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.

 

Effective Date: October 1, 2026

 

ABOUT THIS NOTICE

At Mensana Collaborative ("Practice"), we understand that information about your health and health care is personal, and we are committed to protecting it. We create and maintain records of the health care services you receive through the Practice. These records may contain Protected Health Information ("PHI"). We use these records to provide, coordinate, and manage your care and to comply with applicable legal requirements. This Notice of Privacy Practices ("Notice") describes how Mensana Collaborative may use and disclose your PHI, your rights regarding your PHI, and our legal obligations to protect it.

 

WHO WILL FOLLOW THIS NOTICE

This Notice applies to Mensana Collaborative and its workforce, including its physicians, psychotherapists, other health care professionals, clinical and administrative staff, and other workforce members who are authorized to use or access PHI in connection with their duties for the Practice. It also applies to future clinicians, staff, and other workforce members of Mensana Collaborative.

 

Members of our workforce will follow the privacy practices described in this Notice. Members of our clinical team may use and share PHI with one another as permitted by law for treatment, payment, health care operations, and other purposes described in this Notice.

A current version of this Notice of Privacy Practices is available at our facilities and on our website. Printed copies of this Notice are available upon request.

 

REGULATORY REQUIREMENTS

Mensana Collaborative is required by law to maintain the privacy and security of your PHI, provide you with notice of our legal duties and privacy practices concerning PHI, notify you following a breach of unsecured PHI when required by law, and follow the duties and privacy practices described in the Notice currently in effect.

 

APPLICABLE PRIVACY LAWS

Mensana Collaborative complies with HIPAA and other applicable federal and California privacy laws, including the California Confidentiality of Medical Information Act ("CMIA"). Certain records, including some records relating to substance use disorder treatment, may be subject to additional confidentiality protections under federal or California law. When another law provides greater privacy protection or imposes additional restrictions on the use or disclosure of your health information, Mensana Collaborative will follow that law to the extent required.

 

Substance Use Disorder Records

Certain records relating to substance use disorder ("SUD") diagnosis, treatment, or referral for treatment may receive additional confidentiality protections under federal law, including 42 CFR Part 2 ("Part 2"). When Mensana Collaborative creates, receives, or maintains records protected by Part 2, we will use and disclose those records only as permitted by applicable law.

 

Part 2 records may be subject to additional restrictions beyond those that ordinarily apply to Protected Health Information under HIPAA. When required by law, Mensana Collaborative will obtain your written consent before using or disclosing Part 2 records. Part 2 records generally may not be used or disclosed in civil, criminal, administrative, or legislative proceedings against you unless you provide specific written consent or a court order meeting applicable legal requirements authorizes the use or disclosure. When permitted by Part 2, certain recipients of Part 2 records may redisclose those records in accordance with HIPAA; however, the records remain subject to applicable Part 2 restrictions on their use in legal proceedings against the patient.

 

Fundraising

Mensana Collaborative does not currently use PHI or Part 2 records for fundraising communications. If our practices change, we will comply with applicable notice and opt-out requirements before using such information for fundraising.

 

RIGHTS

You have the following rights regarding your PHI:

 

Restrictions
You may request that Mensana Collaborative restrict the use and disclosure of your PHI. To request a restriction, please submit your request in writing to our Director of Clinical Operations. You may contact us for assistance with submitting your request. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the restrictions to apply; for example, disclosures to your spouse. 

 

Mensana Collaborative is generally not required to agree to a requested restriction. However, if you pay for a health care service or item out of pocket in full and request that we not disclose information about that service or item to your health plan for payment or health care operations, we will honor your request unless disclosure is required by law.

Alternative Communications
You have the right to request that communications of PHI to you from Mensana Collaborative be made by particular means or at locations. For instance, you might request that communications be made at your work address, instead of your home address. Please submit your request in writing to the Director of Clinical Operations. Mensana Collaborative will accommodate your reasonable requests. 

Access Your Health Information

You have the right to inspect and obtain a copy of health information maintained by Mensana Collaborative that is subject to your right of access under applicable law. You may request an electronic or paper copy of your health information. We generally will provide access in the form and format you request if it is readily producible in that form and format.

 

We may charge a reasonable, cost-based fee as permitted by law. In certain limited circumstances, we may deny your request. If we deny access, we will explain the reason in writing and tell you whether you have a right to have the decision reviewed.

