Your Privacy is Important
Wel-Mor Psychology Group, Inc. understands your privacy is important. We are required by law to maintain the privacy of protected health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information. We are required to abide by the terms of this notice. We will handle this information only as allowed by federal/state law and agency policy, adhering to the most stringent law that protects your health information.
If at any time you believe your privacy rights have been violated, you may verbally or in writing contact:
Director at Wel-Mor Psychology Group, Inc.
Orange County Probation Department
Orange County Health Care Agency
Secretary of Health and Human Services of the Federal government
You will not suffer any change in services or retaliation for filing a complaint.
Each time you receive services from us, the provider makes a record of the visit. Typically, this record contains your consent forms, assessments, and progress notes, etc.
Your Federally defined rights under 45 CFR Parts 160 and 164 (HIPAA Privacy Standards).
There are several rights concerning your protected health information that we want you to be aware of:
- You have the right to inspect or to request copies of your medical records. This process will be kept confidential. This right is not absolute. In certain situations, such as if access would cause harm, we can deny access. You must make this request in writing to the Director. If denied access, you will receive a timely, written notice of the decision and reason, and a copy of this notice becomes a part of your record.
- You have the right to request amendment of your medical records if you believe information in the records is inaccurate or incomplete. You must make this request in writing to the Director. We may deny the request for proper reasons but you will be provided with a written explanation of the denial.
- You have the right to obtain a paper copy of this Privacy Notice at any time upon request.
Use and Disclosure of Your Information
Upon signing the program’s Release of Information Form, you are allowing us to use and disclose necessary information about you within the program and with the referring agency (i.e., Orange County Probation Department, Orange County Health Care Agency, the Court system, etc.) in order to provide treatment/service. In addition, the Release of Information allows a space for you to specify additional individuals or agencies that you allow us to release information to as well. If this space is left blank we will assume that you do not authorize the release of information to anyone else. If people (i.e., parents, spouse) call us and request information about you and the Release of Information Form does not specify their name, their request for information will be denied.
Changes to Privacy Practices
Wel-Mor Psychology Group, Inc. reserves the right to change any of its privacy policies and related practices at any time, as allowed by federal and state law and to make the change effective for all protected health information that we maintain.
Revised Privacy Notices will be given to all residents/patients and/or their legal representatives, and available upon request by mailing or discussion with a program staff member or a combination of the three.
- David Welch, Ph.D., Director, (714) 540-9070 ext 102
- Secretary of Health and Human Services,
Immediate Office of the Secretary, Hubert Humphrey Bldg.,
2000 Independence Ave. SW, Washington, DC, 20201,
Phone – (202) 690-7000