HIPAA NOTICE OF PRIVACY PRACTICES
Effective Date: 02/06/2026
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.
I. WHO FOLLOWS THIS NOTICE
This Notice describes the privacy practices of Full Mahina LLC (doing business as Hawaii Play Therapy) and Amber Ashford, Licensed Mental Health Counselor/Licensed Professional Clinical Counselor (Sole Proprietor). For the purposes of this Notice, these entities are collectively referred to as "the Practice," "we," or "us."
II. OUR PLEDGE REGARDING HEALTH INFORMATION
We understand that health information about you and your health care is personal. We are committed to protecting health information about you. We create a record of the care and services you receive from us to provide you with quality care and to comply with certain legal requirements. This Notice applies to all of the records of your care generated by this Practice.
III. HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
The following categories describe different ways that we use and disclose health information.
• For Treatment: We may use health information about you to provide you with counseling or medical treatment. We may disclose health information about you to doctors, nurses, technicians, or other personnel who are involved in taking care of you (e.g., consulting with your psychiatrist).
• For Payment: We may use and disclose health information about you so that the treatment and services you receive may be billed to and payment may be collected from you, an insurance company, or a third party.
• For Health Care Operations: We may use and disclose health information about you for our practice operations, such as quality assessment, licensing, and business management.
• Business Associates: We may disclose Health Information to our business associates that perform functions on our behalf (e.g., billing software, EHR platforms) if the business associate has signed a written agreement to protect the confidentiality of your information.
IV. SPECIAL SITUATIONS (NO CONSENT REQUIRED)
We may use or disclose health information about you without your permission for the following purposes, subject to all applicable legal requirements and limitations:
• As Required By Law: We will disclose health information about you when required to do so by federal, state, or local law.
• To Avert a Serious Threat to Health or Safety: We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
• Public Health Risks: (e.g., prevention of disease, reporting reactions to medications).
• Victims of Abuse, Neglect, or Domestic Violence: We may disclose health information to appropriate government authorities if we believe a patient has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.
• Health Oversight Activities: (e.g., audits, investigations, licensure actions).
• Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order.
• Law Enforcement: We may release health information if asked to do so by a law enforcement official in response to a court order, subpoena, warrant, summons, or similar process.
V. YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
You have the following rights regarding health information we maintain about you:
• Right to Inspect and Copy: You have the right to inspect and copy health information that may be used to make decisions about your care.
• Right to Amend: If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information.
• Right to an Accounting of Disclosures: You have the right to request a list of the accounting of disclosures we made of health information about you (excluding disclosures for treatment, payment, and operations).
• Right to Request Restrictions: You have the right to request a restriction or limitation on the health information we use or disclose about you. We are not required to agree to your request, but if we do, we will comply.
• Right to Request Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location.
• Right to a Paper Copy of This Notice: You have the right to a paper copy of this notice.
VI. CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current notice on our website.
VII. COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
Privacy Officer Contact:
Amber Ashford
(808) 404-8804
aloha@hawaiiplaytherapy.com
U.S. Department of Health and Human Services Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
1-877-696-6775
www.hhs.gov/ocr/privacy/hipaa/complaints/
ADDENDUM: STATE-SPECIFIC PRIVACY LAWS
Because we provide services in multiple states, we comply with the specific privacy laws of the state where you are physically located. Where state law is stricter than federal HIPAA law, we follow the stricter state law.
FOR CLIENTS IN HAWAII
• Mental Health Records: Under Hawaii Revised Statutes (HRS) Chapter 334, we generally cannot disclose mental health records without your specific written authorization, except for treatment purposes, payment, or pursuant to a court order.
• Minors (Age 14+): Under HRS § 577-29, minors who are 14 years of age or older may consent to outpatient mental health treatment without the consent, knowledge, or participation of their parents or legal guardians.
• Right to Privacy: If a minor (14+) consents to their own treatment, they generally have the right to control access to their own medical records.
• Parental Involvement: While Hawaii law encourages parental involvement, the provider may withhold information from parents if the minor requests confidentiality and the provider determines that involvement would be inappropriate or detrimental to the minor’s treatment.
• Insurance Privacy: If a minor (14+) consents to treatment, they have the right to request that their insurance carrier not disclose billing information (like Explanation of Benefits) to the policyholder (parent).
FOR CLIENTS IN WASHINGTON
• Mental Health Confidentiality (RCW 70.02): Washington law provides heightened protections for mental health records and information regarding sexually transmitted infections (STIs/HIV). We generally will not release this specific information without your explicit authorization, even for general medical purposes, unless allowed by law.
• Minors (Age 13+): Under Washington law, minors age 13 and older have the exclusive right to consent to mental health treatment.
• If you are 13 or older, you (not your parents) control access to your mental health records.
• We cannot disclose your records to your parents without your written permission, with limited exceptions involving life-threatening situations.
FOR CLIENTS IN CALIFORNIA
• Confidentiality of Medical Information Act (CMIA): California law strictly prohibits the disclosure of medical information without your authorization, with specific exceptions.
• Minors (Age 12+): Under California Family Code § 6924 and Health & Safety Code § 124260, minors age 12 and older may consent to outpatient mental health treatment if, in the opinion of the provider, they are mature enough to participate intelligently.
• If you consent to your own treatment under these laws, you generally control the privacy of your own records.
• The provider may involve parents if appropriate, but will not disclose records if the provider determines disclosure would be detrimental to the therapeutic relationship or the minor's safety.
• Consumer Notice: The Board of Behavioral Sciences receives and responds to complaints regarding services provided within the scope of practice of professional clinical counselors. You may contact the board online at www.bbs.ca.gov or by calling (916) 574-7830.
