Notice of Privacy Practices
Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information.
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
I. OUR PLEDGE REGARDING HEALTH INFORMATION:
Alliant Therapy Group, PLLC (ATG) understands that health information about you and your healthcare is personal, and we are committed to protecting your health information. We create a record of the care and services you receive from our clinic, and this record is needed to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by this mental health care practice. This notice will tell you about the ways in which we may use and disclose health information about you. It also describes your rights to the health information kept about you, and describes certain obligations we have regarding the use and disclosure of your health information. We are required by law to:
Make sure that protected health information (PHI) that identifies you is kept private.
Give you this notice of ATG’s legal duties and privacy practices with respect to health information.
Follow the terms of the notice currently in effect.
ATG can change the terms of this Notice, and such changes will apply to all information we have about you. Any new Notice will be sent to you via ATG’s client portal.
II. HOW ATG MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU:
The following categories describe different ways that ATG may use and disclose health information. Not every use or disclosure in a category will be listed. However, all of the ways ATG is permitted to use and disclose information will fall within one of the categories. For Treatment Payment, or Health Care Operations:
Federal privacy rules and regulations allow healthcare providers who have a direct treatment relationship with the client to use or disclose the clients personal health information without the clients written authorization, to carry out the healthcare providers own treatment, payment, or healthcare operations. ATG may also disclose your protected health information for the treatment activities of any health care provider. This too can be done without your written authorization. For example, if a clinician were to consult with another licensed healthcare provider about your condition, we would be permitted to use and disclose your personal health information, which is otherwise confidential, in order to assist the clinician in diagnosis and treatment of your mental health condition.
Disclosures for treatment purposes are not limited to the minimum necessary standard, because therapists and other healthcare providers need access to the full record and/or full and complete information in order to provide quality care. The word treatment includes, among other things, the coordination and management of healthcare providers with a third party, consultations between healthcare providers, and referrals of a patient for healthcare from one healthcare provider to another.
Lawsuits and Disputes: If you are involved in a lawsuit, ATG may disclose health information in response to a court or administrative order. ATG may also disclose health information about your child, if applicable, in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:
1. Psychotherapy Notes. ATG providers do keep psychotherapy notes as that term is defined in 45 CFR 164.501, and any use or disclosure of such notes requires your Authorization unless the use or disclosure is:
a. For use in treating you.
b. For use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy.
c. For use in defending ATG and/or any of its clinicians in legal proceedings instituted by you.
d. For use by the Secretary of Health and Human Services to investigate ATG’s compliance with HIPAA.
e. Required by law and the use or disclosure is limited to the requirements of such law.
f. Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.
g. Required by a coroner who is performing duties authorized by law.
h. Required to help avert a serious threat to the health and safety of others.
2. Marketing Purposes. ATG will not use or disclose your PHI for marketing purposes.
3. Sale of PHI. ATG will not sell your PHI in the regular course of business.
IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION. Subject to certain limitations in the law, ATG can use and disclose your PHI without your Authorization for the following reasons:
1. When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.
2. For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyones health or safety.
3. For health oversight activities, including audits and investigations.
4. For judicial and administrative proceedings, including responding to a court or administrative order, although ATG’s preference is to obtain an Authorization from you before doing so.
5. For law enforcement purposes, including reporting crimes occurring on ATG’s premises.
6. To coroners or medical examiners, when such individuals are performing duties authorized by law.
7. For research purposes, including studying and comparing the mental health of patients who received one form of therapy versus those who received another form of therapy for the same condition.
8. Specialized government functions, including ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counter-intelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.
9. For workers’ compensation purposes. Although ATG’s preference is to obtain an Authorization from you, ATG may provide your PHI in order to comply with workers’ compensation laws.
10. Appointment reminders and health related benefits or services. ATG may use and disclose your PHI to contact you to remind you that you have an appointment. ATG may also use and disclose your PHI to tell you about treatment alternatives, or other healthcare services or benefits offered at this clinic.
V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT.
1. Disclosures to family, friends, or others. ATG may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your healthcare, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.
VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:
1. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask ATG not to use or disclose certain PHI for treatment, payment, or healthcare operations purposes. ATG is not required to agree to your request and may say no if it is believed that it would affect your healthcare.
2. The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.
3. The Right to Choose How ATG Sends PHI to You. You have the right to ask ATG to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and ATG will agree to all reasonable requests.
4. The Right to See and Get Copies of Your PHI. Other than psychotherapy notes, you have the right to get an electronic or paper copy of your medical record and other information that ATG has about you. ATG will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your
written request, and may charge a reasonable, cost-based fee for doing so.
5. The Right to Get a List of the Disclosures ATG Has Made. You have the right to request a list of instances in which ATG has disclosed your PHI for purposes other than treatment, payment, or healthcare operations, or for which you provided ATG with an Authorization. ATG will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list ATG will give you will include disclosures made in the last six years unless you request a shorter time. ATG will provide the list to you at no charge, but if you make more than one request in the same year, ATG will charge you a reasonable cost-based fee for each additional request.
6. The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that ATG correct the existing information or add the missing information. ATG may say no to your request, but will tell you why in writing within 60 days of receiving your request.
7. The Right to Get a Paper or Electronic Copy of this Notice. You have the right to get a paper copy of this Notice, and you have the right to get a copy of this notice by e- mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it.
SEPARATE ENTITY: Alliant Therapy Group, PLLC is a separate entity and leases office space from Gina Guddat Properties (Seattle) and Starlight Investors, LLC (Edmonds).