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Notice of Privacy Practices

Tolentino Medical Corporation

Effective Date: September 25, 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.

This Notice applies to protected health information maintained by Tolentino Medical Corporation in connection with care provided by Dr. Jaclyn Tolentino and the Practice’s workforce and authorized service providers, as permitted by law. It applies to in-person and virtual care furnished through Tolentino Medical Corporation. This Notice does not describe the privacy practices of unrelated facilities, landlords, laboratories, pharmacies, imaging centers, specialists, or other independent organizations simply because the Practice refers you to or coordinates with them.

Your Rights

You have important rights regarding your health information. Subject to applicable law, you may:

  • Get a copy of your medical record. You may ask to inspect or receive an electronic or paper copy of medical records and other health information we maintain about you. We generally respond within the time required by law and may charge a reasonable, cost-based fee when permitted.
  • Ask us to correct your record. You may ask us to amend health information you believe is incorrect or incomplete. We may deny certain requests, but if we do, we will explain the reason in writing as required by law.
  • Request confidential communications. You may ask us to contact you in a particular way or at a particular address. We will accommodate reasonable requests.
  • Ask us to limit certain uses or disclosures. You may request restrictions on how we use or disclose your information for treatment, payment, or health care operations. We are not always required to agree. If you pay in full out-of-pocket for a service, you may ask us not to disclose information about that service to a health plan for payment or health care operations, and we will honor the request unless disclosure is required by law.
  • Receive an accounting of certain disclosures. You may request a list of certain disclosures of your health information made during the period allowed by law. Some disclosures, including many for treatment, payment, health care operations, and disclosures you specifically authorized, are not included.
  • Receive a copy of this Notice. You may request a paper or electronic copy at any time, even if you previously agreed to receive it electronically.
  • Choose someone to act for you. If a person has legal authority to act as your personal representative, we will recognize that authority as required by law.
  • File a privacy complaint. You may complain to the Practice or to the U.S. Department of Health and Human Services if you believe your privacy rights have been violated. We will not retaliate against you for filing a complaint.

Your Choices

For certain uses and disclosures, you may tell us your preferences. For example, you may tell us whether and how to share information with family members, close friends, or others involved in your care or payment for your care. If you cannot communicate your preference, we may use professional judgment and applicable law to determine whether a disclosure is in your best interests or needed to address a serious and imminent threat.

Written authorization is generally required for: most uses and disclosures for marketing, the sale of protected health information, and most disclosures of psychotherapy notes. If you authorize a use or disclosure in writing, you may revoke that authorization in writing to the extent permitted by law.

How We May Use and Disclose Your Health Information

  • Treatment. We may use your health information and share it with physicians, clinicians, laboratories, pharmacies, specialists, hospitals, and other professionals involved in your care. For example, we may send relevant information to a specialist to coordinate a referral.
  • Payment. We may use and disclose information to obtain or process payment, confirm payment status, provide receipts or superbills, coordinate benefits where applicable, or conduct related billing activities. Tolentino Medical is a cash-pay private practice, but payment-related disclosures may still occur when permitted or requested.
  • Health care operations. We may use and disclose information to operate the Practice, improve care and services, conduct quality review, train or supervise team members, manage records, support scheduling, maintain technology and security, conduct compliance activities, and communicate with you about your care.
  • Public health and safety. We may disclose information for legally authorized public health activities, product recalls, adverse-event reporting, abuse or neglect reporting, and to prevent or reduce a serious threat to health or safety.
  • Health oversight and government functions. We may disclose information to health oversight agencies and for other government functions when authorized or required by law.
  • Workers’ compensation. We may disclose information as authorized by and to the extent necessary to comply with workers’ compensation or similar programs.
  • Research. We may use or disclose information for research when the requirements of applicable law are satisfied.
  • Legal proceedings and law enforcement. We may disclose information in response to a valid court or administrative order, subpoena, or other lawful process, and for law-enforcement purposes when permitted by law.
  • Required by law. We will disclose information when federal, state, or other applicable law requires us to do so.
  • Decedents and donation. When permitted by law, we may disclose information to coroners, medical examiners, funeral directors, and organ or tissue procurement organizations.

Specially Protected Information

Some categories of health information are subject to additional federal or state confidentiality protections. When a law gives your information greater protection than HIPAA, we will follow the more protective requirement when it applies. This can include, depending on the circumstances, information concerning mental health treatment, HIV or other communicable-disease information, genetic information, reproductive or sexual health information, and substance use disorder information.

If we maintain substance use disorder patient records that are protected by 42 C.F.R. Part 2, we will not use or disclose those Part 2 records in a civil, criminal, administrative, or legislative investigation or proceeding against you unless the disclosure is permitted by Part 2, including through your written consent or an appropriate court order and subpoena. Additional Part 2 restrictions may apply.

Electronic Communications, Patient Portal, and Telehealth

The Practice may communicate with you through its designated patient portal, telephone, telehealth technology, email, text, or other methods as permitted by law and consistent with your communication preferences. Secure portal messaging is intended for non-urgent communication during designated practice hours. Some ordinary communication channels can carry privacy risks, so sensitive clinical information should be sent through the secure method designated by the Practice whenever practicable. Virtual visits with Dr. Tolentino may occur only while you are physically located in California, Florida, New York, or Hawaii at the time of the visit. If Dr. Tolentino is temporarily unavailable, including during planned or unplanned absences, another appropriately qualified and licensed healthcare practitioner may provide limited coverage and access your health information as reasonably necessary for your care and as permitted by law.

Our Responsibilities

  • We are required by law to maintain the privacy and security of protected health information.
  • We will provide notice as required by law if a breach occurs that may have compromised the privacy or security of your information.
  • We must follow the duties and privacy practices described in the Notice currently in effect.
  • We will not use or disclose your information other than as described in this Notice or otherwise permitted by law unless you authorize us in writing. You may revoke a written authorization as permitted by law.
  • We apply the minimum-necessary standard when it is required and use reasonable safeguards to protect your information.

Changes to This Notice

We may change the terms of this Notice and make the revised Notice effective for all health information we maintain, including information created or received before the change. The current Notice will be available on our website, through the Practice, and upon request.

Questions or Complaints

To ask a privacy question, exercise a privacy right, request a copy of this Notice, or make a complaint to Tolentino Medical Corporation, contact our Privacy Officer:

Privacy Contact:
Privacy Officer
Tolentino Medical Corporation
(310) 736-1240
support@drjaclyntolentino.com		Mailing Address:
8601 Lincoln Blvd., Suite 180 PMB 249
Los Angeles, CA 90045

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights:

Tolentino Medical Corporation will not retaliate against you for filing a privacy complaint.

Practice Locations and Website

  • Manhattan Beach: 3201 N. Sepulveda Blvd., Unit F (2nd Floor), Manhattan Beach, CA 90266
  • Brentwood / Los Angeles: 11990 San Vicente Blvd., Suite 250, Los Angeles, CA 90049

Website: drjaclyntolentino.com