HIPAA AND WASHINGTON STATE

NOTICE OF PRIVACY PRACTICES

Modern Therapy Seattle

2366 Eastlake Ave E. #402
Seattle, WA 98102
(901) 206-5535

 

NOTICE

Modern Therapy Seattle maintains records of the health care services provided to you. You have the right to obtain copies of those records, request amendments or corrections to the record, and understand how your information is used and disclosed. Modern Therapy Seattle will not disclose your health information to others without your authorization unless permitted or required by law.

You may request a copy of your record of receive information by contacting us at:

2366 Eastlake Ave E. #402,

Seattle, WA 98102

(901) 206-5535

 

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION.

PLEASE REVIEW IT CAREFULLY.

 

Protected Health Information (PHI)

Your health record contains personal information about you and your health. Federal and Washington State laws protect the confidentiality of this information.  Protected Health Information (PHI) includes information that identifies you (including demographic information) and that relates to your past, present, or future physical and mental health, or condition, and related health care services. 

This Notice of Privacy Practices describes:

  • How Modern Therapy Seattle may use and disclose your PHI

  • Your rights regarding how you may gain access to and control your PHI. 

  • The legal duties of Modern Therapy Seattle regarding your PHI

Modern Therapy Seattle is required by law to:

  • Maintain the privacy of your PHI

  • Provide you with this Notice of Privacy Practices

  • Abide by the terms of this Notice of Privacy Practices currently in effect

We reserve the right to change this Notice of Privacy Practices at any time. Any revised Notice will apply to all PHI maintained by Modern Therapy Seattle and will be made available on our website, electronically, or in person.

How We May Use and Disclose Your PHI

For Treatment. 

Modern Therapy Seattle may use and disclose your PHI to provide, coordinate, or manage your mental and relational health care. This includes individual therapy, relational therapy, sex therapy, creative arts therapies, group therapy, consultation among clinicians within the practice, supervision, training, and referrals to other providers.

Group Therapy & Confidentiality.

Group therapy involves the sharing of information among multiple participants. While our clinicians take reasonable steps to protect your privacy, we cannot guarantee that other group members will maintain the confidentiality of information disclosed in group sessions. Group members are expected to respect the privacy of others, but they are not legally bound by HIPAA.

For Payment.  

Modern Therapy Seattle may use and disclose your PHI to obtain payment for services provided, including issuance of superbills or collecting unpaid balances.

For Healthcare Operations. 

Modern Therapy Seattle may use or disclose PHI to support the operations of Modern Therapy Seattle, including quality assurance, clinical supervision, training, administrative functions, scheduling, legal or accounting services, and business management. When PHI is shared with business associates, appropriate agreements are in place to safeguard your information.

Telehealth and Electronic Communication.

We may use and disclose PHI through secure electronic systems, including telehealth platforms, electronic health records, scheduling software, billing systems, and secure email. While reasonable safeguards are used, electronic communications carry some inherent risk.

Without Your Authorization.

We may disclose PHI without your written authorization when permitted or required by law, including:

  • Required by Law:

    • Modern Therapy Seattle may use or disclose your PHI to the extent that the use or disclosure is required by law, made in compliance with the law, and limited to the relevant requirements of the law. Examples of this type of disclosure include healthcare licensure related reports, public health reports, and law enforcement reports.  Under the law, Modern Therapy Seattle must make certain disclosures of your PHI to you upon your request.  In addition, Modern Therapy Seattle must make disclosures to the US Secretary of the Department of Health and Human Services for the purpose of investigating or determining my compliance with the requirements of privacy rules.

  • Health Oversight:

    • Modern Therapy Seattle may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies and organizations that provide financial assistance to the program (such as third-party payors) and peer review organizations performing utilization and quality control.  If Modern Therapy Seattle discloses PHI to a health oversight agency, to the extent Moderm Therapy Seattle is required by law will have an agreement in place that requires the agency to safeguard the privacy of your information.

  • Abuse, Neglect, or Exploitation:

    • Modern Therapy Seattle may disclose your PHI to a state or local agency that is authorized by law to receive reports of abuse or neglect.  However, the information we disclose is limited to only that information which is necessary to make the initial mandated report.

  • Threats to Health or Safety:

    • Modern Therapy Seattle may disclose your PHI to law enforcement officials if your clinician reasonably believes that the disclosure will avoid or minimize an imminent threat to the health or safety of yourself or any third party.

  • Judicial and Administrative Proceedings:

    • Modern Therapy Seattle may be required to disclose your PHI if a court of competent jurisdiction issues an appropriate order, if Modern Therapy Seattle has been notified in writing at least fourteen days in advance of a subpoena or other legal demand, if required, if no protective order has been obtained, and if a competent judicial officer has determined that the rule of privilege does not apply.

  • Coroners, Medical Examiners, and Deceased Clients

    • Modern Therapy Seattle may disclose PHI regarding deceased clients for the purpose of determining the cause of death, in connection with laws requiring the collection of death or other vital statistics or permitting inquiry into the cause of death.

  • Essential Government Functions

    • Modern Therapy Seattle may be required to disclose your PHI for certain essential government functions.  Such functions include assuring proper execution of a military mission, conducting intelligence and national security activities that are authorized by law, providing protective services to the President, making medical suitability determinations for U.S. State Department employees, protecting the health and safety of inmates or employees in a correctional institution, and determining eligibility for or conducting enrollment in certain government benefit programs.

