NOTICE OF PRIVACY PRACTICES
Effective Date: 02/26/2026
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.
Dr. David Henry, DO (“we,” “our,” or “us”) is required by law to maintain the privacy of your Protected Health Information (“PHI”) and to provide you with this Notice of our legal duties and privacy practices.
Protected Health Information includes information that identifies you and relates to your past, present, or future physical or mental health condition and related healthcare services.
How We May Use and Disclose Your Health Information
1. For Treatment
We may use and disclose your PHI to provide, coordinate, or manage your healthcare and related services.
Example: Sharing information with another physician involved in your care.
2. For Payment
We may use and disclose PHI to obtain payment for services provided.
Example: Submitting information to your insurance company.
3. For Healthcare Operations
We may use and disclose PHI for practice operations such as:
• Quality assessment
• Staff training
• Licensing
• Accreditation
• Business management
Other Permitted or Required Uses and Disclosures
We may disclose your PHI:
• When required by law
• For public health reporting
• For health oversight activities
• For judicial or administrative proceedings
• To prevent serious threats to health or safety
• For workers’ compensation claims
Uses and Disclosures Requiring Your Authorization
We will obtain your written authorization for:
• Use of photographs for marketing purposes
• Disclosure of psychotherapy notes (if applicable)
• Any other use not described in this Notice
You may revoke your authorization at any time in writing.
Your Rights Regarding Your Health Information
You have the right to:
1. Inspect and Obtain a Copy
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You may request access to your medical records.
2. Request an Amendment
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You may request corrections to your medical record if you believe information is inaccurate.
3. Request Restrictions
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You may request limitations on certain uses or disclosures.
4. Request Confidential Communications
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You may request that we contact you in a specific way (e.g., at work instead of home).
5. Receive an Accounting of Disclosures
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You may request a list of certain disclosures we have made.
6. Receive a Paper Copy of This Notice
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You may request a paper copy at any time.
Our Responsibilities
We are required by law to:
• Maintain the privacy of your PHI
• Provide you with this Notice
• Abide by the terms of this Notice
• Notify you in the event of a breach of unsecured PHI
Complaints
If you believe your privacy rights have been violated, you may file a complaint with:
Dr. David Henry, DO
(951) 703-2599
You may also file a complaint with:
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
You will not be retaliated against for filing a complaint.
Changes to This Notice
We reserve the right to change this Notice at any time. Any revised Notice will be posted in our office and on our website.