HIPAA

NOTICE OF PRIVACY PRACTICES

Olympia Therapy PLLC

1534 Bishop Rd SW Tumwater WA 98512 360.357.2370 office. 360.357.2374 fax info@olympiatherapy.com www.olympiatherapy.com

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.

As part of my professional practice, I maintain personal information about you and your health. State and federal law protects such information by limiting its uses and disclosures. “Protected Health Information” (“PHI”) is information about you, including demographic information, that may identify you or be used to identify you, and that relates to your past, present or future physical or mental health condition, the provision of health care services, or the past, present or future payment for the provision of health care.

Your Rights Regarding Your PHI The following are your rights regarding PHI I maintain about you:

❖ Right of Access to Inspect and Copy. You have the right, which may be restricted only in certain limited circumstances, to inspect and copy your PHI that I maintain. I may charge a reasonable, cost-based fee for copies.
❖ Right to Amend. If you feel that the PHI I have about you is incorrect or incomplete, you may ask me to amend the information although I am not required to agree to the amendment.
❖ Right to an Accounting of Disclosures. You have the right to request a copy of the required accounting of disclosures that I make of your PHI.
❖ Right to Request Restrictions. You have the right to request restriction or limitation on the use or disclosure of your PHI for treatment, payment, or health care operations. I am not required to agree to your

request.
❖ Right to Request Confidential Communication. You have the right to request that I communicate with you in a certain way or at a certain location. I will accommodate reasonable requests and will not ask why

you are making the request.
❖ Right to a Copy of this Notice. You have the right to a paper copy of this notice.
❖ Right of Complaint. You have the right to file a complaint in writing with me or with the Secretary of Health and Human Service if you believe I have violated your privacy rights. I will not retaliate against you

for filing a complaint.

My Uses and Disclosures of PHI for Treatment, Payment, and Health Care Operations
Treatment: I may use your PHI for the purpose of providing you with health care treatment. To coordinate and manage your care, I may disclose your PHI to others of your current providers, and to the extent you have not raised an objection in writing to your prior providers, or to other persons, including family members, involved in your care.
Payment: I may use your PHI in connection with billing statements and my system for tracking charges and credits to your account. In addition, but with your authorization, I may disclose your PHI to third payers to obtain information concerning benefit eligibility, coverage, and remaining availability, as well as to submit claims for payment and to disclose PHI for medical necessity and quality assurance reviews.
Health Care Operations: I may use and disclose to you PHI for the health care operations of my professional practice in support of the functions of treatment and payment. Such disclosures would be to Business Associates for health care education, or to provide planning, quality assurance, peer review, administrative, legal, or financial services to assist in the delivery of your health care.
Other Uses and Disclosures That Do Not Require Your Authorization or Opportunity to Object
Required by Law. I 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 are public health reports, abuse and neglect reports, law enforcement reports, and reports to coroners and medical examiners in connection with investigation of deaths. I also must make disclosures to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining my compliance with the requirements of the Privacy Rule. Health Oversight. I may disclose your PHI to a health oversight agency for activities authorized by law, such as my professional licensure. Oversight agencies also include government agencies and organizations that audit their provision of payment to me (such as third-party payers). Threat of Health or Safety. I may disclose your PHI when necessary to minimize an imminent danger to the health or safety of you or any other individual. Business Associates. I may disclose your PHI to Business Associates that are contracted by me to perform health care operations or payment activities on my behalf, which may involve their collection, use, or disclosure of your PHI. My contract with them must require them to safeguard the privacy of your PHI. Compulsory Process. I will disclose your PHI if a court of competent jurisdiction issues an appropriate order. I will also disclose your PHI if (1) you and I have each been notified in writing at least fourteen days in advance of a subpoena or other legal demand, identifying the PHI sought, and the date by which a protective order must be obtained to avoid my compliance, (2) no qualified judicial or administrative protective order has been obtained, (3) I have received satisfactory assurances that you received notice of an opportunity to have limited or quashed the discovery demand, and (4) such time has elapsed. Electronic Health Record. For medical recordkeeping, our office uses Practice Fusion, which is supported by advanced encryption and is fully HIPPA compliant. Paper records can be scanned, uploaded securely and duplicates destroyed. See http://www.practicefusion.com/pages/secure reliable her.html for details.