  • Research:

    • Modern Therapy Seattle may disclose PHI to researchers if (a) an Institutional Review Board reviews and approves the research and a waiver to the authorization requirement; (b) the researchers establish protocols to ensure the privacy of your PHI; and (c) the researchers agree to maintain the security of your PHI in accordance with applicable laws and regulations.

  • Law Enforcement Purposes:

    • Modern Therapy Seattle may be authorized to disclose your PHI to law enforcement officials for law enforcement purposes under the following six circumstances, and subject to specified conditions: (1) as required by law (including court orders, court-ordered warrants, and subpoenas) and administrative requests; (2) to identify or locate a suspect, fugitive, material witness, or missing person; (3) in response to a law enforcement official’s request for information about a victim or suspected victim of a crime; (4) to alert law enforcement of a person’s death, if I suspect that criminal activity caused the death; (5) when I believes that protected health information is evidence of a crime that occurred on my premises; and (6) in a medical emergency not occurring on my premises, when necessary to inform law enforcement about the commission and nature of a crime, the location of the crime or crime victims, and the perpetrator of the crime.

  • Psychotherapy Notes.

    • Modern Therapy Seattle must obtain your authorization to use or disclose psychotherapy notes with the following exceptions.  Clinicians at Modern Therapy Seattle may use the notes for your treatment. Modern Therapy Seattle may also use or disclose, without your authorization, the psychotherapy notes for my own training, to defend myself in legal or administrative proceedings initiated by you, as required by the Washington Department of Health or the US Department of Health and Human Services to investigate or determine my compliance with applicable regulations, to avert a serious and imminent threat to public health or safety, to a health oversight agency for lawful oversight, for the lawful activities of a coroner or medical examiner or as otherwise required by law.

With Authorization.

We will obtain your written authorization before:

  • Using or disclosing psychotherapy notes (except as noted above)

  • Using PHI for marketing purposes

  • Selling PHI

You may revoke an authorization in writing at any time in writing in accordance with 45 CFR. 164.508(b)(5).

Incidental Use and Disclosure.  I am not required to eliminate every risk of an incidental use or disclosure of your PHI.  Specifically, a use or disclosure of your PHI that occurs as a result of, or incident to an otherwise permitted use or disclosure is permitted as long as I have adopted reasonable safeguards to protect your PHI, and the information being shared was limited to the minimum necessary.

Your Rights Regarding Your PHI

You have the following rights regarding PHI that Modern Therapy Seattle maintains about you.  Any requests with respect to these rights must be in writing.  A brief description of how you may exercise these rights is included.

You have the right to:

Access and Copies

You may inspect and obtain a copy of your PHI that is contained in a designated record set for as long as Modern Therapy Seattle maintains the record.  A “designated record set” contains medical and billing records and any other records that your clinician at Modern Therapy Seattle uses for making decisions about you.  Your request must be in writing.  Modern Therapy Seattle may charge you a reasonable cost-based fee for the copying and transmitting of your PHI.  Modern Therapy Seattle can deny you access to your PHI in certain circumstances.  In some of those cases, you will have a right of recourse to the denial of access.  Please contact Modern Therapy Seattle if you have questions about access to your medical record.

Amendments

You may request, in writing, that Modern Therapy Seattle amends your PHI that has been included in a designated record set.  In certain cases, Modern Therapy Seattle may deny your request for an amendment.  If Modern Therapy Seattle denes your request for amendment, you have the right to file a statement of disagreement.  Modern Therapy Seattle may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.

Accounting of Disclosures

You may request an accounting of disclosures other than those made to you, for treatment purposes, or made as a result of your authorization, for a period of up to six years.  Modern Therapy Seattle may charge you a reasonable fee if you request more than one accounting in any 12-month period.  Please contact me Modern Therapy Seattle if you have questions about accounting of disclosures.

Restrictions

You have the right to ask Modern Therapy Seattle not to use or disclose any part of your PHI for treatment, payment or health care operations or to family members involved in your care.  Your request for restrictions must be in writing and Modern Therapy Seattle is not required to agree to such restrictions.  You also have the right to restrict certain disclosures of your PHI to your health plan if you pay out of pocket in full for the healthcare that Modern Therapy Seattle provides to you.  Please contact Modern Therapy Seattle if you would like to request restrictions on the disclosure of your PHI.

Confidential Communications

You have the right to request to receive confidential communications from Modern Therapy Seattle by alternative means or at an alternative location.  Modern Therapy Seattle will accommodate reasonable written requests.  Modern Therapy Seattle may also condition this accommodation by asking you for information regarding how payment will be handled or specification of an alternative address or other method of contact.  Please contact Modern Therapy Seattle if you would like to make this request.

Copy of This Notice

You have the right to obtain a copy of this notice from Modern Therapy Seattle.  Any questions you have about the contents of this document should be directed to Modern Therapy Seattle.

Breach Notification

You have the right to be notified of any breach of your unsecured PHI.

Contact Information

Modern Therapy Seattle designates a Privacy Officer responsible for compliance with privacy and security regulations.

Modern Therapy Seattle
Privacy Officer
2366 Eastlake Ave E. #402
Seattle, WA 98102
(901) 206-5535

 

Complaints

If you believe your privacy rights have been violated, you may file a written complaint with Modern Therapy Seattle’s Privacy Officer or with the Washington State Department of Health or the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.

 

Effective Date

Effective date of this notice: January 1, 2025