Privacy Statement

Protecting Your Privacy


Tessie Cleveland has always been committed to protecting our clients' privacy and maintaining the confidentiality of their personal and medical information in all settings. In fact, we have a special committee dedicated to monitoring all of our processes and procedures to protect this important information.

The Notice of Privacy Practices describes Tessie Cleveland's comprehensive policy regarding the confidentiality of client information.


A copy of our Notice of Privacy Practices can be downloaded and viewed below:

LACDMH Notice of Privacy Practices

Notice of Privacy Practices [English]

Notice of Privacy Practices [Spanish]




As a client of Tessie Cleveland, you can ask Tessie Cleveland to release or discuss your own personal health information. In some instances, someone else can act as a client's "personal representative" - for example, a parent for a child, or a legal guardian for an incapacitated adult - and receive health information on behalf of the client.

If someone other than the client or the client’s personal representative (for example, a client’s  spouse) asks Tessie Cleveland to release or discuss that client's personal health information, Tessie Cleveland will require the client to submit a HIPAA Authorization Form specifically granting such third-party access.

Tessie Cleveland also has an addendum at the bottom of the HIPAA Authorization Form titled “Revocation of Authorization” that a client can use to revoke, or cancel, a HIPAA Authorization. A client can revoke a HIPAA Authorization at any time.

A copy of our HIPAA Authorization Form can be downloaded and viewed below:

HIPAA Authorization Form




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