Uses and Disclosures of PHI With Your Written Authorization

I will make other uses and disclosures of your PHI only with your written authorization. You may revoke such authorization in writing at any time, unless I have taken substantial action in reliance on the authorization such as providing you with health care services for which I must submit subsequent claim(s) for payment. This Notice
This Notice of Privacy Practices informs you of how I may use and disclose your protected health information (“PHI”) and your rights regarding your PHI. I am required by law to maintain the privacy of your PHI and to provide you with notice of my legal duties and privacy practices with respect to your PHI. I am required to abide by the terms of the Notice of Privacy Practices. 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 providing you a copy upon your request, or providing a copy to you at your next appointment.

Contact Information

If you have any questions about this Notice of Privacy Practices, please contact the office at:

Olympia Therapy LLC
1534 Bishop Rd SW, Tumwater, WA 98512 (360) 357.2370 office or (360) 357.2374 fax

Complaints: If you believe someone has violated your privacy rights, you may file a complaint in writing to the office. We will not retaliate against you for filing a complaint. You may also file a complaint with the Secretary of the Department of Health and Human Services.

Counseling or Hypnotherapy Clients

Client and Counselor Responsibilities and Rights

Counselors must provide disclosure information to each client per chapter 18.19 RCW prior to the implementation of a treatment plan. The disclosure information must be specific to the type of counseling service offered; in language that can be easily understood by the client; and contain sufficient detail to enable the client to make an informed decision whether or not to accept treatment from the disclosing counselor.

If you have concerns about being dependent upon your counselor or hypnotherapist, talk to him or her about it. Remember, you are going to that person to seek assistance that helps you learn how to control your own life. You can and should ask questions if you don’t fully understand what your counselor or hypnotherapist is doing or plans to do.

Requirements for Registration or Licensure

Your counselor or hypnotherapist must be either registered under chapter 18.19 RCW or certified under chapter 18.25 through the Washington State Department of Health unless otherwise exempt. To be registered, a person fills out an application and pays a fee. To become licensed, a person fills out an application form and pays a fee, but he or she must also show proof of appropriate education and training. There are some people who do not need to be either registered or certified because they are exempt from the law. You should ask your counselor or hypnotherapist if he or she is registered or licensed and discuss his or her qualifications to be your counselor or hypnotherapist.

Definitions

Counseling means using therapeutic techniques to help another person deal with mental, emotional, and behavioral problems or to develop human awareness and potential. A registered or certified counselor is a person who gets paid for providing counseling services.

Confidentiality

Your counselor or hypnotherapist cannot disclose any information you’ve told them during a counseling session except as authorized by RCW 18.19.180:
1. With the written consent of that person or, in the case of death or disability, the person’s personal representative, other person authorized to sue, or the beneficiary or an insurance policy on the person’s life, health, or physical condition;

That a person registered or certified under this chapter is not required to treat as confidential communication that reveals the contemplation or commission of a crime or harmful act;
If the person is a minor, and the information acquired by the person registered or certified under this chapter indicates that the minor was the victim or subject of a crime, the person registered or certified may

testify fully upon any examination, trial, or other proceedings in which the commission of the crime is the subject of the inquiry;

If the person waives the privilege by bringing charges against the person registered or certified under this chapter;
In response to a subpoena from a court of law or the secretary. The secretary may subpoena only records related to a complaint or report under chapter 18.130 RCW; or
As required under chapter 26.44 RCW.

Assurance of Professional Conduct

Thousands of people in the counseling or hypnotherapy professions practice their skills with competence and treat their clients in a professional manner. If you and the counselor agree to the course of treatment and the counselor deviates from the agreed treatment, you have the right to question the change and to end the counseling if that seems appropriate to you.
We want you to know that there are acts that would be considered unprofessional conduct. If any of the following situations occur during your course of treatment, you are encouraged to contact the Department of Health at the address or phone number in this publication to find out how to file a complaint against the offending counselor or hypnotherapist. The following situations are not identified to alarm you but are identified so you can be an informed consumer of counseling or hypnotherapy services. The conduct acts, or conditions listed below give you a general idea of the kinds of behavior that could be considered a violation of law as defined in RCW 18. t130.180.

