The Health Insurance Portability and Accountability Act (HIPAA) mandates the protection and confidential handling of protected healthcare information. This Notice informs you of your rights regarding your healthcare information under HIPAA. Your health information includes any information that your therapist records or receive about your past, present, and future healthcare. HIPAA regulations require that he/she maintains this privacy and provide you a copy of this Notice.

​RECORD KEEPING PRACTICES

Standard practice requires your therapist to keep a record of your treatment. This includes relevant data about dates of service, payments for service, insurance billing, and relevant treatment information. This record of treatment is your protected health care information or “PHI.” Your therapist may use or disclose your PHI for treatment, payment, and healthcare operation purposes.

USES AND DISCLOSURES FOR TREATMENT, PAYMENT, & HEALTH CARE OPERATIONS

TREATMENT. Your therapist may use or disclose your PHI to coordinate or manage your treatment. An example of treatment would be when he/she consults with another healthcare provider or therapist.

​PAYMENT. Emmaus will disclose your health care information if you request that we bill a third party. An example of payment is when Emmaus discloses your protected health information to your health insurer to obtain reimbursement or to determine eligibility or coverage.

​HEALTHCARE OPERATIONS. Emmaus may disclose your PHI during activities that relate to the performance and operation of my practice. Examples of health care operations are quality assessment activities, case management, legal, audits, and administrative services.

​USES AND DISCLOSURES THAT DO NOT REQUIRE YOUR AUTHORIZATION OR AN OPPORTUNITY TO OBJECT

​REQUIRED BY LAW. Your therapist 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, law enforcements reports, abuse and neglect reports, and reports to coroners and medical examiners in connection with death. Your therapist 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. Your therapist may disclose your healthcare information to a health oversight agency for activities authorized by law, such as my professional licensure. Oversight agencies also include government agencies and organizations that provide financial assistance to Emmaus, such as third-party payers.

CHILD ABUSE OR NEGLECT. If your therapist has reasonable cause to believe that a child has suffered abuse or neglect, he/she is required by law to report it to the proper law enforcement agency or the Washington Department of Social and Health Services.

ADULT ABUSE. If your therapist has reasonable cause to believe that abandonment, sexual or physical abuse, financial exploitation, or neglect of a vulnerable adult has occurred, he/she must report the abuse to the Washington Department of Social and Health Services.

THREAT TO HEALTH OR SAFETY. In the instance when you or someone else is in imminent danger of harm your therapist may disclose your healthcare information for the purposes of safety.

​CRIMINAL ACTIVITY. Your therapist may disclose your healthcare information to law enforcement officials if you have committed a crime on my premises or against him/her.

BUSINESS ASSOCIATES. Your therapist may disclose your healthcare information with business associates that he/she contract with to administer billing and/or legal services. Your therapist’s contract with them requires them to safeguard the privacy of your information.

USES AND DISCLOSURES OF HEALTHCARE INFORMATION WITH YOUR WRITTEN AUTHORIZATION

Your therapist will make other uses and disclosures of your protected healthcare information only when your appropriate authorization is obtained. An “authorization” is written permission that permits specific disclosures. You may revoke this authorization in writing at any time, unless your therapist has taken an action in reliance on the authorization of the use or disclosure you permitted, such as providing you with healthcare services for which he/she must submit subsequent claims for payment.

YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION

1. You have the right to inspect and copy your PHI, which may be restricted in certain limited circumstances, for as long as Emmaus maintains it. You will be charged you a reasonable cost-based fee for copies.

2. You have the right to ask that your therapists amend your record if you feel that the protected health information is incorrect or incomplete. Your therapist is not required to amend it, however you have the right to file a statement of disagreement with him/her, to which they are allowed to prepare a rebuttal and it will all go into your record.

3. You have the right to request the required accounting of disclosures that your therapist makes regarding your PHI. This documents any non-routine disclosures made for purposes other than your treatment, as well as disclosures made pertaining to your treatment for purposes of quality of care.

4. You have the right to request a restriction or limitation on the use of your protected health information for treatment, payment, or operations of you therapist. Your therapist is not required to agree to your request, and in instances where he/she believes it is in the best interest of quality care he/she will not honor your request.

5. You have the right to request confidential communication with your therapist. An example of this might be to send your mail to another address or not call you at home. He/she will accommodate reasonable requests and will not ask why you are making the request.

6. You have the right to have a paper copy of this Notice.

7. If you believe your therapist has violated your privacy rights you have the right to file a complaint in writing with him/her and/or the Secretary of Health and Human Services. Your therapist will not retaliate against you for filing a complaint.

THERAPIST’S DUTIES

This Notice describes your rights regarding how you may gain access to and control your protected healthcare information and how your therapist may use and disclose it. He/she is required by law to abide by the terms of this Notice of Privacy Practices and reserve the right to change the terms of this Notice at any time. Any new Notice of Privacy Practices will be effective for all personal healthcare information that your therapist maintains, whether or not you are still in treatment with him/her. You may request a copy of our revised Notice of Privacy Practices at your appointment time, or by leaving a request with our clinic to receive a copy through the mail.

CONTACT INFORMATION

If you have any questions about this Notice of Privacy Practices, please contact our practice manager at 425.869.2644, ext. 17.

COMPLAINTS

If you believe your therapist has violated your privacy rights, you may file a complaint in writing to him/her. He/she will not retaliate against you for filing such a complaint. You may also file a complaint with the U.S. Secretary of Health and Human Services.

For more information, see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.