Ask Us to Correct Your Health Information

If you believe that your PHI maintained by Mensana Collaborative is incorrect or incomplete, you may ask us to correct your PHI. Your request must be made in writing to the Director of Clinical Operations, and it must explain why you are requesting an amendment to your PHI. We can deny your request if your request relates to PHI: (i) not created by Mensana Collaborative; (ii) not part of the records Mensana Collaborative maintains; (iii) not subject to being inspected by you; or (iv) that is accurate and complete. If your request is denied, we will provide you a written denial that explains the reason for the denial and your rights to: (i) file a statement disagreeing with the denial; (ii) if you do not file a statement of disagreement, submit a request that any future disclosures of the relevant PHI be made with a copy of your request and Mensana Collaborative’s denial attached; and (iii) complain about the denial.

 

Accounting of Disclosures

You have the right to request a list, or "accounting," of certain disclosures we have made of your PHI during the six years before the date of your request. The accounting will not include certain disclosures that are excluded from this requirement by law.

 

We will provide one accounting in any 12-month period without charge. We may charge a reasonable, cost-based fee for additional requests during the same period after notifying you of the cost and giving you an opportunity to withdraw or modify your request.

 

Choose Someone to Act for You

If you have given someone medical power of attorney or if someone is your legal guardian or otherwise authorized by law to act as your personal representative, that person may exercise your rights and make choices about your health information as permitted by law. We will verify the person's authority before taking action.

Right to Copy of Notice

You have the right to receive a paper copy of this notice upon request.  To obtain a paper copy of this notice, please contact the Director of Clinical Operations at the address and contact information stated at the end of this notice.

 

HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION

Mensana Collaborative may use and disclose your Protected Health Information ("PHI") without your written authorization for treatment, payment, health care operations, and other purposes permitted or required by law, as described in this Notice.

 

For Treatment

Mensana Collaborative may use and disclose your PHI to provide, coordinate, and manage your health care and related services. Members of the Mensana Collaborative clinical team may access and share PHI with one another as appropriate for treatment, clinical consultation, care coordination, coverage, and other activities related to your care.

 

For example, a psychiatrist and psychotherapist within Mensana Collaborative may review relevant information in your health record and communicate with one another regarding your symptoms, diagnoses, medications, treatment plan, clinical progress, safety, or other information relevant to your care. This may occur whether you receive ongoing treatment from one or more Mensana Collaborative clinicians.

 

Mensana Collaborative may also disclose your PHI to health care providers outside the Practice for treatment purposes as permitted by law. Except where authorization is specifically required by law, your written authorization is not required for uses or disclosures of PHI for treatment.

For Payment

Mensana Collaborative may use and disclose your PHI as necessary to bill and collect payment for health care services, process payments, prepare superbills or other documentation you request, and carry out other payment-related activities permitted by law.

For Health Care Operations

Mensana Collaborative may use and disclose PHI as necessary to operate the Practice and improve the quality of care we provide. These activities may include quality assessment and improvement, reviewing clinician and staff performance, training, compliance and risk management, credentialing, auditing, business planning and administration, legal and accounting services, and other activities permitted by law. When we use outside individuals or organizations to perform services involving PHI on our behalf, we require appropriate privacy protections as required by law.

As Required by Law and Law Enforcement

Mensana Collaborative may use or disclose PHI when required or permitted by applicable law, including in response to certain judicial or administrative proceedings or qualifying law enforcement requests. We will disclose information only when the applicable legal requirements for the disclosure have been satisfied. Certain categories of health information may receive additional protections under federal or California law.

For Public Health Activities and Public Health Risks

Mensana Collaborative may disclose PHI to government officials in charge of collecting information about births and deaths, preventing and controlling disease, or notifying a person who may have been exposed to a communicable disease or may be at risk of contracting or spreading a disease or condition.

For Health Oversight Activities

Mensana Collaborative may disclose PHI to the government for oversight activities authorized by law, such as audits, investigations, inspections, licensure or disciplinary actions, and other proceedings, actions or activities necessary for monitoring the health care system, government programs and compliance with civil rights laws.

