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.

Effective date: 10/20/2026

This notice applies to Dane Rana, DO, A Professional Medical Corporation, doing business as Liwanag Psychiatry Medical Clinic ("the practice," "we"), 595 E. Colorado Blvd., Suite 318, Pasadena, CA 91101. It covers the health information the practice creates or receives about you, in person and by telehealth.

If you have questions about this notice, contact our Privacy Officer using the details at the end.

Our duties to you

We are required by law to maintain the privacy and security of your health information and to give you this notice of our legal duties and privacy practices. We must follow the terms of the notice currently in effect. We must notify you promptly if a breach occurs that may have compromised the privacy or security of your information.

We will not use or share your information other than as described here unless you tell us we can in writing. If you give us permission, you may change your mind at any time by telling us in writing.

How we use and share your information for treatment, payment, and operations

The law allows us to use and share your health information for these purposes without your written authorization. The examples below do not list every use.

Treatment. We use your information to evaluate and treat you, and we may share it with others involved in your care. For example, we send prescriptions to your pharmacy, order laboratory tests, or speak with a hospital if you need emergency care. Our practice is to ask your permission before contacting your therapist, primary care physician, or other clinicians, except in an emergency.

Payment. This is a private-pay practice. We do not submit claims to health insurance on your behalf. We use your information to bill you and process your payments. We prepare superbills, statements with diagnosis and service codes that you may submit to your insurer. If a medication we prescribe needs prior authorization, we may share the information your pharmacy benefit requires to approve it.

Health care operations. We use your information to run the practice and improve care. Examples include record keeping, quality review, legal and accounting services, and communication with our professional liability insurer.

Business associates. Some services are provided by companies on our behalf, such as our electronic health record, scheduling, telehealth, phone and secure messaging, and payment processing. Each must sign a business associate agreement requiring it to protect your information as we do.

Appointment reminders and text messages. We may contact you by phone, text, or email to remind you of appointments. If you agree to receive text messages, we may also send brief messages about your care, such as letting you know a prescription has been sent or that a secure message is waiting, and we keep clinical details in texts to a minimum. You may ask us to contact you only in certain ways (see "Your rights").

Other uses and disclosures we may make without your authorization

The law permits or requires us to share information in the situations below, usually under strict conditions. We share only what the situation requires.

• When required by law. We disclose information when federal or California law requires it.
• Abuse and neglect reporting. California law requires us to report suspected abuse or neglect of a child, an elder, or a dependent adult to the appropriate authorities.
• Serious threats to health or safety. If you communicate a serious threat of physical violence against a reasonably identifiable person, California law requires us to take reasonable steps to warn and protect that person, including notifying the person and law enforcement. We may also share information to prevent a serious and imminent threat to your safety or someone else's. If a mental health condition leaves you unable to provide for your own food, clothing, or shelter, we may share the information needed to arrange an emergency evaluation.
• Controlled substance monitoring. When we prescribe controlled substances, we consult California's prescription drug monitoring program (CURES) as state law requires, and your pharmacy reports dispensed prescriptions to it.
• Public health. For example, reporting certain diseases, adverse medication reactions to the FDA, or product recalls.
• Health oversight. To government agencies that oversee health care, such as the Osteopathic Medical Board of California, for audits, investigations, inspections, and licensure.
• Lawsuits and legal proceedings. In response to a court or administrative order, or to a subpoena that meets the notice requirements of California law. If you place your mental or emotional condition at issue in a lawsuit, related records may become subject to disclosure.
• Law enforcement. In limited circumstances, such as reporting a crime on our premises or responding to a court-ordered warrant.
• Coroners and medical examiners. To identify a deceased person or determine the cause of death.
• Organ and tissue donation. To organizations that handle organ, eye, or tissue donation.
• Research. Only with your authorization, or when an institutional review board has approved the research and found that it meets strict privacy protections.
• Workers' compensation. As authorized by workers' compensation laws.
• Specialized government functions. For military command authorities if you are a member of the armed forces, and for authorized national security, intelligence, or protective services.
• The Secretary of Health and Human Services. When the federal government investigates our compliance with privacy law.

Disclosures that depend on your permission

Family, friends, and others involved in your care. We will not share your information with family members, friends, or anyone who pays for your care without your express permission, except in an emergency. In an emergency, if you are not present or cannot agree, we may share what we judge to be in your best interest.

