HIPAA PATIENT NOTICE

Notice of Privacy Practices

Your information. Your rights. Our responsibilities. | Effective date: 11/4/2026

This notice explains how health information about you may be used and disclosed by Mental Wealth Ambition, and how you can access it. Please review it carefully. This notice applies to the healthcare components of the practice that are covered by HIPAA, subject to confirmation of the legal covered entity, affiliated providers and any applicable organized healthcare arrangement. California confidentiality rules may provide additional protections.

Privacy contact: Privacy Officer Dr. Rebecca Nolan, Mental Wealth Ambition, 7755 Center Avenue, Suite 1100, Huntington Beach, CA 92647; (949) 734-0748; info@mentalwealthambition.com

Your rights

Access or receive a copy of your record

You can ask to inspect or obtain an electronic or paper copy of your medical record and other health information about you. We will usually respond within 30 days and may charge only fees permitted by law. California law may provide faster access or other protections in particular circumstances. Access to separately maintained psychotherapy notes may be subject to special rules.

Ask us to correct information

You can request an amendment if you believe information is inaccurate or incomplete. We may decline a request as permitted by law but will explain a denial in writing, generally within 60 days under HIPAA, with applicable rights to submit a statement of disagreement.

Choose confidential communications

You may request that we contact you in a specific way or at another address. We will accommodate reasonable requests and will discuss secure alternatives when needed. Please notify us if a voicemail, text, insurance explanation of benefits or mail to a shared address could put privacy at risk.

Request limits on disclosure

You may ask us not to use or disclose certain information for treatment, payment or operations. We do not always have to agree. If you pay in full out of pocket for an item or service, we generally must honor your request not to disclose related information to your health plan for payment or health care operations unless law requires otherwise.

Receive an accounting of disclosures

You may request an accounting of certain disclosures during the six years before your request. The accounting generally excludes treatment, payment and operations disclosures and other categories permitted by law. One accounting in a 12-month period is generally free; a permissible cost-based fee may apply to further requests. Special Part 2 rules may apply to qualifying records.

Obtain a paper copy; appoint someone; complain

You can request a paper copy of this notice even if you agreed to receive it electronically. We will verify the legal authority of any personal representative. You may complain to our Privacy Officer or the U.S. Department of Health and Human Services Office for Civil Rights at https://www.hhs.gov/hipaa/filing-a-complaint/ or 1-877-696-6775. We will not retaliate against you for filing a complaint.

Your choices and authorizations

You may tell us your preferences for sharing with relatives, friends or caregivers involved in care or payment, when permitted by law. We will respect valid preferences and the specific confidentiality rights of minors and other patients. In an emergency or where a serious threat exists, disclosures may be allowed under limited legal conditions. We will obtain written authorization before using or disclosing health information for marketing activities that require it, selling protected health information, or disclosing most separately maintained psychotherapy notes. You may revoke a written authorization prospectively, subject to permitted reliance already taken.

We do not offer a general hospital directory. If we undertake fundraising using protected health information, we will provide the required opportunity to opt out; use of protected Part 2 records requires additional protections and advance choice. We do not assume a patient permits publication of testimonials, pictures or treatment information merely by accepting these notices.

How we may use or disclose health information

Treatment

We use health information to provide, coordinate and manage treatment, including clinical consultation and referrals when permitted. We apply California confidentiality requirements where more restrictive, and use special handling for psychotherapy notes and Part 2 records.

Payment, insurance and billing

We may use and disclose the information legally necessary for insurance eligibility and benefit checks, prior authorizations, claim submission and correction, coordination of benefits, coverage appeals, reimbursements, copays, deductibles, invoicing, claims audits and payment disputes. We may share needed information with insurers, health plans, Medicare, Medi-Cal, other responsible payers, clearinghouses and billing vendors, subject to applicable law. Our authorized collection agency or billing contractor may receive information reasonably necessary to collect lawful amounts owed, using a business associate agreement where required and the minimum necessary standard. This is not permission to report California medical debt to consumer credit reporting agencies.

Health care operations

We may use or share information to run our practice, ensure care quality, supervise and train staff, review performance, maintain credentials, conduct audits, address patient concerns, detect fraud, maintain business continuity and comply with oversight requirements, as permitted by law. Vendors handling protected health information on our behalf must have appropriate safeguards and agreements when required.

Other legally permitted or required purposes

Subject to the conditions of federal and California law, we may use or disclose information for public health, mandatory reporting of child or elder abuse, threats to health or safety, healthcare oversight, workers compensation, limited research uses, lawful government requests, certain medical examiner or funeral director functions, and valid court or legal processes. A subpoena or request does not automatically authorize disclosure; we evaluate the applicable legal requirements and protections, including special psychotherapy and SUD record rules.

Specially protected information

Psychotherapy notes

Separately maintained psychotherapy notes, as defined by HIPAA, generally require your written authorization before use or disclosure except for narrow legal exceptions. Progress notes and ordinary medical records are not automatically psychotherapy notes. We do not make broad psychotherapy-note disclosures to insurers or collections vendors.

Substance use disorder records under 42 CFR Part 2

If we maintain or receive patient records protected by 42 CFR Part 2, additional restrictions apply. We will follow applicable consent rules for uses or disclosures, including restrictions relating to SUD counseling notes. Such records generally may not be used or disclosed in civil, criminal, administrative or legislative proceedings against a patient unless the patient provides the specific consent required by law or the law’s court-order requirements are met. We will not use Part 2 records for fundraising without the required advance notice and choice, and we will provide the information required by the 2026 notice rules.

Children, adolescents, couples and families

Parents or guardians do not automatically have unconditional access to all records. We honor applicable court orders, legal-representative rules and California protections where a minor may consent to outpatient mental health care. When services involve more than one person, we explain whose record is maintained and the confidentiality and release rules in the separate informed consent. We never treat a website agreement as a substitute for obtaining required clinical consent.

California protections

California’s Confidentiality of Medical Information Act and applicable mental health and minor-consent laws may further restrict disclosures. Where California law is more protective than HIPAA, we follow the applicable stricter requirements. We will not disclose medical information for unrelated marketing or other purposes without a valid legal basis or authorization.

Our responsibilities

• We are legally required to safeguard the privacy and security of protected health information and follow the practices described in this notice.

• We will notify affected individuals of breaches when required under applicable laws.

• We will obtain authorizations and apply the minimum necessary principle wherever required, and protect information handled by qualified business associates.

• We will give you access to this notice online and on request and post it prominently at physical locations where required.

• We may revise the notice as practices or law change. The new notice may apply to information already maintained, as law permits, and will be available on our website and in our office.

Contact, effective date and coverage

Privacy / legal contact: Mental Wealth Ambition, Attn: Privacy Officer, 7755 Center Avenue, Suite 1100, Huntington Beach, CA 92647. Email: info@mentalwealthambition.com. Telephone: (949) 734-0748.

Effective date: 11-4-2026. Covered healthcare components and legal entity: Mental Wealth Ambition. This notice is separate from the website Privacy Policy and Terms of Service.