THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU (OR YOUR CHILD, IF APPLICABLE) MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
*Please note that the business name(s) Seattle Integrative Therapies LLC and Seattle Integrative Therapy may be used interchangably. They are the same business entity.
If you have any questions about this notice, please
contact our business office at 206-669-4303 or email Shari Schwartz, owner of Seattle Integrative Therapies LLC and Privacy Officer, at shari@seattleintegrativetherapies.com
OUR OBLIGATIONS.
We are required by law to:
-Maintain the privacy of protected health information (PHI)
-Give you this notice of our legal duties and privacy practices regarding your health information.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION.
Seattle Integrative Therapies LLC respects your privacy. We understand that your personal health information is very sensitive. Described as follows are the ways we may use and disclose health information that identifies you ("Health Information"). Except for the following purposes, we will use and disclose Health Information only with your written permission. You may revoke such permission at any time by writing to our privacy officer.
Treatment.
We may use and disclose Health Information for your treatment to provide you with treatment-related health care services. This includes use and disclosure of Health Information with Seattle Integrative Therapies staff as it relates to your treatment. In addition, we may disclose Health Information to your doctors, nurses, technicians, or other personnel, who are involved in your medical care and need the information to provide you with medical care.
Payment.
Please see payment policies and fees below. At this time, Seattle Integrative Therapies LLC does not accept insurance reimbursement. You may independently apply to have your services reimbursed, if possible. We will not share your PHI with other parties for reimbursement, at this time.
Sharing Health Information for Reimbursement Purposes.
If, in future, we offer insurance reimbursement as a form of payment, we may use and disclose Health Information so that we or others may bill and receive payment from you, an insurance company, or a third party for the treatment and services you received. For example, we may provide your health plan with information, including diagnosis (typically from your primary care or other medical provider), procedures performed, progress, goals or recommended care, so that they will pay for your treatment.
Electronic Storage.
Any Health Information obtained electronically via Formsite Corp is stored on a secure server and has restricted access only to Seattle Integrative Therapies staff and on very rare occasions, Formsite Staff in order to maintain the system and records. Seattle Integrative Therapies, LLC has entered into a third party agreement with Formsite who has ensured and will ensure that data stored through their site is highly secure and can only be accessed by authorized individuals. For more informaiton about formsite's security, please see the following:
Information, including responses to New Client Forms, progress notes and treatment goals and plans, are secured locally on a password protected computer that is kept in a locked building/secure office space and are backed up onto a secure portable hard-drive, also physically secured within a locked office space.
Communications.
Unless otherwise stated, emails sent via regular email, as well as text and phone messages, are not secure and are not HIPAA complaint. In these cases, Protected Health data is at risk of being seen by outside parties. Clients of Seattle Integrative Therapies, LLC are asked not to send any specific Protected Health Information via regular email, electronic text message or voicemail as security cannot be guaranteed. Any information sent via these methods (regular email, text or voicemail) is sent at the client's own risk and discretion.
Should the client permit, Seattle Integrative Therapies LLC providers may occasionally ask permission to leave a voicemail or text message regarding a client's treatment. Clients are not required to give this permission, particularly, if it is felt that their PHI's security may be compromised or for any other reason. Should a client grant the provider permission to leave a voicemail, send a text message or email, it is implied and implicitly understood by the client/consumer that security of Protected Health Information cannot be fully guaranteed, though the provider will make her/his best efforts.
The clinic email and phone number are for scheduling and general information purposes only. Clients/Consumers may give written or verbal permission for the provider to leave a voice mail or text message on a case by case basis. Any information willingly shared by the client using non HIPAA-compliant means is implicitly permitted by said client and is provided with the implicit understanding that this Protected Health Information may be visible to unauthorized individuals and that data security when using these methods of communication is compromised.
Health Care Operations.
We may use and disclose Health Information for health care operation purposes. These uses and disclosures are necessary to make sure that all of our clients receive quality care and to operate and manage our clinic. For example, we may use and disclose information to make sure the care you receive is of the highest quality. We also may share information with entities that have a relationship with you (such as your health plan) for their health care operation activities.
Appointment Reminders, Treatment Alternatives, and Health-Related Benefits and Services.
We may use and disclose Health Information to contact you and to remind you of your appointment with us. We also may use and disclose Health Information to tell you about treatment alternatives or health-related benefits and services that may be of interest to you.
