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EASTSIDE COUNSELING CENTER

9757 NE JUANITA DRIVE SUITE #206,

KIRKLAND, WA 98034, USA

(425) 242-6267

[email protected]

HIPAA COMPLIANCE & NOTICE OF PRIVACY PRACTICES

This notice describes how medical information about you may be used and disclosed, and how you can get access to this information. This information will include Protected HealthInformation (PHI), as that term is defined in privacy regulations issued by the United States Department of Health and Human Services pursuant to the Health Insurance Portability andAccountability Act of 1996 (“HIPAA”) and, as applicable, RCW Chapter 70.02 entitled “MedicalRecords - Health Care Access and Disclosure.”

Eastside Counseling Center Services respects your privacy. We understand that yourPersonal health information is very sensitive. We will not disclose your information to others unless you tell us to do so, or unless the law authorizes or requires us to do so. The law protects the privacy of the health information we create and obtain in providing our careand services to you. For example, your protected health information includes your symptoms, test results, diagnoses, treatment, health information from other providers, andbilling and payment information relating to these services. Federal and state law allows us touse and disclose your protected health information for purposes of treatment and healthcare operations. State law requires us to get your authorization to disclose this informationfor payment purposes.

Protected Health Information (PHI):

PHI is defined as individually identifiable health information that is: transmitted by electronicmedia; maintained in any medium described in the definition of electronic media; ortransmitted or maintained in any other form or medium.

Examples of Use and Disclosure

For treatment: Information obtained by any member of our health care team will berecorded in your medical record and used to help decide what care may be right for you. Wemay also provide information to others providing you care, which will help them stayinformed about your care. We may disclose your health information to notify or assist in thenotification of a family member or anyone responsible for your care, in case of anyemergency involving your care, your location, your general condition or death. If at allpossible we will provide you with an opportunity to object to this use or disclosure. Underemergency conditions or if you are incapacitated we will use our professional judgment todisclose only that information directly relevant to your care. We will also use ourprofessional judgment to make reasonable inferences of your best interest by allowingsomeone to pick up filled prescriptions, x-rays or other similar forms of health informationand/or supplies unless you have advised us otherwise

For payment: In Washington State, written patient permission is required to use or disclose PHI for payment purposes, including to your health insurance plan (RCW 70.02.030(6)). Wewill have you sign a form for this purpose. Health plans need information from us aboutyour medical care. Information provided to health plans may include your diagnoses,procedures performed, or recommended care.

For health care operations: We use your medical records to assess quality and improveservices. We may use and disclose medical records to review the qualifications andperformance of our health care providers and to train our staff. We may contact you toremind you about appointments and give you information about treatment alternatives orother health-related benefits and services. We may use and disclose your information toconduct or arrange for services, including: medical quality review by your health plan;accounting, legal, risk management, and insurance services; audit functions, including fraudand abuse detection and compliance programs

Your Health Information Rights

The health and billing records we create and store are the property of Eastside CounselingCenter. The protected health information in it, however, generally belongs to you. You have a right to:

Receive, read, and ask questions about this Notice;
You have the right t ask us to restrict certain uses and disclosures. However, you must deliver this request in writing to us. We are not required to grant the request, but may comply with any request granted.
Request and receive from us a paper copy of the most current Notice of Privacy Practices for Protected Health Information (“Notice”);
Request that you be allowed to see and get a copy of your protected health information. You may make this request in writing. We have a form available for this type of request.
Have us review a denial of access to your health information—except in certain circumstances;
Ask us to change your health information. You may give us this request in writing. You may write a statement of disagreement if your request is denied. It will be stored in your medical record, and included with any release of your records.
When you request, we will give you a list of disclosures of your health information. The list will not include disclosures to third-party payors. You may receive this information without charge once every 12 months. We will notify you of the cost involved if you request this information more than once in 12 months.
Ask that your health information be given to you by another means or at another location. Please sign, date, and give us your request in writing.
Cancel prior authorizations to use or disclose health information by giving us a written revocation. Your revocation does not affect information that has already been released. It also does not affect any action taken before we have it. Sometimes, you cannot cancel an authorization if its purpose was to obtain insurance.
Amendment: You have the right to add an amendment to your healthcare information if you feel it is inaccurate or incomplete. Your request must be in writing and must include an explanation of why the information should be amended. Under certain circumstances, your request may be denied.

