of another person or the public. Any disclosure, however, will be limited to someone able to help prevent the threat.
Public Health Activities
We may disclose your PHI for public health activities, such as reporting diseases, injuries, births, and deaths; reporting child abuse or neglect; reporting reactions to medications or problems with products; notifying people of recalls of products they may be using; and notifying a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
Victims of Abuse, Neglect, or Domestic Violence
We may notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.
Health Oversight Activities
We may disclose your PHI to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, and licensure.
Lawsuits and Disputes
If you are involved in a lawsuit or dispute, we may disclose your PHI in response to a court or administrative order. We may also disclose your PHI in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
Law Enforcement
We may release PHI if asked by a law enforcement official in response to a court order, subpoena, warrant, summons, or similar process; to identify or locate a suspect, fugitive, material witness, or missing person; about the victim of a crime; about a death resulting from criminal conduct; about criminal conduct on the premises; 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 release PHI to a coroner, medical examiner, or funeral director to identify a deceased person or determine the cause of death.
National Security and Intelligence Activities
We may release your PHI to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Protective Services for the President and Others
We may disclose your PHI to authorized federal officials so they may provide protection to the President, other authorized persons, or foreign heads of state, or conduct special investigations.
Workers' Compensation
We may release your PHI for workers’ compensation or similar programs that provide benefits for work-related injuries or illnesses.
USES AND DISCLOSURES THAT REQUIRE YOUR AUTHORIZATION
Other uses and disclosures of your PHI not covered by this Notice will be made only with your written authorization. This includes most uses and disclosures of psychotherapy notes, uses and disclosures for marketing purposes, and disclosures that constitute a sale of PHI. If you provide us with an authorization, you may revoke it at any time by submitting a written revocation, and we will no longer disclose your PHI under the authorization. However, disclosures made in reliance on your authorization before you revoked it will not be affected by the revocation.
YOUR RIGHTS REGARDING YOUR PHI
Right to Inspect and Copy
You have the right to inspect and obtain a copy of your PHI that may be used to make decisions about your care. This includes medical and billing records but excludes psychotherapy notes. To inspect and copy your PHI, you must submit your request in writing to Earl Andrew B. De Guzman MD, APC. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other supplies associated with your request as outlined in the Practice Policies and Agreement.
Right to Amend
If you believe that your PHI is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the practice. To request an amendment, your request must be made in writing and submitted to Earl Andrew B. De Guzman MD, APC. You must provide a reason that supports your request. We may deny your request if you ask to amend information that was not created by us, is not part of the medical information kept by the practice, is not part of the information which you would be permitted to inspect and copy, or is accurate and complete.
Right to an Accounting of Disclosures
You have the right to request an “accounting of disclosures.” This is a list of the disclosures we made of your PHI. To request this list, you must submit your request in writing to Earl Andrew B. De Guzman MD, APC. Your request must state a time period, which may not be longer than six years prior to the date of your request. 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.
Right to Request Restrictions
You have the right to request a restriction or limitation on the use or disclosure of your PHI for treatment, payment, or health care operations. You also have the right to request a limit on the medical information we disclose to someone involved in your care or the payment for your care, like a family member or friend. We are not required to agree to your request unless you are asking us to restrict the use and disclosure of your PHI to a health plan for payment or health care operations purposes and such information you wish to restrict pertains solely to a health care item or service for which you have paid “out-of-pocket” in full. If we agree, we will comply with your request unless the information is needed to provide you with emergency treatment.
Right to Request Confidential Communications
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you by mail or at work. To request confidential communications, you must make your request in writing to Earl Andrew B. De Guzman MD, APC. Your request must specify how or where you wish to be contacted. We will accommodate reasonable requests.
Right to a Paper Copy of This Notice
You have the right to a paper copy of this notice, even if you have agreed to receive this notice electronically. You may ask us to give you a copy of this notice at any time.
CHANGES TO THIS NOTICE
We reserve the right to change this notice and make the new notice apply to PHI we already have as well as any information we receive in the future. A copy of the current notice will be sent electronically to patients and will be posted on the practice website. The notice will contain the effective date on the first page.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with Earl Andrew B. De Guzman MD, APC., at (626) 239-8610 or info@earldeguzmanmd.com, or with the Secretary of the Department of Health and Human Services at (877) 696-6775 or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. To file a complaint with The Practice contact us directly at 595 East Colorado Boulevard, Suite 205, Pasadena, CA 91101. All complaints must be made in writing. You will not be penalized for filing a complaint.
If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to:
Department of Health and Human Services
Office of Civil Rights
Hubert H. Humphrey Bldg.
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201
Medical Board of California Notice to Patients
Medical doctors are licensed and regulated by the Medical Board of California. To check up on a license or to file a complaint go to www.mbc.ca.gov, email: licensecheck@mbc.ca.gov, or call (800) 633-2322.
Centers for Medicare & Medicaid Services Notice to Patients - Open Payments Database
For informational purposes only, a link to the federal Centers for Medicare and Medicaid Services (CMS) Open Payments web page is provided here. The federal Physician Payments Sunshine Act requires that detailed information about payment and other payments of value worth over ten dollars ($10) from manufacturers of drugs, medical devices, and biologics to physicians and teaching hospital be made available to the public. You may search this federal database for payments made to physicians and teaching hospitals by visiting this website: https://openpaymentsdata.cms.gov/.