Coroners, Medical Examiners and Funeral Directors

Mensana Collaborative may disclose PHI to coroners, medical examiners and funeral directors for the purpose of identifying a decedent, determining a cause of death or otherwise as necessary to enable these parties to carry out their duties consistent with applicable law.

 

Research

Under certain circumstances, Mensana Collaborative may use or disclose PHI for research when permitted by law and when applicable authorization, review, waiver, or other legal requirements have been satisfied.

 

To Avoid a Serious Threat to Health or Safety

Mensana Collaborative may use and disclose PHI to law enforcement personnel or other appropriate persons to prevent or lessen a serious threat to the health or safety of a person or the public.

 

Specialized Government Functions

Mensana Collaborative may use and disclose PHI of military personnel and veterans under certain circumstances. Mensana Collaborative may also disclose PHI to authorized federal officials for intelligence, counterintelligence, and other national security activities, and for the provision of protective services to the president or other authorized persons or foreign heads of state or to conduct special investigations.

 

Disclosures to You or for HIPAA Compliance Investigations

Mensana Collaborative may disclose your PHI to you or to your personal representative and is required to do so in certain circumstances described below in connection with your rights of access to your PHI and to an accounting of certain disclosures of your PHI. Mensana Collaborative must disclose your PHI to the Secretary of the United States Department of Health and Human Services (the "Secretary") when requested by the Secretary in order to investigate Mensana Collaborative’s compliance with privacy regulations issued under the federal Health Insurance Portability and Accountability Act of 1996.

 

Disclosures to Individuals Involved in Your Health Care or Payment for Your Health Care

Unless you object, Mensana Collaborative may disclose your PHI to a family member, other relative, friend, or other person you identify as involved in your health care or payment for your health care. We will limit the information shared to information relevant to that person's involvement in your care or payment for your care, as appropriate and permitted by law.

 

USES AND DISCLOSURES REQUIRING YOUR WRITTEN AUTHORIZATION

Other types of uses and disclosures of your PHI not described above will be made only with your written authorization, which with some limitations, you have the right to revoke your authorization in writing. If you revoke your authorization, Mensana Collaborative will no longer use or disclose PHI about you for the reasons covered in your written authorization. Please understand that Mensana Collaborative is unable to recover any disclosures already made with your authorization, and that Mensana Collaborative is required to retain records of the care provided to you.

 

Psychotherapy Notes

Most uses and disclosures of psychotherapy notes, as defined by federal law, require your written authorization. Psychotherapy notes are notes created by a mental health professional that document or analyze the contents of counseling sessions and are maintained separately from your medical record. Psychotherapy notes do not include ordinary clinical documentation maintained in your medical record, such as information regarding diagnosis, symptoms, functional status, treatment plans, progress, prognosis, medication prescribing and monitoring, session times, treatment modality or frequency, or clinical test results.

 

Except as otherwise permitted or required by law, Mensana Collaborative will obtain your written authorization before using or disclosing psychotherapy notes.

 

Marketing and Sale of PHI

Mensana Collaborative will obtain your written authorization before using or disclosing your PHI for marketing purposes when authorization is required by law. Mensana Collaborative does not sell your PHI. If we were ever to engage in a disclosure that constitutes a sale of PHI under HIPAA, we would obtain your written authorization as required by law.

 

BREACH NOTIFICATION

We will notify you as required by law if a breach occurs that may have compromised the privacy or security of your PHI.

 

RIGHT TO FILE A COMPLAINT

You may submit any complaint regarding your privacy rights to: 

Privacy Officer

Mensana Collaborative

3771 Rio Rd, Suite 111

Carmel, CA 93923

831.293.7300

contact@mensanacollab.com

 

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. Information about filing a complaint is available at the HHS Office for Civil Rights website or by calling 1-877-696-6775.

 

Mensana Collaborative will not retaliate against you for filing a complaint.

 

CHANGES TO THIS NOTICE

Mensana Collaborative reserves the right to change the terms of this Notice and our privacy practices. Changes may apply to PHI we already maintain as well as PHI we receive or create in the future. If we make a material change, we will revise this Notice. The current Notice will be available upon request, at our office, and on our website.

 

PLEASE CONTACT THE DIRECTOR OF CLINICAL OPERATIONS IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE OF PRIVACY PRACTICES OR YOUR PRIVACY RIGHTS.