1. The commission of any act involving moral turpitude, dishonesty, or corruption relating to the practice of the person’s profession, whether the act constitutes a crime or not. If the act constitutes a crime, conviction in criminal proceedings is not a condition precedent to disciplinary action. Upon such a conviction, however, the judgment and sentence is conclusive evidence at the ensuing disciplinary hearing of the guilty of the license holder or applicant of the crime described in the indictment or information, and of the person’s violation of the statute on which it is based. For the purpose of this section, conviction includes all instances in which a plea of guilty or nolo contendere is the basis for the conviction and all proceedings in which the sentence has been deferred or suspended. Nothing in this section abrogates rights guaranteed under chapter 9.96A RCW;

Misrepresentation or concealment of a material fact in obtaining a license or in reinstatement thereof;
All advertising which is false, fraudulent or misleading;
Incompetence, negligence, or malpractice which results in injury to a patient or which creates an unreasonable risk that a patient may be harmed. The use of a nontraditional treatment by itself shall not

constitute unprofessional conduct, provided that it does not result in injury to a patient or create an unreasonable risk that a patient may be harmed;
5. Suspension, revocation, or restriction of the individual’s license to practice any health care profession by competent authority in any state, federal, or foreign jurisdiction, a certified copy of the order, stipulation, or agreement being conclusive evidence of the revocation, suspension, or restriction;
6. The possession, use, prescription for use, or distribution of controlled substances or legend drugs in any way other than for legitimate or therapeutic purposes, diversion of controlled substances or legend drugs, the violation of any drug law, or prescribing controlled substances for oneself;
7. Violation of any state or federal statute or administrative rule regulating the profession in question, including any statute or rule defining or establishing standards of patient care or professional conduct or practice;
8. Failure to cooperate with the disciplining authority by:

(a) Not furnishing any papers or documents;
(b) Not furnishing in writing a full and complete explanation covering the matter contained in the complaint filed with the disciplining authority;
(c) Not responding to subpoenas issued by the disciplining authority, whether or not the recipient of the subpoena is the accused in the proceedings;
(d) Not providing reasonable and timely access for authorized representatives of the disciplining authority seeking to perform practice reviews at facilities utilized by the license holder;

Failure to comply with an order issued by the disciplining authority or a stipulation for informal disposition entered into with the disciplining authority;
Aiding or abetting an unlicensed person to practice when a license is required;
Violations of rules established by any health agency;
Practice beyond the scope of practice as defined by law or rule;
Misrepresentation or fraud in any aspect of the conduct of the business or profession;
Failure to adequately supervise auxiliary staff to the extent that the consumer’s health or safety is at risk;
Engaging in a profession involving contact with the public while suffering from a contagious or infectious disease involving serious risk to public health;
Promotion for personal gain of any unnecessary or inefficacious drug, device, treatment, procedure, or service;
Conviction of any gross misdemeanor or felony relating to the practice of the person’s profession. For the purposes of this subsection, conviction includes all instances in which a pleas of guilty or nolo

contendere is the basis for conviction and all proceedings in which the sentence has been deferred or suspended. Nothing in this section abrogates rights guaranteed under chapter 9.96A RCW;

The procuring, or aiding or abetting in procuring, a criminal abortion;
The offering, undertaking, or agreeing to cure or treat disease by a secret method, procedure, treatment, or medicine, or the treating, operating, or prescribing for any health condition by a method, means or

procedure which the licensee refuses to divulge upon demand of the disciplining authority;

The willful betrayal of a practitioner-patient privilege as recognized by law;
Violation of chapter 19.68 RCW;
Interference with an investigation or disciplinary proceeding by willful misrepresentation of facts before the disciplining authority or its authorized representative, or by the use of threats or harassment against

any patient or witness to prevent them from providing evidence in a disciplinary proceeding or any other legal action, or by the use of financial inducements to any patient or witness to prevent or attempt to prevent him or her from providing evidence in a disciplinary proceeding;
23. Current misuse of:

(a) Alcohol;
(b) Controlled substances; or
(c) Legend drugs

Abuse of a client or patient or sexual contact with a client or patient;
Acceptance of more than a nominal gratuity, hospitality, or subsidy offered by a representative or vendor of medical or health-related products or services intended for patients, in contemplation of a sale or for

use in research publishable in professional journals, where a conflict of interest is presented, as defined by rules of the disciplining authority, in consultation with the department, based on recognized professional ethical standards.

This publication should not be considered as the final source of information. If you want more information about the law regulating counselors and hypnotherapists or want to file a complaint, please write to:

Department of Health, Health Professions Quality Assurance, PO Box 47869, Olympia, Washington 98405-7869.

If you want to contact someone by phone to discuss the law or talk about a possible complaint, call (360) 236-4700 Monday through Friday, 8:00 a.m. to 5:00 p.m.