HIPAA Notice of Privacy Practices
Effective Date of this Notice:
This notice went into effect on February 29, 2024.
NOTICE OF PRIVACY PRACTICES
This notice describes how health information may be used and disclosed and how you can get access to this information. Please review it carefully.
For additional information on HIPAA and Health Information, see the U.S. Department of Health and Human Services' website.
MY RESPONSIBILITIES REGARDING YOUR PROTECTED HEALTH INFORMATION (PHI)
I am required by law to maintain the privacy and security of your PHI.
I will let you know promptly if a breach occurs that may have compromised the privacy or security of your PHI.
I must follow the duties and privacy practices described in this notice and give you a copy of it.
I will not use or share your information other than as described here, unless you tell me I can in writing.
HOW I MAY USE AND DISCLOSE YOUR PHI
As a client of Deep Roots Counseling, your PHI is typically used or shared in the following ways:
To treat you. I can use and share your health information to provide, manage, or coordinate care. Disclosures for treatment purposes are not limited to the minimum necessary standard.
To run my practice. I can use and share your health information to run my practice, improve your care, and contact you when necessary.
To bill for services. I can use and share your health information with your health insurance plans or other entities, so they can help pay for your services.
USES AND DISCLOSURES THAT DO NOT REQUIRE YOUR AUTHORIZATION
In addition to the ways I typically use or share your PHI outlined immediately above, healthcare providers are allowed or required to share your information in other ways without written consent. Subject to certain limitations in the law, I can use and disclose your information without your authorization in the following cases:
To help with public health and safety issues.
To comply with the law.
To work with a medical examiner or funeral director.
To address workers’ compensation, law enforcement, and other government requests.
To respond to lawsuits and legal actions.
USES AND DISCLOSURES THAT YOU CAN OBJECT TO
If you have a clear preference for how I share your information in the following cases, tell me what you want me to do, and I will follow your instructions. Unless you object in whole or in part, I may disclose your PHI:
To a family member, friend, or other person that you indicate is involved in your care or the payment for your care.
In a disaster relief situation.
Be aware, consent may be obtained retroactively in emergency situations. If you are not able to tell me your preference, (e.g., if you are unconscious), I may go ahead and share your information if I believe it is in your best interest. I may also share your information, when needed, to lessen a serious and imminent threat to health or safety.
USES AND DISCLOSURES THAT REQUIRE YOUR AUTHORIZATION
In these cases, your information cannot be shared without written permission:
Marketing purposes. As a counselor, I will not use or disclose your PHI for marketing purposes.
Sale of your information. As a counselor, I will not use or sell your PHI in the regular course of my business.
Most sharing of psychotherapy notes. I keep “psychotherapy notes” as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your written authorization, except when the use or disclosure is:
For my use in treating you.
For my use in clinical consultation or supervision.
For my use in defending myself in legal proceedings instituted by you.
For use by the Secretary of Health and Human Services to investigate my compliance with HIPAA.
Required by law and the use or disclosure is limited to the requirements of such law.
Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes.
Required by a coroner who is performing duties authorized by law.
Required to help avert a serious threat to the health and safety of others.
YOUR RIGHTS REGARDING YOUR PHI
Any requests with respect to these rights must be in writing. A brief description of how you may exercise these rights is included.
Right of Access to Inspect and Copy. You can ask to review the health information I have about you for as long as I maintain the record. I will provide an electronic or paper copy and may charge you a reasonable cost-based fee for the copying and transmitting of your PHI. I can deny you access in certain circumstances. In some of those cases, you will have a right of recourse to the denial of access. Please contact me if you have questions about access to your medical record
Right to Amend. You may request that I amend your health information if you think it is incorrect or incomplete. You must identify what information you want changed, and explain why. I may deny your request for an amendment but will explain my decision in writing within 60 days.
Right to an Accounting of Disclosures. You may ask for an accounting of the times I’ve shared your health information, who I shared it with, and why for a period of up to six years. I will include all disclosures except for those about treatment, payment, and health care operations and those made to you or with your authorization. I may charge you a reasonable fee if you request more than one accounting in any 12-month period.
Right to Request Restrictions. You have the right to ask me not to use or disclose certain health information for treatment, payment, or health care operations, although I am not required to agree to your request, and I may decline if it would affect your care. You also have the right to restrict certain disclosures of your PHI to your health insurer if you pay out of pocket in full for the healthcare that I provide to you. Please contact me if you would like to request restrictions on the disclosure of your PHI.
Right to Request Confidential Communication. You can ask me to contact you in a specific way or to send mail to a different address. I will accommodate reasonable written requests, although I may condition this accommodation on specification of an alternative address or other method of contact. Please contact me if you would like to make this request.
Right to a Copy of this Notice. You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically, and I will provide you with a paper copy promptly.
Right to Choose Someone to Act for You. You have the right to have a medical power of attorney or your legal guardian exercise your rights and make choices about your health information. I will make sure the person has this authority and can act for you before taking any action.
Right to File a Complaint. If you believe I have violated your privacy rights, you may file a complaint with me, as my own Privacy Officer. You also have the right to file a complaint with the Washington Department of Health. I will not retaliate against you in any way for filing a complaint.
CHANGES TO THE TERMS OF THIS NOTICE
I reserve the right to change the terms of my Notice of Privacy Practices at any time. Any new Notice of Privacy Practices will be effective for all PHI that I maintain at that time. I will make available a revised Notice of Privacy Practices by sending you an electronic copy or, upon request, sending a copy to you in the mail.
CONTACT INFORMATION
I act as my own Privacy and Security Officer. If you have any questions about this Notice of Privacy Practices, please contact me. My contact information is:
Darby Robertson
Address: 614 W McGraw St, Suite 204, Seattle, WA 98119
Phone: (206) 627-0874
Email: darby@deeproots-counseling.com