The law protects the relationship between a client and a psychotherapist, and information cannot be disclosed without written permission.
- Suspected child abuse or dependent adult or elder abuse, for which we am required by law to report this to the appropriate authorities immediately.
- If a client is threatening serious bodily harm to another person/s, we must notify the police and inform the intended victim.
- If a client intends to harm himself or herself, we will make every effort to enlist their cooperation in ensuring their safety. If they do not cooperate, we will take further measures without their permission that are provided to us by law in order to ensure their safety.
- If you bring suit against a provider, s/he may release confidential information to defend him/herself.
NOTICE OF PRIVACY PRACTICES
THIS JOINT NOTICE DESRIBES HOW YOUR RECORDS AND MENTAL HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice is being provided to you on behalf of Bluestone Psychological Services, LLC (BPS), Julie Hanson Counseling, PLLC, Roedel Psychological Services, PLLC, Michael Ruthrauff, MD, PLLC, Mothering Voice Psychological Services, PLLC, Randie Clark Counseling, PLLC, Susa Holt Integrative Psychotherapy, PLLC, and other business associates who help with the business management of our services. We are collectively referred to as the Providers.
Bluestone is committed to protecting the confidentiality of your health information. We are required by law to maintain the privacy of your Protected Health Information (PHI), including PHI that we keep in electronic form (ePHI). This Notice will help explain to you how we maintain your records, among other things. We are also required to inform you of our legal obligations and how this impacts the privacy protections for your health information.
Application of this Notice:
The information privacy practices described in this Notice will be followed by:
- Any mental health professional who works with you at Bluestone.
- Other professionals who contract with us as business service providers who may have access to your PHI.
This Notice provides detailed information about how we may use and disclose your health information with or without authorization as well as more information about your specific rights regarding your health information.
All the providers listed below share health information, when appropriate, to provide mental health care services.
Bluestone Psychological Services, LLC: BPS provides professional office space and practice management services to various mental health providers. When one or more of the independent providers coordinate care for you, PHI may be exchanged. PHI may also be exchanged between the service providers and BPS’s business associates who support the business operations of BPS. Such support operations may include reception, bookkeeping, billing, and legal services.
Julie Hanson Counseling, PLLC (JHC): Julie Hanson Counseling is an independent mental health counseling service of Julie Hanson, Psy.D., LMHC. JHC’s outpatient counseling services operate out of BPS’s Edmonds office. Independently of BPS, JHC also provides supervision to graduates accumulating hours towards their professional counseling licensing. Julie Hanson shares ownership of BPS with Bill Roedel.
Roedel Psychological Services, PLLC: Roedel Psychological Services is an independent mental health counseling service of Bill Roedel, Ph.D. Counseling services are provided on an outpatient basis to clients who are referred by BPS at the BPS Edmonds office as well as occasionally at its downtown Seattle office. Some clients are also referred directly to Roedel Psychological Services from other sources. Dr. Roedel is co-owner of BPS with Julie Hanson.
Mothering Voice Psychological Services, PLLC: Mothering Voice Psychological Services is the independent counseling practice of Terri Buysse, Ph.D. All psychotherapy services are all offered on an outpatient basis at the BPS Edmonds location to clients referred through BPS and other sources. Mothering Voice also provides services to the local community in other ways at other locations (e.g., postpartum support groups, parenting classes).
Randie Clark Counseling, PLLC (RCC): RCC is the independent counseling practice of Randie Clark, MA, LMHC. Counseling services are offered on an outpatient basis at the BPS Edmonds location to clients referred through BPS and other sources. Counseling services are also provided independently of BPS at its Seattle office.
Susa Holt Integrative Counseling, PLLC (SHIC): SHIC is the independent counseling practice of Susa Holt, ND, MA, LMHCA. Counseling services are offered on an outpatient basis at the BPS Edmonds location to clients referred through BPS and other sources. Counseling services are also provided independently of BPS at its Seattle office.
