Western Pacific Re-Hab
Notice of Privacy Practices

THIS NOTICE DESCRIBES:
• HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
• HOW YOU CAN GET ACCESS TO THIS INFORMATION
• YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION
• HOW TO FILE A COMPLAINT CONCERNING A VIOLATION OF THE PRIVACY OR SECURITY OF YOUR HEALTH
INFORMATION, OR OF YOUR RIGHTS CONCERNING YOUR INFORMATION
PLEASE REVIEW THIS NOTICE CAREFULLY. YOU HAVE A RIGHT TO A COPY OF THIS NOTICE (IN PAPER OR
ELECTRONIC FORM) AND TO DISCUSS IT WITH OUR PRIVACY OFFICER AT (818) 956-3737 OR
info@westpacmed.com IF YOU HAVE ANY QUESTIONS.
Our Uses and Disclosures
Western Pacific Re-Hab. is a narcotic treatment program that provides services to help and treat
individuals with substance use disorders (“SUD”). As a result, we create or maintain records of the
identity, diagnosis, prognosis, or treatment of patients in connection with SUD education,
prevention, training, treatment, and rehabilitation (“SUD Records”). SUD Records are subject to
federal SUD confidentiality law and regulations found at 42 U.S.C. § 290dd2 and 42 C.F.R. Part 2
(“Part 2”) in addition to the federal Health Insurance Portability and Accountability Act of 1996
(“HIPAA”).
In this Notice, we use terms like “we,” “us”, “our”, or “Part 2 Program” to refer to Western
Pacific Re-Hab., a covered entity under HIPAA and a Part 2 Program under Part 2, and its health
care personnel, employees, staff, and other workforce members. This Notice applies to all programs
and services offered by us.
We may not use or disclose your SUD Records without your written consent unless otherwise permitted
or required by law, as detailed further below.
Uses and Disclosures That Do Not Require Your Consent
We are allowed or required to share your information in certain ways without your consent – usually
in ways that contribute to the public good, such as public health and research. We have to meet
many conditions in the law before we can share your information for these purposes. In particular,
we may use or share your information in the following circumstances:
• Within our program, with an organization that has administrative control over our program, and
with contractors who help us run our program.

• To a medical personnel member during a bona fide medical emergency, if we cannot obtain your
consent.
• To Food and Drug Administration (“FDA”) medical personnel so that they can notify you or your
physician that your health may have been compromised by an error in the manufacturing, labeling, or
sale of a product regulated under the FDA.
• For research purposes, if the recipient has met certain requirements or exceptions under HIPAA
and Part 2.
• For certain management audits, financial audits, and program evaluations. The individuals
perform such audits or evaluations will be subject to Part 2’s restrictions on redisclosures of
your information.
• To a public health authority, if your information has been de-identified so that the information
cannot be used to identify you.
• To the Department of Veterans Affairs.
• To a qualified service program who is providing services to the Part 2 Program.
• To report to law enforcement when a patient commits or threatens to commit a crime within our
program or against our staff.
• To state or local authorities to report suspected child abuse and neglect as required by
law.
• As permitted by a valid court order.
Uses and Disclosures That Require Your Consent or Notice
If we would like to use or disclose your SUD Records in a manner which is not described above, we
must first obtain your specific written consent allowing us to make the disclosure. For example, we
may ask that you help us care for you and support your treatment goals by providing a written
consent that allows our Part 2 Program’s providers to disclose your treatment information to your
friends and advocates involved in your treatment or recovery.
With your consent, we may use and share your information in the following ways:
• To whomever you name in a consent to share your information;
• To prevent multiple enrollments in withdrawal management or maintenance treatment
programs;
• To report participation in treatment required by the criminal justice system; or
• To report prescribed substance use disorder treatment medications to a state prescription drug
monitoring program when required by law.
You may also execute a single written consent for all future uses and disclosures for treatment and
payment purposes and to run our business, in which case we may share your information with other
substance use disorder treatment programs, doctors’ offices, and health care businesses for those
activities. If the person who receives it is subject to HIPAA, then they are allowed to use and
share your information again without your consent for the purposes that HIPAA allows. Your
information still cannot be used in legal proceedings against you unless (1) you consent or (2)
based on a Part 2 court order and a subpoena (or similar legal requirement).