Disaster relief. We may share information with a disaster relief organization to coordinate your care or notify family of your location and condition. We will give you a chance to agree or object whenever we practically can.

Uses that require your written authorization

Psychotherapy notes. These are notes a mental health professional may keep, separate from the rest of your medical record, about the contents of therapy sessions. We will not use or share psychotherapy notes without your written authorization, except in limited cases the law allows. Those include use by the clinician who wrote them, defending the practice in a legal proceeding you bring, oversight of that clinician, and situations where the law requires disclosure, such as a serious threat to safety.

Marketing and sale of information. We will never use your information for marketing or sell it without your written authorization. We do not do either.

Fundraising. We do not contact patients for fundraising.

All other uses. Any use or disclosure not described in this notice requires your written authorization. You may revoke an authorization at any time by writing to our Privacy Officer. Revocation does not undo disclosures we already made in reliance on it.

Additional protections

California law. California's Confidentiality of Medical Information Act and related laws give additional protection to certain information. That includes mental health and psychotherapy information, HIV test results, and information about reproductive health and gender-affirming care. Where California law is more protective than federal law, we follow California law.

Substance use disorder treatment records. We may receive records from substance use disorder treatment programs that are protected by federal law (42 CFR Part 2). Those records are subject to stricter limits than this notice otherwise describes. Part 2 records, or testimony about their contents, will not be used or disclosed in any civil, criminal, administrative, or legislative proceeding against you unless you give specific written consent or a court issues an order that meets Part 2's requirements.

Redisclosure. Information we disclose as permitted by federal privacy law may be redisclosed by the person or organization that receives it, and may then no longer be protected by federal privacy law. California law may continue to limit redisclosure by some recipients.

Your rights

To use any of these rights, contact our Privacy Officer. Some requests must be in writing, and we can help you prepare them.

See and get a copy of your records. You may inspect your medical and billing records, and get a paper or electronic copy. Under California law, we will make records available for inspection within 5 working days of your written request and provide copies within 15 days. Copies are provided at no charge. In rare cases where seeing mental health records would pose a substantial risk of significant harm to you, we may decline. If so, we will explain why in writing, and you may ask that the records be provided to another licensed professional you choose or that the decision be reviewed. Federal law does not give a right to inspect psychotherapy notes; California law may, and we will handle any request as California law requires.

Ask us to correct your records. If you believe information in your record is incorrect or incomplete, you may ask us in writing to amend it. We will respond within 60 days. If we decline, we will explain why in writing. You may also add a written statement of up to 250 words to your record about any item you believe is incorrect or incomplete, and we will include it whenever that item is disclosed.

Get a list of disclosures. You may ask for a list of the times we shared your information in the six years before your request, other than for treatment, payment, health care operations, disclosures you authorized, and certain others. One list per year is free.

Ask us to limit what we use or share. You may ask us not to use or share certain information for treatment, payment, or operations. We are not required to agree, and may decline if it would affect your care. If you pay for a service in full yourself and ask us not to share information about it with your health plan, we must agree unless the law requires the disclosure.

Ask for confidential communications. You may ask us to contact you in a particular way, such as only by mobile phone, or at a particular address. We will accommodate reasonable requests and will not ask why.

Choose someone to act for you. If you have given someone medical power of attorney, or someone is your legal guardian, that person can exercise your rights. We will confirm their authority before acting.

Be notified of a breach. You will be notified if a breach compromises the privacy of your information.

Get a copy of this notice. You may ask for a paper copy at any time, even if you received it electronically.

Changes to this notice

We may change this notice, and the changes will apply to all information we hold about you. The current notice, with its effective date, is always posted in our office and on our website, and a copy is available on request.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer. You may also file one with the U.S. Department of Health and Human Services, Office for Civil Rights, online at hhs.gov/ocr/complaints, by phone at 1-877-696-6775, or by mail to 200 Independence Avenue SW, Washington, DC 20201. We will not retaliate against you for filing a complaint.

Contact

Privacy Officer: Dane Rana, DO
Dane Rana, DO, A Professional Medical Corporation, doing business as Liwanag Psychiatry Medical Clinic
595 E. Colorado Blvd., Suite 318, Pasadena, CA 91101
Phone: (626) 887-8191
Email: DrRana@LiwanagPsych.com