Privacy, consent, billing rights, and what to do in a crisis.

Notice of Privacy Practices (HIPAA)

This notice describes how medical and mental health information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.

Overview

This Notice applies to Jonathan Dang, LMFT, CEDS, doing business as C–Work Therapy (“I,” “me,” or “the practice”), and to any associate or service provider who assists in your care. I am required by law to keep your health information private, to give you this notice of my legal duties and privacy practices, to notify you if a breach of your unsecured health information occurs, and to follow the terms currently in effect. I reserve the right to change these practices and to make a revised notice effective for health information I already have about you as well as information I receive in the future; the current version will always be available on this page. This Notice is effective as of January 1, 2026.

How I may use and disclose your information

I may use and disclose your health information for the purposes of providing treatment, obtaining payment, and conducting the necessary operations of my practice. Some examples, though this list is not exhaustive:

• Treatment: To provide, coordinate, or manage your care — for example, consulting with another treating provider (such as a physician or psychiatrist) with your authorization, or referring you to a higher level of care if needed.
• Payment: To bill you directly, or to provide documentation (such as a superbill, or in the future, a claim submitted to an in-network insurance plan) so that services can be paid for.
• Health care operations: For activities like appointment reminders, clinical supervision or consultation to ensure quality care, recordkeeping, and complying with licensing board requirements.

For any use or disclosure outside of treatment, payment, and health care operations, I am required to obtain your written authorization, unless an exception applies (see below). Psychotherapy notes — my private process notes, kept separate from your clinical record — receive extra protection under HIPAA and are almost never disclosed without your specific written authorization. Any authorization you provide may be revoked in writing at any time, except to the extent I have already acted on it.

Disclosures that can be made without your authorization

• Emergencies: Sufficient information may be shared to address an immediate emergency you are facing.
• Judicial and administrative proceedings: I may disclose health information in response to a valid court order or other legal process.
• Danger to self or others: If I believe you present a serious and imminent danger to yourself or an identifiable other person, I may disclose information to the appropriate authorities and/or anyone who may be in danger.
• Suspected child, elder, or dependent adult abuse: I am a mandated reporter and must report suspected abuse or neglect to the appropriate agency.
• Health oversight activities: I may disclose the minimum information necessary to a licensing board or health oversight agency for activities authorized by law.
• Business associates: I work with vendors that perform certain functions on my behalf — for example, my electronic health record and billing platform (SimplePractice) and, once applicable, insurance claims processing. These vendors are contractually bound to protect your information and may only use it as needed to provide their service to me.
• Scheduling: I may email, text, or call you to schedule or remind you of appointments.

Your individual rights

To exercise any of the rights below, contact me in writing at Jdang@cminusworktherapy.com.

• Right to inspect and copy: You may look at or request copies of your health information, with limited exceptions. A reasonable fee may apply to cover the cost of copies.
• Right to amend: You may request that I amend your health information if you believe it is incomplete or incorrect. I may decline this request under certain circumstances, and will explain why if so.
• Right to an accounting of disclosures: You may request a list of instances in which I disclosed your health information for a purpose other than treatment, payment, or health care operations, covering up to the prior six years.
• Right to request restrictions: You may ask me to restrict how I use or disclose your health information. I am not required to agree, except where you have paid for a service in full and are asking that I not disclose that information to your health plan for payment purposes — in that case, I am required to honor your request.
• Right to request confidential communications: You may ask that I contact you in a specific way or at a specific location (for example, by email only, or not at your workplace). I will accommodate reasonable requests.
• Right to a paper copy: You may request a paper copy of this Notice at any time, even if you've agreed to receive it electronically.
• Right to file a complaint: You may file a complaint with me directly, or with the U.S. Department of Health and Human Services, if you believe your privacy rights have been violated. You will not be retaliated against for filing a complaint.

Email & text messages

If you choose to communicate with me by email or text for scheduling or administrative matters, please know that these channels carry inherent privacy and security risks — messages can occasionally be misdirected or intercepted, and are not a fully secure substitute for a session. With your awareness of that risk, relevant messages may become part of your clinical record. For anything urgent or an emergency, please don't rely on email or text — call 911 or use the crisis resources listed below.

Consent to Treatment

By scheduling services with C–Work Therapy, you (or, where applicable, your authorized representative) are giving consent to receive psychotherapy services from Jonathan Dang, LMFT, CEDS. Before beginning treatment, we will discuss your presenting concerns, a general approach to treatment, and any reasonable alternatives, so you can make an informed decision about moving forward.

Confidentiality is a core part of this work, and I am bound by law and professional ethics to safeguard it, with the limited exceptions described throughout this page. You generally have the right to review your own treatment records; in rare cases, I may use professional discretion to withhold certain information where disclosure could reasonably cause harm, consistent with California law.

This consent may be withdrawn by you in writing at any time, without affecting your right to future care.