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• Treatment. If you execute a written consent, we can share your SUD Records with other
professionals who are treating you. For example, if a doctor treating you for a chronic condition
asks a doctor at our program about your health condition and medications you are taking, with your
consent, we can disclose the medications to your provider, to avoid complications.
• Payment. If you provide us a written consent, we can use and share information in your SUD
Records to submit claims for the services you received. For example, if your health insurance
company requests information about your treatment for a bill, with you consent, we can disclose
your treatment and dates of services.
• Health Care Operations. If you provide us written consent, we can use health information to
improve our services, run our program, and contact you when necessary. For example, we can use your
SUD Records, with your consent, to review the services we offer.
Legal Proceedings and Court Orders
We must follow certain procedures before using or sharing your information for investigations and
legal proceedings.
• We will not use or share your information or provide testimony about your information in any
civil, administrative, criminal, or legislative proceedings against you without your written
consent or a court order.
• We will only respond to a court order to use or share your health information if it is
accompanied by a subpoena or other similar legal mandate requiring us to comply.
• We will only use or share your information in proceedings against you based on a court order
after we have received notice and an opportunity to be heard or you tell us that you have received
notice.
• We may use or share your information to respond to legal proceedings against our program based
on a court order and you may not be notified in advance. You have the right to seek to overturn or
change the court order after you learn about it.
Fundraising
We may contact you about fundraising, but we won’t use or share your SUD Records for fundraising
unless we first give you a clear opportunity to opt-out of fundraising communications.
Representatives
You can choose someone to act for you.
• If someone has authority to act as your personal representative, such as if someone has your
medical power of attorney or if someone is your legal guardian, that person can exercise your
rights and make choices about your SUD Records.
• We will make sure the person has this authority and can act for you before we take any
action.
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Revoking Consent
You may revoke your written consent in writing in accordance with HIPAA and Part 2, except to the
extent that we or others have already relied on the consent in using or disclosing your
information. If you signed the written consent because you are participating in the Part 2 Program
as a condition of a criminal justice proceeding, such as probation or parole, your consent can be
revoked upon the conclusion of certain events, such as the end of your probation or parole.
Your Rights
You have the following rights in connection to your SUD Records:
Provide Consent when we Use or Share your Information for Most Purposes
• As noted above, you may provide a single consent for all future uses or disclosures for
treatment, payment, and health care operations purposes.
• You may provide consent for more limited purposes (for example, to only disclose information to
another health care provider for your treatment); however, doing so may affect the services we can
provide you or how you pay for services.
• You may provide a general consent to share your information through certain third parties, such
as a health information network or a research institution, where your treating health care
providers can access it.
Ask us to Limit what we Use or Share
• You can ask us not to use or share certain SUD Records for treatment, payment, or our health
care operations after you have provided consent for all those purposes. We are not required to
agree to your request, and we may say “no” if, for example, it could affect your care. If we agree
to your request, we may still share this information in the event that you need emergency
treatment.
• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share
that information for the purpose of payment or our health care operations with your health insurer.
We will say “yes” unless a law requires us to share that information.
Request an Accounting of Disclosures
• You can ask for a list (accounting) of the times we have shared your electronic SUD Records for
three (3) years prior to the date you ask, who we shared it with, and why.
• If you have given written consent to an intermediary (such as a health information exchange) to
use or share your SUD Records, you can ask the intermediary for a list of the times they have
shared your SUD Records for three (3) years prior to the date you ask, who received the records and
when, and what parts of your records were disclosed.

