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NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

I. OUR PLEDGE REGARDING HEALTH INFORMATION

At InnerPeace Counseling HA, PLLC, we understand that your health information is personal and we are committed to protecting it. We create and maintain a record of the care and services you receive from us, which helps us provide you with quality treatment and comply with legal requirements.

This Notice applies to all records of your care created by this practice. It explains how we may use and disclose your health information, your rights regarding your information, and our legal duties.

We are required by law to:

• • Ensure that protected health information (“PHI”) that identifies you is kept private.

  • Provide you with this Notice of our legal duties and privacy practices regarding your PHI.

  • Follow the terms of this Notice currently in effect.

We reserve the right to change this Notice, and changes will apply to all PHI we maintain. An updated copy will be available in our office and on our website.

II. HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU

The law allows us to use and disclose your PHI without your written authorization for certain purposes related to your treatment, payment for services, and health care operations.

1. Treatment, Payment, and Health Care Operations

• • Treatment: We may use and share your PHI with other healthcare providers involved in your care. Example: Consulting with another licensed provider about your case.

  • Payment: We may use and disclose PHI to obtain payment for services rendered. Example: Providing necessary information to your insurance company.

  • Health Care Operations: We may use PHI for practice management, quality assessment, training, and licensing.

Disclosures for treatment purposes are not limited to the “minimum necessary” standard because clinicians require full information to provide quality care.

III. USES AND DISCLOSURES REQUIRING YOUR AUTHORIZATION

Some uses and disclosures of PHI require your written authorization, including:

• • Psychotherapy Notes: These will not be shared without your written consent except in limited situations (e.g., emergencies, compliance investigations, legal defense, or as otherwise required by law).

  • Marketing Purposes: We will not use or disclose your PHI for marketing.

  • Sale of PHI: We do not sell your PHI.

You may revoke your authorization at any time in writing, except to the extent that action has already been taken.

IV. USES AND DISCLOSURES NOT REQUIRING YOUR AUTHORIZATION

We may use or disclose PHI without your authorization in situations such as:

• • Required by state or federal law.

  • Reporting suspected abuse or neglect of children, elders, or dependent adults.

  • Preventing or reducing a serious threat to someone’s health or safety.

  • Audits, compliance checks, or investigations.

  • Court orders, subpoenas, or legal proceedings.

  • Law enforcement purposes (e.g., crimes on our premises).

  • Public health activities or research approved by an institutional review board.

  • Specialized government functions (e.g., military, security, correctional facilities).

  • Workers’ compensation claims.

  • Appointment reminders or information about treatment alternatives.

V. USES AND DISCLOSURES WITH OPPORTUNITY TO OBJECT

We may disclose your PHI to a family member, close friend, or other person involved in your care or payment for your care—unless you object. In emergencies, we may do so without your consent, but you will have the opportunity to object later.

VI. YOUR RIGHTS REGARDING YOUR PHI

You have the right to:

1. 1. Request Restrictions: You may ask us not to use or disclose certain PHI for treatment, payment, or health care operations. We are not required to agree but will consider all requests.

   2. Restrict to Health Plans: If you fully pay for a service out-of-pocket, you may request that we not disclose related PHI to your health plan.

   3. Confidential Communications: You may request that we contact you in a specific way (e.g., at a different phone number or mailing address).

   4. Access Your Records: You can request an electronic or paper copy of your record, excluding psychotherapy notes, within 30 days. A reasonable fee may apply.

   5. Accounting of Disclosures: You may request a list of certain disclosures of your PHI made in the past six years.

   6. Amend Your Record: You may request corrections to your PHI. If we deny your request, we will explain why in writing.

   7. Receive a Copy of This Notice: You may request this Notice in paper or electronic form at any time.

VII. QUESTIONS OR COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with:

InnerPeace Counseling HA, PLLC
Roy, WA 98580
Phone: 978 679 8999
Email: info@inner-peace.health

Acknowledgment of Receipt of Privacy Notice
By signing or electronically acknowledging below, you confirm that you have received a copy of this Notice of Privacy Practices and understand your rights under HIPAA.