PROTECTED HEALTH INFORMATION
This Notice applies to protected health information (PHI) created or received by the Providers in this Notice that identifies you; relates to your past, present or future mental health needs; relates to the care provided; or relates to the past, present or future payment for your care. PHI typically includes your symptoms, diagnoses, the treatment provided to you, information that may be provided about you by others who have been involved in your care, and billing and payment information relating to your care. PHI may come in traditional paper form or be kept and communicated in electronic form, referred to as ePHI. Examples of ePHI include any records we keep on the computer and/or on cloud based programs. This Notice applies to both formats.
Some of the uses for the information often contained in your mental health record include:
- A means of communication among multiple health care providers involved in your treatment. These may include your physician(s), other treating therapists and/or your psychiatrist.
- The legal record describing the care you receive.
- A means by which you or a third-party payor (e.g., your insurance company) can verify that services billed for your care were provided.
- A source of information for BPS business planning and to improve the care we give.
It is to your benefit to understand what is in your record and how your health information is used and disclosed so that you can:
- Ensure the accuracy of your record.
- Better understand who, what, when, where, and why others may access your record.
- Make an informed decision when authorizing disclosures to others.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION WITHOUT YOUR PERMISION
Providers may use or disclose PHI/ePHI without your authorization in the following circumstances:
- Joint Activities and Your Treatment: Your PHI may be used and shared by the Providers to further their joint activities and with other individuals or organizations that engage in your treatment, payment or healthcare operational activities with the Providers. Health information is shared when necessary to provide clinical care services and to secure payment for services provided. Examples of such disclosures include letting your psychiatrist know about your response to prescribed mental health medications and communicating between Providers about shared clients, such as in family counseling.
- To Contact You: Your PHI may be used to call you or send you a letter about your care, for appointment reminders if you choose that service, to provide you with treatment options, or to advise you about other health-related benefits and services.
- For Payment Purposes: We may use your PHI/ePHI to prepare claims to your insurance company. We will include information that identifies you, as well as your diagnosis, dates and types of service provided, and any payments you have made
- When Required by Law: We may use or disclose your health information when required by law. If this happens, disclosures will be made in compliance with the law and will be limited to the relevant requirements of the law. Examples include law enforcement reports, abuse and neglect reports, military command authorities, and reports to coroners and medical examiners in connection with death. The Providers must also comply with the Secretary of the Department of Health and Human Services for the purpose of investigating or determining its compliance with the requirements of the Privacy Rule.
- For Healthcare Operations/Oversight: The Providers may disclose your PHI to a health oversight agency, such as a government agency, for activities authorized by law, such as for professional licensure and for healthcare operations, such as seeking reimbursement from an insurance company.
- Business Associates: Your PHI may be used by Providers and disclosed to individuals or organizations that assist the Providers with their legal obligations as described in the Notice. For example, we may disclose information to consultants or attorneys who assist us in our business activities. Business Associates also contract with the Providers to assist in business operations, such as billing and administrative support. These business associates are required to protect the confidentiality of your information with administrative, technical and physical safeguards.
- Workers Compensation: If you file a worker’s compensation claim, with certain exceptions, your therapist must make available, at any stage of the proceedings, all mental health information in his/her possession relevant to that particular injury in the opinion of the Washington Department of Labor and Industries, to your employer, your representative, and the Department of Labor and Industries upon request.
USES AND DISCLOSURE WHEN YOU HAVE THE OPPORTUNITY TO OBJECT
- Disclosure to and Notification of Family, Friends or Others: Unless you object, Providers may use their professional judgment to provide relevant protected health information to your family member, friend, or another person. This person would be someone that you indicate has an active interest in your care or the payment for your mental health care or who may need to notify others about your location (for example, for transportation purposes) or general condition.
- Clinical Notes: Notes recorded by your Provider documenting the contents of a counseling session and your care are part of your PHI. These will not be disclosed without your consent, unless for purposes already explained herein. For example, you must authorize the release of your record to your attorney, to a life insurance company, to your employer, the military, or your school. You may revoke any such authorization at any time, provided the request is made in writing.