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• We will include all the disclosures except for those about treatment, payment, and health care
operations, and certain other disclosures (such as any you asked us to make). We’ll provide one
accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one
within 12 months.
Ask Us to Correct Your Medical Record
You can ask us to correct health information about you that you think is incorrect or incomplete.
Ask us how to do this. W may say “no” to your request, but we’ll tell you why in writing within 60
days.
Request Confidential Communications
You can ask us to contact you in a specific way (for example, home, office, or cell phone) or to
send mail to a different address. We will say “yes” to all reasonable requests.
Get a Copy of, or Inspect, Your Medical Record
• You can ask to see or get an electronic or paper copy of your medical record and other health
information we have about you. You will have to submit this request in writing. Ask us how to do
this.
• We will provide a copy or a summary of your health information, usually within 30 days of your
request. We may charge a reasonable, cost-based fee, to the extent permitted by law.
Receive a Copy of this Notice
You can ask for a paper copy of this Notice at any time, even if you have agreed to receive the
Notice electronically. We will provide you with a paper copy promptly.
Discuss this Notice with someone in our program
You can ask questions or obtain more information about this Notice and our privacy practices by
calling or emailing the contact person at the top of this Notice.
Choose in advance about fundraising
You have the right to a clear and obvious notice in advance of, and a choice about whether to
receive, fundraising communications for our program, as described above.
File a complaint if you feel your rights are violated
• You can complain if you feel we have violated your rights by contacting us in writing at
info@westpacmed.com.
• You can file a complaint with the U.S. Department of Health and Human Services’ Office for Civil
Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling
1-877-696-6775, or visiting https://www.hhs.gov/hipaa/filing-a-complaint/index.html.
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• We will not retaliate against you for filing a complaint.
Our Responsibilities
• We are required to obtain your consent for most uses and sharing of your SUD Records, as
detailed above.
• We are required by law to maintain the privacy and security of your SUD Records.
• We must let you know promptly if a breach occurs that may have compromised the privacy or
security of your SUD Records.
• We must follow the duties and privacy practices described in this Notice and give you a copy of
it.
• We will not use or share your SUD Records other than as described in this Notice unless you tell
us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in
writing if you change your mind.
• In some circumstances, we may be required to provide more restrictive treatment to certain
categories of health information that may limit or preclude some accesses, uses or disclosures
described in this Notice, such as records containing psychotherapy notes, genetic testing
information, information on persons with developmental disabilities, information concerning
HIV/AIDS testing, treatment for mental health conditions or substance use disorders, or information
regarding emancipated minors. Government health benefit programs, such as Medi-Cal, may also limit
the disclosure of beneficiary information for purposes unrelated to the program.
• In the case of psychotherapy notes (meaning notes recorded, in any medium, by a health care
provider who is a mental health professional documenting or analyzing the contents of conversation
during a private counseling session or a group, joint, or family counseling session and that are
separated from the rest of the individual’s medical record, but not including any medication
prescription and monitoring, counseling session start and stop times, the modalities and
frequencies of treatment furnished, results of clinical tests, and any summary of the following
items: diagnosis, functional status, the treatment plan, symptoms, prognosis, and progress to
date), we may not use or disclose psychotherapy notes without your written authorization unless
otherwise permitted or required by law.
• In the case of SUD counseling notes (meaning notes recorded in any medium by a Part 2 Program
provider who is a SUD or mental health professional documenting or analyzing the contents of
conversation during a private SUD counseling session or a group, joint, or family SUD counseling
session and that are separated from the rest of the patient’s SUD and medical record, but excluding
medication prescription and monitoring, counseling session start and stop times, the modalities and
frequencies of treatment furnished, results of clinical tests, and any summary of the following
items: diagnosis, functional status, the treatment plan, symptoms, prognosis, and progress to
date): We may not use or disclose SUD counseling notes without your written authorization unless
otherwise permitted or required by law.

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Changes to the Terms of this Notice
We reserve the right to change the terms of this Notice at any time. We reserve the right to make
the new Notice provisions effective for all SUD Records that we currently maintain, as well as any
health information we receive in the future. If we make material or important changes to our
privacy practices, we will promptly revise our Notice. We will post a copy of the current Notice in
our offices. Each version of the Notice will have an effective date, along with the date it was
last updated on the first page. Updates to this Notice are also available at our website.
Effective Date
This Notice is effective as of February 16, 2026.

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Western Pacific Re-Hab.
Acknowledgement of Receipt of Notice of Privacy Practices
Applicable law requires us to give you a notice of our privacy practices and to acknowledge your
receipt of the notice.
What is the Notice of Privacy Practices?
The Notice of Privacy Practices explains how your SUD Records may be used or disclosed by us. In
addition, it explains your rights with regard to your SUD Records, as well as our legal
responsibilities.