Description text goes hereTHIS 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.

I. COMMITMENT TO PROTECTED HEALTH INFORMATION (PHI)

--------------------------------------------------------------------------------

Dr. Jin is committed to preserving the privacy and security of your medical data. Under federal and state law, the practice is required to:

• Maintain the confidentiality of your Protected Health Information (PHI).

• Provide you with this formal Notice detailing privacy duties and protocols.

• Abide by the terms of the Notice currently in effect.

• Notify you promptly in the unlikely event of a breach of unsecured PHI.

II. ROUTINE & STATUTORY DISCLOSURES OF PHI

--------------------------------------------------------------------------------

• Direct Patient Care: PHI is utilized to conduct clinical evaluations and coordinate care with designated external providers (e.g., your PCP, neurologist, or laboratory).

• Direct-Pay Financial Administration: PHI is used to process visit fees and generate itemized Superbills directly to you.

• Permitted Disclosures Without Consent: PHI may be disclosed without prior authorization to avert serious threats to public safety, comply with child/elder abuse reporting mandates, or satisfy valid court orders and subpoenas.

III. INDIVIDUAL PRIVACY RIGHTS

--------------------------------------------------------------------------------

• Electronic Chart Access: You have the right to inspect and obtain an electronic copy of your medical record within 15 to 30 days of written request.

• Amending Records: You may request amendments to medical information you believe is inaccurate or incomplete. We may say “no” to your request, but we’ll tell you why in writing within 60 days.

• Restriction on Out-of-Pocket Disclosures: Under 45 CFR § 164.522, because you pay for all healthcare services out-of-pocket in full, you maintain the absolute right to mandate that the practice NOT disclose any PHI regarding those services to any health plan.

• Accounting of Disclosures: You have the right to receive an accounting of non-routine disclosures made by the practice during the six years prior to your request.

IV. QUESTIONS & COMPLAINT FILING

--------------------------------------------------------------------------------

If you have questions or believe your privacy rights have been violated, contact Dr. Richard Jin at (415) 320-6595. You may also submit a formal complaint to the U.S. Department of Health and Human Services Office for Civil Rights (200 Independence Avenue, S.W., Washington, D.C. 20201, or at www.hhs.gov/ocr/privacy/hipaa/complaints/). The practice will not retaliate against you for filing a complaint.

Financial Transparency & Commitment to Predictable Care

Our practice is committed to complete financial transparency. We operate on a direct-pay, out-of-network model with clear, predictable fee schedules established prior to any clinical encounter. Patients will never receive unexpected charges or administrative fees that have not been explicitly reviewed and mutually agreed upon within our outpatient treatment agreement.

Your Rights Under the No Surprises Act

Under federal law (Public Health Service Act § 2799B-6 and 45 C.F.R. § 149.610), healthcare providers are required to provide self-pay patients—including those who do not have commercial insurance or who elect not to submit claims to their insurance provider—a Good Faith Estimate (GFE) detailing the expected cost of non-emergency medical items and services.

• Scope of Estimate: You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency clinical services reasonably expected to be furnished by this practice. In our outpatient setting, this encompasses standalone comprehensive diagnostic evaluations, extended follow-up psychopharmacology, and collaborative psychiatric care. (Any external services, such as outpatient laboratory testing or retail prescription medications, are billed independently by third-party facilities.)

• Delivery Timelines: If you schedule a clinical appointment at least 3 business days in advance, our office will provide your individualized written Good Faith Estimate within 1 business day of booking. If you schedule at least 10 business days in advance, your estimate will be provided within 3 business days of booking. You may also request a written estimate prior to scheduling any service.

• Dispute Resolution: If you receive a bill from this practice that is at least $400 greater than the total expected charges outlined in your Good Faith Estimate, you have the statutory right to dispute the bill through the federal Patient-Provider Dispute Resolution (PPDR) process. Initiating a dispute does not affect the quality or continuity of your clinical care.

