This notice describes how information about you may be used and disclosed
and how you can get access to this information. Please review it carefully.
A number of laws are in place in Washington State and at the federal
level that protect and guide the use of healthcare information. Any suspected
violation of federal and state laws may be reported to appropriate authorities.
I maintain a confidential clinical record of the services provided to
you. The record typically contains an initial assessment, a treatment
plan, progress notes and other information related to the services you
receive. The record, or information in the record, is used:
- To plan and track your care.
- To notify you of appointments and coordination of services.
- To document services for payment of care.
- To communicate between the professionals who provide care.
- To support regular clinical service operations.
- To educate care professionals.
- As a data source for organizational planning and management.
- As a tool to continually assess and improve care.
- To verify the quality of services to managed care, licensing, and
The clinical record is my physical property, however, you may:
- Request access to your record and review your record.
- Request copies of your record or specific reports from your record.
- Amend your record.
- Authorize sharing or disclosures of information sent outside of the
office except those made to carry out treatment, obtain payment for
services, or provide for clinical service operations.
- Obtain an accounting of disclosures of information sent outside of
the office except those disclosures made to carry out treatment, obtain
payment for services, or provide for clinical service operations.
- Request a restriction on certain uses and disclosures of your information.
I apply privacy and confidentiality standards of practice to creating
and maintaining clinical records related to client care. The practice
is guided by state and federal law in its privacy practices. Policies
and procedures that are revised periodically also guide the practice's
actions. If for any reason I am not able to accomodate your request in
regard to clinical information, you will be notified. As the Notice of
Privacy Practices changes, it will be updated and posted in a location
accessible to clients. You may always obtain a current Notice of Privacy
Outside organization or individuals that provide services to me are required
by written agreement to protect client confidentiality. I will not disclose
or use your clinical information without your authorization except as
described in this notice or provided by law.
If you have questions or would like additional information, please contact
me. If you believe your privacy rights have been violated, you can file
a complaint with me or with the secretary of Health and Human Services.
There will be no retaliation for filing a complaint.
Effective Date of this Notice: April 15, 2003