Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL AND FINANCIAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. REVIEW IT CAREFULLY. THE PRIVACY OF YOUR MEDICAL AND FINANCIAL INFORMATION IS VERY IMPORTANT TO US.
We are committed to maintaining the confidentiality of your medical and financial information. This Notice of Privacy Practices informs you about how we may collect, use, and disclose your personal information and your rights regarding that information.
Both State and Federal law require healthcare agencies to maintain the privacy of your health information. Health care agencies are required to give you this Notice about privacy practices, legal obligations, and your rights concerning your health information (“Protected health Information” or “PHI”). If you ever have any questions about privacy practices, please contact the office by email at firstname.lastname@example.org. Additional copies of this Notice can be obtained through the website: www.sinclairmethod.org
Uses and Disclosures of Protected Health Information (PHI)
Confidentiality is an essential aspect of mental health services. SinclairMethod.Org will not disclose any information about your care, including the fact that you are or have been a patient, without your written consent. If you provide written consent, you maintain the right to revoke that permission at any time. The possible legal exceptions to this policy are listed below.
Our responsibilities to protect your personal information
Under both the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Gramm-Leach-Bliley Act, we must take measures to protect the privacy of your personal information. In addition, other state and federal privacy laws may provide additional privacy protection. Examples of your personal information include your name, Social Security number, address, telephone number, account number, employment, medical history, health records, and claims information.
We are required by law to:
- protect the privacy of your personal information;
- provide this Notice explaining our duties and privacy practices regarding your personal information;
- notify you following a breach of your unsecured personal information; and
- abide by the terms of this Notice.
Permissible Uses and Disclosures without Your Written Authorization
- Where there is reason to suspect the occurrence of abuse or neglect of a child, a dependent adult, or a developmentally disable person.
- Where there is a clear threat to do serious bodily harm to yourself or others.
- In a response to a subpoena issued by the Secretary of Heath that is associated with a regulatory complaint.
- Disclosures for public health activities.
- Disclosures related to communicable diseases.
- Health oversight activities including disclosures to state or federal agencies authorized to access PHI
- If you are involved in some legal action, a court order might require your records.
- Disclosures for research when approved by an institutional review board.
- Disclosures to military or national security agencies, coroners, medical examiner, and correctional institutions.
- In the event of an emergency, emergency personnel or service providers may be given necessary information.
- In the event of the client’s death or disability, information may be released if the client’s personal or the beneficiary of an insurance policy on the client’s life signs a release authorizing disclosure.
- In the event you reveal the contemplation or commission of a crime or harmful act.
- For auditing purposes or state licensing review or as otherwise authorized by law.
- Your PHI will not be used for marketing or fundraising communications without your written consent.
- Uses and disclosures other than those described above will only be made with your written authorization. For example, you will need to sign an authorization form before I could send PHI to your attorney. You may revoke any such authorization at any time.
Your Individual Rights
- Right to inspect and copy: You may request access to your medical and billing records maintained by me in order to inspect and request copies of these records. All requests must be made in writing. You have the right to appeal any denials. You may be charged charge a fee for the costs of copying and sending you any requested records.
- Right to alternative communication: You may request any reasonable written request for you to receive alternative means of communication or at alternative locations.
- Right to request restrictions: You have the right to request restrictions on certain uses and disclosure of your healthcare information used for treatment, payment, or operations.
- Right to request amendment: You have the right to request that your PHI be amended. Your request must be in writing and your request may be denied under certain circumstances.
- Right to obtain notice: You have the right to obtain a copy of this Notice by contacting the office directly or through accessing the website at www.sinclairmethod.org
Question and Complaints
If you believe your privacy rights have been violated, you may file a complaint in writing with SinclairMethod.Org and/or with the Secretary of the Department of Health. You will not be retaliated against for filing such a complaint. You may contact the Dept. of Health at 360-236-4700, or by writing to Washington State Department of Health, Health Systems Quality Assurance, PO Box 47850, Olympia, WA 98504-7850. You can access information on acts of unprofessional conduct online at http://www.legal.wa.gov/wsladm/rcw.htm. You may also file written complaints with the Director, Office for Civil Rights of the US Department of Health and Human Services.
SinclairMethod.Org is required by law to abide by the terms of this document, though it is legally allowed to change the terms, and to make the provisions of any modified version effective for all healthcare information provided. You may request that a modified version be given to you or you may access a current electronic version through the website: www.sinclairmethod.org