CLIENT Notices

This notice describes how medical information about you can be used and disclosed and how you can get access to this information. Please review this notice carefully. This statement contains summary information about our services and the Health Insurance Portability and Accountability Act (HIPAA) that provides privacy protections and client rights with regard to the use and disclosure of your Protected Health Information (PHI) use for the purpose of treatment, payment, and health care operations. As a Licensed Marriage and Family Therapist, licensed Washington State Department of Health, I create and maintain treatment records that contain individually identifiable health information about you. These records are generally referred to as “medical records” or “mental health records,” or “Protected Health Information (PHI)”. This notice, among other things, concerns the privacy and confidentiality of those records and the information contained therein. I am required by law to maintain the privacy and confidentiality of your personal health information. This notice is intended to let you know of my legal duties, your rights, and my privacy practices with respect to such information. I am required to abide by the terms of the notice currently in effect. I reserve the right to change the terms of this notice and/or my privacy practices and to make the changes effective for all protected health information that I maintain, even if it was created or received prior to the effective date of the notice revision. If I make a revision to this notice, I will make the notice available at my office upon request on or after the effective date of the revision and I will post the revised notice in a clear and prominent location. Use and Disclosure of your PHI Federal privacy rules and regulations allow health care providers who have a direct treatment relationship with the client to use or disclose the client’s personal health information, without the client’s written authorization, to carry out treatment, payment, or health care operations. ​ Treatment. I may use your PHI for the purpose of providing you with health care treatment. To coordinate and manage your care, I may disclose your PHI with your written consent to your current providers, or to other persons, including family members involved in your care. Without your written consent, I may consult with another licensed health care provider about your condition, I would be permitted to use and disclose your personal health information, which is otherwise confidential, in order to assist me in the diagnosis or treatment of your mental health condition or to make an appropriate referral for additional services. Payment. If your health plan requests a copy of your health records, or a portion thereof, in order to determine whether or not payment is warranted under the terms of your policy or contract, I am permitted to use and disclose your personal health information without your authorization. With your verbal or written authorization, your PHI may also be used to obtain information related to benefit eligibility, coverage, fees from your insurance company. I may also disclose your information to business associates such as lawyers and billing agencies. Without your written authorization, I may use and disclose your protected PHI so that I can receive payment for the treatment services provided to you including using third parties to help collect any payment owed. ​ Health Care Operations. I may use and disclose your PHI for the health care operations of my professional practice in support of the functions of treatment and payment. Such disclosures would be if your health plan decides to audit my practice in order to review my competence and my performance, or to detect possible fraud or abuse, your mental health records may be used or disclosed for those purposes. State and Federal law also permits me to disclose information about you without your authorization in situations. I may be required or permitted to disclose your personal health information (e.g., your mental health records) without your written authorization. The following circumstances are examples of when such disclosures may or will be made: -To the extent disclosure is required by law - For health oversight activities including licensing boards and insurance company audits and if disclosure is compelled by a board, commission, or administrative agency pursuant to an investigative subpoena issued pursuant to its lawful authority. -For public health and safety purposes as allowed or required by law - To report suspected abuse or neglect of a vulnerable person such as child or elderly person. - In the course of judicial/administrative proceedings including subpoenas and court orders. - For law enforcement purposes as allowed or required by law and if disclosure is compelled by a search warrant lawfully issued to a governmental or law enforcement agency. - Concerns regarding safety of yourself or another person (s) such as: You are in such mental or emotional condition as to be dangerous to yourself or to the person or property of others, and if I determine that disclosure is necessary to prevent the threatened danger. You tell me of a serious threat (imminent) of physical violence to be committed by you against a reasonably identifiable victim or victims. The above list is not an exhaustive list, but informs you of most circumstances when disclosures without your written authorization may be made. Other uses and disclosures will generally (but not always) be made only with your written authorization, even