- Marketing Communications: The Providers may send you communications containing a variety of information that may be of interest to you. You may remove yourself from such a mailing list at any time without any concern for it impacting the quality of your care. You may contact us directly or follow the “unsubscribe” procedure at the bottom of an email newsletter. Your PHI will not be sold or given to any outside vendor for any reason without your written authorization to do so.
YOUR INDIVIDUAL RIGHTS ABOUT PATIENT HEALTH INFORMATION
You have rights related to the use and disclosure of your protected health information. To contact the Providers to exercise your rights, you may contact:
Julie Hanson, Psy.D., LMHC
Clinic Manager and Privacy Officer
Bluestone Psychological Services, LLC
7522 221st PL SW
Edmonds, WA 98026
Your Specific Rights are listed below:
- Right to request restrictions: You have the right to request in writing that we not use or disclose your information for treatment, payment, and/or operational activities except when authorized by you, when required by law, or in emergency circumstances. We are not legally required to agree to your request. After you make your request to BPS, we will provide you with written notice of our decision about your request.
- Right to request nondisclosure to health plans for services that are self-pay: You have the right to request in writing that services for which you self-pay for in full in advance of your visit not be disclosed to your health plan.
- Right to receive confidential communications: You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations. (For example, you may not want a family member to know that you are seeing a therapist. Upon your request, your therapist or this office will send your bills to another address.) To request confidential communications, you must make your request in writing to the address above and specify how or where you wish to be contacted. We will grant all reasonable requests.
- Right to inspect and receive copies: In most cases, you have the right to inspect and obtain copies of PHI in your therapist’s mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record. Your Provider may deny your access to PHI under certain circumstances, but in some cases you may have this decision reviewed. On your request, your Provider will discuss with you the details of the request and denial process. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.
- Right to request an amendment to your record: If you believe that information in your record is incorrect or that important information is missing, you have the right to request in writing that your Provider amend your PHI for as long as the PHI is maintained in the record. In your request, you must give a reason for the amendment. We are not required to agree to your request but a copy of your request will be added to your record.
- Right to know about disclosures: You have the right to receive a list of instances when disclosures of your PHI have been made. Certain disclosures will not be included, such as disclosures for your treatment, billing, other healthcare operations, or when you have authorized the use or disclosure. Your first accounting of disclosures in a calendar year is free of charge. Any additional request within the same calendar year requires a processing fee.
- Right to make complaints: If you are concerned that we have violated your privacy, or you disagree with a decision we made about access to your records, you may file a complaint with the entity that provided the services to you. Or, you may file a complaint with the Bluestone Psychological Services Privacy Officer using the contact information previously given. The Providers will not retaliate against anyone for filing a complaint. If you believe that your privacy rights have been violated, you may also contact the US Department of Health and Human Services, Office for Civil Rights:
Office for Civil Rights
US Department of Health and Human Services
2201 Sixth Avenue – Mail Stop RX-11
Seattle, WA 98121-1831
206-615-2290206-615-2290; 206-615-2296206-615-2296 (TTY)
Toll Free: 1-800-362-17101-800-362-1710 FREE; 1-800-537-76971-800-537-7697 FREE (TTY)
PROVIDERS’ LEGAL DUTIES
We are required by law to protect the privacy of your PHI and to notify affected individuals if there is a breach in the security of your PHI. We are also required to provide you with this Notice about our privacy practices, and follow the privacy practices that are described in this Notice.
EFFECTIVE DATE AND CHANGES TO THE NOTICE
This notice will go into effect on September 1, 2013 and will continue until changes are necessary.
We reserve the right to change the privacy practices described in this Notice. We may revise or change the Notice effective for protected health information we already have as well as any information we may receive in the future. We will post a copy of the current Notice at BPS and on the BPS website at www.BluestonePS.com. At any time, you may download this Notice or request a copy of the Notice when you are at BPS.