Psychotherapy Notes:

Notes recorded (in any medium) by a health care provider who is a mental health professional documenting or analyzing the contents of a conversation during a private counseling session or a group, joint, or family counseling session and that are separated from the rest of the individuals’ medical record. Psychotherapy notes exclude medication prescription and monitoring, counseling session start and stop times, the modalities and frequencies of treatment furnished, results of clinical tests, and any summary of the following items: diagnosis, functional status, the treatment plan, symptoms, prognosis, and progress to date. An authorization to use or disclose psychotherapy notes is required except if used by the originator of the notes for treatment, to a person or persons reasonably able to prevent or lessen the threat (including the target of the threat), if the originator believes in good faith that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public, if the notes are to be used in the course of training students, trainees or practitioners in mental health; to defend a legal action or any other legal proceeding brought forth by the patient; when used by a medical examiner or coroner; for health oversight activities of the originator; or when required by law.

Our Responsibilities

We are required to: Keep your protected health information private; Give you this Notice; Follow the terms of this Notice. We have the right to change our practices regarding the protected health information we maintain. If we make changes, we will update this Notice. You may receive the most recent copy of this Notice by calling and asking for it or by visiting our office or medical records department to pick one up.

To Ask for Help or Complain

If you have questions, want more information, or want to report a problem about the handling of your protected health information, you may contact: CCFH If you believe your privacy rights have been violated, you may discuss your concerns with CCFH.

Or You may send a written complaint to the Washington State Department of Health at:9757 NE Juanita Drive, Suite 206 Kirkland, WA 98034

You may also file a complaint with the U.S. Secretary of Health and Human Services.We respect your right to file a complaint with us or with the U.S. Secretary of Health andHuman Services. If you complain, we will not retaliate against you.

Other Disclosures and Uses of Protected Health InformationNotification of Family and Others

Unless you object, we may release health information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. We may tell your family or friends your condition and that you are in a hospital. This would be limited to your name and general health condition (for example, “critical,” “poor,” “fair,” “good” or similar statements). In addition, we may disclose health information about you to assist in disaster relief efforts. You have the right to object to this use or disclosure of your information. If you object, we will not use or disclose it. We may use and disclose your protected health information without your authorization as Follows:

To Report Suspected Abuse or Neglect: We may disclose your health information to appropriate public authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes. This information will be disclosed only to the extent necessary to prevent a serious threat to your health or safety or that of others.

With Medical Researchers - if the research has been approved and has policies to protect the privacy of your health information. We may also share information with medical researchers preparing to conduct a research project.
With Government Agencies as required by law.
To Comply With Workers’ Compensation Laws—if you file a workers’ compensation claim.
In the Course of Judicial/Administrative Proceedings at your request, or as directed by a subpoena or court order.
Incidental Disclosures. We may use or disclose PHI incident to a use or disclosure permitted by the HIPAA Privacy Rule so long as we have reasonably safeguarded against such incidental uses and disclosures and have limited them to the minimum necessary Information.

Special Authorizations

Certain federal and state laws that provide special protections for certain kinds of personal health information call for specific authorizations from you to use or disclose information. When your personal health information falls under these special protections, we will contact you to secure the required authorizations to comply with federal and state laws such as: Uniform Health Care Information Act (RCW 70.02), Sexually Transmitted Diseases (RCW70.24.105), Drug and Alcohol Abuse Treatment Records (RCW 70.96A.150), Mental Health Services for Minors (RCW 71.05.390-690), Communicable and Certain Other Diseases Confidentiality (WAC 246-100-016), Confidentiality of Alcohol and Drug Abuse Patients (42CFR Part 2).

If we need your health information for any other reason that has not been described in this notice, we will ask for your written authorization before using or disclosing any identifiable health information about you. Most importantly, if you choose to sign an authorization to disclose information, you can revoke that authorization at a later time to stop any future use and disclosure.

Other Uses and Disclosures of Protected Health Information

Uses and disclosures not in this Notice will be made only as allowed or required by law or with your written authorization.

Generalized Anxiety Disorder (GAD)

GAD affects 6.8 million adults, or 3.1% of the U.S. population, yet only 43.2% are receiving treatment.
Women are twice as likely to be affected as men.
GAD often co-occurs with major depression.

Panic Disorder(PD)

PD affects 6 million adults, or 2.7% of the U.S. population.
Women are twice as likely to be affected as men.

Social Anxiety Disorder (SAD)

SAD affects 15 million adults, or 6.8% of the U.S. population.
SAD is equally common among men and women and typically begins around age 13.
According to a 2007 ADAA survey, 36% of people with social anxiety disorder report experiencing symptoms for 10 or more years before seeking help.

Specific Phobias

Specific phobias affect 19 million adults, or 8.7% of the U.S. population.
Women are twice as likely to be affected as men.
Symptoms typically begin in childhood; the average age-of-onset is 7 years old.

Treatment For Anxiety

Psychotherapy or “talk therapy” can help people with anxiety disorders. To be effective, psychotherapy must be directed at the person’s specific anxieties and tailored to his or her needs.