Individuals Involved in Your Care or Payment for Your Care.
When appropriate, we may share Health Information with a person who is involved in you or your child's, if applicable, medical care or payment for your or your child’s care, when applicable, such as your family or a close friend. We also may notify your family about your location or general condition or disclose such information to an entity assisting in a disaster relief effort.
SPECIAL SITUATIONS.
As Required by Law, we will disclose Protected Health Information without your prior authorization when required to do so by international, federal, state, or local law.
To Avert a Serious Threat to Health or Safety.
We may use and disclose Health Information when necessary to prevent a serious threat to the health and safety of the public or another person. Disclosures, however, will be made only to someone who may be able to help prevent the threat.
Public Health Risks.
We may disclose Health Information for public health activities. We will only make this disclosure if you agree or when required or authorized by law. These activities generally include disclosures to prevent or control disease, injury, or disability; report births and deaths; report child abuse or neglect; report reactions to medications or problems with products; notify people of recalls of products they may be using; inform a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and report to the appropriate government authority if we believe a child has been the victim of abuse, neglect, or domestic violence.
Health Oversight Activities.
We may disclose Health Information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes.
If you are involved in a lawsuit or a dispute, we may disclose Health Information in response to a court or administrative order. We also may disclose Health Information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
Law Enforcement.
We may release Health Information if asked by a law enforcement official if the information is: 1) in response to a court order, subpoena, warrant, summons, or similar process; 2) limited information to identify or locate a suspect, fugitive, material witness, or missing person; 3) about the victim of a crime even if, under certain very limited circumstances, we are unable to obtain the person's agreement; 4) about a death we believe may be the result of criminal conduct; 5) about criminal conduct on our premises; and 6) in an emergency to report a crime, the location of the crime or victims, or the identity, description, or location of the person who committed the crime.
YOUR RIGHTS.
You have the following rights regarding Health Information we have about you:
- Right to Inspect and Copy. You have a right to inspect and copy Health Information that may be used to make decisions about your care or payment for your care. To inspect a copy of this Health Information, you must make your request, in writing to Shari@seattleintegrativetherapies.com
- Right to Amend. If you feel that Health Information we have is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for Seattle Integrative Therapies. To request an amendment, you must make your request, in writing, to Shari Schwartz OTR/L, Shari@seattleintegrativetherapies.com
- Right to an Accounting of Disclosures. You have the right to request a list of certain disclosures we made of Health Information for purposes other than treatment, payment, and health care operations or for which you provided written authorization. To request an accounting of disclosures, you must make your request, in writing, to Shari Schwartz, OTR/L, Seattle Integrative Therapies, LLC Seattle, WA or shari@seattleintegrativetherapies.com
- Right to Request Restrictions. You have the right to request a restriction or limitation on the Health Information we use or disclose for treatment, payment, or health care operations. You also have the right to request a limit on the Health Information we disclose to someone involved in your child’s care or the payment for your child’s care, like a family member or friend. For example, you could ask that we not share information about a particular diagnosis or treatment with your extended family that is involved in your or your child’s care, if applicable.
To request a restriction, you must make your request, in writing, to Seattle Integrative Therapies, Seattle, WA 98112 or to Shari@seattleintegrativetherapies.com We are not required by law to agree to your request. If we agree, we will comply with your request unless the information is needed to provide you or your child (if applicable) with emergency treatment.
- Right to Request Confidential Communication. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we contact you only by mail or at work. To request confidential communication, you must make your request, in writing, to Shari@seattleintegrativetherapies.com or to the clinic address. Your request must specify how or where you wish to be contacted. We will accommodate reasonable requests.
- Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice in future.
CHANGES TO THIS NOTICE
We reserve the right to change this notice and make the new notice apply to Health Information we already have as well as any information we receive in the future. We will post a copy of our current notice at the clinic. The notice will contain the effective date on each page, in the lower right-hand corner. A paper copy of the new policies will be available upon request.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with Seattle Integrative Therapies, LLC or with the Secretary of the Department of Health and Human Services.
To file a complaint with Seattle Integrative Therapies, LLC, contact us via email at Shari@seattleintegrativetherapies.com All complaints must be made in writing. You will not be penalized for filing a complaint.
Please print a copy of this agreement for your records. You may request a paper copy should you desire, or print one directly from the link on our site.
A printable version of this form can be found here: https://fs27.formsite.com/SeattleIntegrativeTherapies/form2/print