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: October 1, 2026
Our commitment to your privacy
At Prae Servare, we take the protection of your personal and medical information seriously. This notice explains how we may use and share information about you, and what rights you have over that information. We are required by federal law (the Health Insurance Portability and Accountability Act, or HIPAA) and by California law (the Confidentiality of Medical Information Act, or CMIA) to keep your protected health information (PHI) private, to give you this notice, and to follow the terms of the notice currently in effect.
1. How we may use and disclose your health information without your authorization
The following uses and disclosures do not require your written authorization.
Treatment. We use and share your health information to provide, coordinate, and manage your care. For example, our clinicians may review your medical history to select an appropriate treatment; a treating physician may consult with a colleague about your care; or we may share information with another provider you have asked us to communicate with.
Payment. We use and share your health information to obtain payment for services rendered. Prae Servare is a cash-pay practice and does not bill insurance directly. If you request a superbill to submit to your insurance carrier or health savings account (HSA/FSA), we will provide the information necessary for that submission.
Healthcare operations. We use and share your health information to run the practice — including quality assessment, staff training, credentialing, business planning, legal and accreditation matters, and internal auditing.
Business associates. We share limited information with vendors who provide services to us (electronic medical records, payment processors, appointment reminder platforms, IT support, accountants, attorneys). Each business associate is bound by a written agreement to protect your information under HIPAA.
Appointment reminders and communications. We may contact you by phone, text message, email, or mail to remind you of appointments, follow up on treatment, request feedback, or share information about services and products that may interest you. You may opt out of any of these communications at any time.
Loyalty and rewards programs. If you enroll in Alle, Aspire, Evolus Rewards, or any similar manufacturer loyalty program, we will share the information necessary to enroll you and track your points (typically your name, contact information, and products administered). You may decline enrollment at any time.
Family, friends, and others involved in your care. With your permission (verbal or written), we may share information about your treatment with a family member, friend, or other person you identify. In an emergency, we may share information with a person we reasonably believe is involved in your care, using our professional judgment.
Required by law and public interest disclosures. We may use or disclose your information as required or permitted by law, including: public health activities; reporting suspected abuse, neglect, or domestic violence; health oversight activities (audits, investigations, licensure); judicial or administrative proceedings (in response to a subpoena or court order); law enforcement purposes as permitted by law; coroners, medical examiners, and funeral directors; organ and tissue donation; research (with appropriate approvals); to avert a serious threat to health or safety; military and national security activities; workers’ compensation; and correctional institutions.
2. Uses and disclosures that require your written authorization
The following uses always require your specific, signed authorization. You may revoke any authorization in writing at any time.
Marketing. Any use of your name, image, likeness, testimonial, or treatment information for marketing purposes — including social media, advertising, the Prae Servare website, print materials, and third-party press — requires your signed Photograph, Video & Media Authorization. Signing our general intake documents does not authorize marketing use.
Sale of PHI. We will not sell your health information.
Psychotherapy notes. Not applicable to Prae Servare’s services; if this ever changes, separate authorization would be required.
Most other uses and disclosures not described in this notice will be made only with your written authorization.
3. Your rights regarding your health information
You have the following rights. To exercise any of them, contact our Privacy Officer using the information at the end of this notice.
Right to inspect and copy. You may request access to your medical record. We will provide it in the form you request (paper or electronic) when readily producible. We will respond within 30 days. A reasonable cost-based fee for copying may apply, consistent with California law.
Right to amend. If you believe information in your record is incorrect or incomplete, you may request an amendment. We may deny the request in limited circumstances and will explain the reason in writing.
Right to an accounting of disclosures. You may request a list of certain disclosures we have made of your PHI in the six (6) years prior to your request (excluding disclosures for treatment, payment, healthcare operations, and certain other categories).
Right to request restrictions. You may ask us to limit how we use or share your information for treatment, payment, or healthcare operations. We are not required to agree, except that we must agree to a request to restrict disclosure to a health plan for services you paid for in full out of pocket.
Right to confidential communications. You may ask us to contact you at a specific address, phone number, or by a specific method (for example, only by email, or only at a work address). We will accommodate reasonable requests.
Right to a paper copy. You may request a paper copy of this notice at any time, even if you agreed to receive it electronically.
Right to be notified of a breach. You have the right to be notified if there is a breach of your unsecured PHI, as required by federal and California law.
Right to file a complaint. You may file a complaint with us or with the U.S. Department of Health and Human Services. Contact information is at the end of this notice. You will not be retaliated against for filing a complaint.
4. Additional rights under California law
California law provides additional protections beyond HIPAA in certain areas:
Sensitive information. California law provides heightened protection for information related to HIV/AIDS testing and treatment, mental health, developmental disability, genetic testing, and substance use treatment. We will not disclose this information without your specific written authorization except as narrowly permitted by law.
Confidentiality of Medical Information Act (CMIA), Civil Code §56 et seq. CMIA generally requires your written authorization for most disclosures of medical information to third parties and imposes penalties for improper disclosure.
Minors. California law permits minors to consent to certain healthcare services without parental involvement (for example, certain reproductive, mental health, and substance use services). When a minor lawfully consents to care, the minor — not the parent — controls the confidentiality of that record.
California Consumer Privacy Act (CCPA). PHI regulated by HIPAA and CMIA is exempt from most CCPA provisions. Non-medical personal information collected through our website may be subject to CCPA; please see our website Privacy Policy.
5. Our responsibilities
We are required by law to maintain the privacy and security of your PHI, to give you this notice of our legal duties and privacy practices, to follow the terms of the notice currently in effect, and to notify you if a breach affecting your unsecured PHI occurs.
6. Changes to this notice
We reserve the right to change this notice and to make the revised notice effective for all PHI we maintain. The revised notice will be posted in our office and on praeservare.com. You may request a paper copy of any revised notice.
7. Complaints
If you believe your privacy rights have been violated, you may file a complaint with:
Prae Servare Privacy Officer
Nualla Rogowski, RN, BSN, Clinical Director and Practice Manager
2659 Mission Street, San Marino, CA 91108
nualla@praeservare.com · (626) 219-0015
U.S. Department of Health & Human Services, Office for Civil Rights
Region IX, 90 7th Street, Suite 4-100, San Francisco, CA 94103
(800) 368-1019 · www.hhs.gov/ocr/privacy/hipaa/complaints
California Department of Public Health, Office of Health Information Integrity
CDPH-OHII, MS 5107, P.O. Box 997377, Sacramento, CA 95899
You will not be penalized or retaliated against in any way for filing a complaint.
8. Contact
For questions about this notice or to exercise any of your rights, please contact our Privacy Officer at the address, email, or phone above.