Telehealth Informed Consent

Services at C–Work Therapy are provided exclusively via telehealth (live video, and in limited cases telephone). By scheduling and attending a session, you consent to receive services in this format and acknowledge the following:

• You have the right to withhold or withdraw your consent to telehealth at any time, without affecting your right to future care or any benefit you would otherwise be entitled to.
• Possible benefits of telehealth include increased accessibility and flexibility, and the ability to receive care without the need for an in-person office visit.
• Possible risks and limitations of telehealth include disruption or failure of the technology, a small risk that an unauthorized person could gain access to a session despite reasonable safeguards, and a more limited ability to respond immediately in a crisis compared to in-person care.
• While telehealth has been shown to be effective for a wide range of mental health concerns, results cannot be guaranteed, and your experience and outcomes may vary.
• Sessions are not recorded by either party, except where we have both explicitly agreed to it in advance.
• All federal and state confidentiality protections that apply to in-person psychotherapy apply equally to telehealth. Information shared during sessions, and records related to them, will not be disclosed without your written authorization, except where disclosure is required or permitted by law — for example, suspected abuse of a child, elder, or dependent adult; a serious and imminent danger to yourself or someone else; or a court order.
• If you are experiencing active suicidal or homicidal thoughts, significant psychosis, or a crisis that cannot be safely addressed through telehealth, I may determine, in my professional judgment, that telehealth is not appropriate at that time, and recommend a higher level of care or in-person services instead.
• If a session is interrupted by a technical failure and we are unable to reconnect within about ten minutes, I will call or text the phone number you have on file to reschedule or continue by phone.
• If I become seriously concerned for your safety during a session, I may contact your emergency contact and/or local emergency services, consistent with the confidentiality limits described above.
• Telehealth does not eliminate the option of in-person care; if at any point we agree telehealth is not the right fit, I will do my best to provide referrals to in-person providers.
• You must be physically located in California at the time of each session, as I am licensed to practice in California only.

By attending your first session, you confirm that you have read this information, understand its contents, and that any questions you had were answered to your satisfaction. Full informed consent documentation is also reviewed and signed as part of your intake paperwork.

Good Faith Estimate & Your Billing Rights

Under the No Surprises Act (effective January 1, 2022), health care providers are required to give patients who are not using insurance an estimate of the bill for services.

• You have the right to receive a Good Faith Estimate explaining how much your care will cost before your first appointment and anytime your services change.
• This estimate is not a bill and does not include unknown or unexpected costs that may arise during treatment.
• If you are billed significantly more than your Good Faith Estimate (generally $400 or more above the estimate), you have the right to dispute the bill.
• Keep a copy of your Good Faith Estimate for your records.

For questions or to start a dispute, visit cms.gov/nosurprises or call 1-800-985-3059.

Fees, Payment & Insurance

• Intake session: $225. Follow-up sessions: $190. Sliding scale available upon request, based on need and availability.
• Payment is due at the time of each session, charged via the method set up through the client portal. Receipts are available at the time of charge or monthly upon request.
• Appointments cancelled with less than 24 hours' notice, or missed without notice, may be charged the full session fee. Cancellation fees cannot be submitted to insurance for reimbursement.

Insurance

C–Work Therapy currently accepts private pay and is in the process of joining select insurance panels; in-network plans will be listed here as those credentialing agreements are finalized. If you are paying privately, a superbill is provided upon request so you may seek out-of-network reimbursement.

For sessions billed under an in-network plan once available, the following will apply:

• You are responsible for any applicable deductible, co-payment, co-insurance, or other cost-sharing required by your plan.
• By receiving services under your insurance plan, you authorize C–Work Therapy to submit claims on your behalf and to receive payment directly from your insurance company, rather than paying you directly.
• You authorize the release of information reasonably necessary to obtain authorization for, and payment of, your insurance benefits, and for coordination of care with other treating providers as needed.
• If your insurance denies a claim, or your covered benefits run out, you will be responsible for the full cost of services from that point forward; I will let you know as soon as I'm aware this applies.
• It's ultimately your responsibility to understand your plan's coverage, deductible, and session limits. I'm glad to help with what I know, but your insurance company is the authoritative source for your specific benefits.

Crisis & Emergency Protocol

If you are experiencing a mental health crisis, having thoughts of harming yourself or someone else, or facing any medical emergency:

• Call 911 or go to your nearest emergency room.
• Call or text 988 (Suicide & Crisis Lifeline) — available 24/7, free and confidential.
• Text HOME to 741741 (Crisis Text Line).

As a solo private practitioner, I am not able to provide 24/7 crisis coverage. Discussing a crisis plan and local resources is part of our work together from the start.

Confidentiality & Its Limits

What you share in session is confidential and protected by law, with the following exceptions where I am legally required to act, even without your consent:

• Suspected abuse or neglect of a child, elder, or dependent adult.
• A serious, imminent threat of harm to yourself or an identifiable other person.
• A court order requiring disclosure of records.

Questions or Complaints

If you have questions about any of the above, or a concern about your care, please reach out directly at Jdang@cminusworktherapy.com or (626) 214-5695. You may also contact the California Board of Behavioral Sciences at bbs.ca.gov to verify a license or file a complaint.