though federal privacy regulations or state law may allow additional uses or disclosures without your written authorization. Uses or disclosures made with your written authorization will be limited in scope to the information specified in the authorization form, which must identify the information “in a specific and meaningful fashion.” You may revoke your written authorization at any time, provided that the revocation is in writing and except to the extent that I have taken action in reliance on your written authorization. Your right to revoke an authorization is also limited if the authorization was obtained as a condition of obtaining insurance coverage for you. In general, uses or disclosures by me of your personal health information (without your authorization) will be limited to the minimum necessary to accomplish the intended purpose of the use or disclosure. Similarly, when I request your personal health information from another health care provider, health plan or health care clearinghouse, I will make an effort to limit the information requested to the minimum necessary to accomplish the intended purpose of the request. ​ Your Rights Regarding Protected Health Information Right to access, inspect, and copy. You have the right to request, inspect, and receive a copy of your records, with the exception of some information which may be restricted. A fee may be charged for all records released. All requests for a copy of your records must be in writing. ​ Right to Request Restrictions. You have the right to request a restriction or limitation on the use or disclosure of your PHI. I am not required to agree to your request if Washington State or Federal laws require the release of information. ​ Right to Request Confidential Communication. You have the right to request how I can communicate with you. ​ Right to Amend. If you believe your PHI is incorrect or incomplete, you have the right to request an amendment to your PHI. ​ Right to an Accounting of Disclosures. You have the right to request an accounting of certain disclosures of your PHI. ​ Right to a Copy of this Notice. You have the right to receive a copy of this notice. As the Privacy Officer of this practice, Tina Hanson has a duty to develop, implement and adopt clear privacy policies and procedures for Beyond Solutions Counseling and has so. Tina Hanson is the individual who is responsible for assuring that these privacy policies and procedures are followed not only by me, but by any employees that work for me or that may work for Beyond Solutions Counseling in the future. Tina Hanson has trained or will train any employees that may work for Beyond Solutions Counseling so that they understand the privacy policies and procedures. In general, client records, and information about clients, are treated as confidential in my practice and are released to no one without the written authorization of the client, except as indicated in this notice or except as may be otherwise permitted by law. Client records are kept secured so that they are not readily available to those who do not need them. Because Tina Hanson is the owner of this practice, you may complain to her and to the Washington State Department of Health if you believe your privacy rights may have been violated by those who are employed by Beyond Solutions Counseling. You may file a complaint with Tina by simply providing Tina with a writing that specifies the manner in which you believe the violation occurred, the approximate date of such occurrence, and any details that you believe will be helpful. My telephone number is (206) 718-8185. I will not retaliate against you in any way for filing a complaint with me or the Washington State Department of Health. ​ As a consumer, you have certain basic rights as follows: you have the right to appropriate care and treatment, employing the least restrictive alternatives available, the rights to choose a counselor who best suits your needs and purposes; the right to be treated with respect and dignity; the right to receive treatment which is non-discriminatory and sensitive to difference of race, culture, language, sex, age, national origin, disability, creed socioeconomic status, sexual orientation; the right to an individualized treatment plan reflecting the concerns and needs you identified; the right to confidentiality; the right to refuse any proposed treatment; the right to review your case record under specified conditions; the right to be free of any sexual exploitation or harassment; and the right to lodge a grievance if you feel your rights have been violated. Complaints about the work or ethical behavior of any counselor can be directed to: Washington State Department of Health Health System Quality Assurance Complaint Intake P.O. Box 46857 Olympia, WA 98504-7857 (360) 236-4700 http://www.doh.wa.gov/LicensesPermitsandCertificates/FileComplaintAboutProviderorFacility “ Counselors practicing counselor for a fee must be registered or licensed with the Department of License for the protection of the public health and safety. A registration of an individual with the department does not include a recognition of any practice standards nor necessarily implies the effectiveness of any treatment.” If you need or desire further information related to this Notice or its contents, or if you have any questions about this Notice or its contents, please feel free to contact me at (206) 718-8185. As the owner of this practice, I will do my best to answer your questions and to provide you with additional information. Tina Hanson, owner of Beyond Solutions Counseling ​