• Record Retention: We recommend retaining a printed or digital copy of your Good Faith Estimate for your personal financial and medical records.

For questions regarding your Good Faith Estimate, our fee structure, or the dispute resolution process, please contact our office directly at 650-468-0572 or visit the Centers for Medicare & Medicaid Services (CMS) at www.cms.gov/nosurprises.

STATUTORY LIMITS OF CONFIDENTIALITY & MANDATED REPORTING

(Pursuant to California Evidence Code § 1010–1027, Cal. Penal Code § 11166, and 17 CCR § 2806)

All communications, clinical documentation, and diagnostic formulations generated within this practice are privileged medical records protected under California law and HIPAA. These protections are legally subordinated to statutory mandates requiring disclosure without patient consent under the following strict circumstances:

• 3.1 Imminent Danger to Self or Others (Tarasoff / CA Civil Code § 43.92): When a patient communicates a serious, imminent threat of physical violence against an identifiable victim, or presents an acute, life-threatening risk of suicide or self-harm where intervention is necessary to preserve life.

• 3.2 Child, Elder, and Dependent Adult Abuse (Cal. Penal Code § 11166 & WIC § 15630): Any reasonable suspicion or direct disclosure of physical abuse, sexual abuse, emotional abuse, abandonment, or severe neglect involving a minor (under 18 years of age), an elderly individual (age 65 or older), or a dependent adult.

• 3.3 Judicial Process & Court-Ordered Compulsion: Receipt of a legally valid court order or subpoena issued by a judge in a court of competent jurisdiction.

• 3.4 Cognitive Impairment & California DMV Reporting (17 CCR § 2806 & CA Health & Safety Code § 103900): California law statutorily requires physicians to report immediately to the Department of Public Health (which reports to the Department of Motor Vehicles) any patient diagnosed with a medical, neurological, or psychiatric condition characterized by lapses of consciousness, episodic disorientation, or severe cognitive/psychomotor impairment that may compromise the safe operation of a motor vehicle.

STATUTORY MBC NOTICE TO PATIENTS

(Mandated under California Business and Professions Code § 138 and 16 CCR § 1355.4)

NOTICE TO PATIENTS

Medical doctors are licensed and regulated by the Medical Board of California

To check up on a license or to file a complaint:

Website: www.mbc.ca.gov

Email: licensecheck@mbc.ca.gov

Toll-Free Telephone: (800) 633-2322

Educational Intent & Diagnostic Specificity

All materials, scientific commentary, clinical perspectives, and written formulations published on this website—including text, diagnostic frameworks, scientific citations, graphics, and multimedia assets—are provided strictly for general educational, academic, and informational purposes.

Psychiatric formulation and biological medicine require an individualized, multi-source assessment of neurobiology, longitudinal development, medical history, and current physiologic parameters. Accordingly, no material on this platform is intended to serve as, or substitute for, individualized medical advice, clinical diagnosis, or prescriptive treatment planning.

Readers should not act upon, rely on, or alter any ongoing health regimen based on content found on this site without consulting their personal treating physician, psychotherapist, or qualified healthcare specialist. Nothing published here should ever cause a reader to delay seeking professional medical evaluation or disregard individualized guidance provided by their existing medical team.

Establishment of the Physician-Patient Relationship

Navigating this website, submitting a preliminary inquiry form, transmitting collateral records, or engaging in an initial introductory telephone conversation does not establish a physician-patient, therapeutic, or fiduciary psychiatric relationship with Dr. Jin.

A formal physician-patient relationship and legal duty of care are established solely upon the bilateral execution of our formal Outpatient Psychiatric Treatment Agreement following a completed comprehensive diagnostic evaluation.

This digital portal and its associated communications are not monitored for acute clinical crisis intervention or urgent medical triage. If you or a loved one are experiencing acute psychological distress, active suicidal ideation, or a medical emergency, please dial or text 988 to reach the Suicide & Crisis Lifeline, call 911, or report immediately to the nearest hospital emergency department.