HIPAA – Notice of Privacy Practices

At SVPS, the privacy of your health information is very important to us. As a patient receiving mental health services, you have rights under both Washington state law, namely the Medical Records – Health Care Information Access and Disclosure Act (RCW 70.02), and federal law, namely the Health Insurance Portability and Accountability Act or HIPAA. Under these laws we are required to maintain the privacy of your health information and provide a detailed description of how medical/psychological information about you may be used and disclosed, as well as how you can access this information. Please review these policies carefully and let us know if you have any questions or concerns.

About Patient Records, Access, and Security

At SVPS, we maintain two separate and distinct records or files for each patient. One is a clinical or treatment record and the other is a billing record. Together, these constitute your health record and are considered protected health information (PHI) because they personally identify you or a family member as the patient. Clinical records are maintained and controlled by your Psychologist. Billing records are maintained by our billing service. All current and recently closed patient records are stored in locked filing cabinets located on our premises. All other closed patient records are kept in locked storage units at a gated, controlled access storage facility.

Clinical records contain patient information and treatment consent forms, Personal History Questionnaires, intake and treatment/progress notes, release of information forms, along with any other clinical or administrative forms or information pertaining to your care. Clinical records may also contain written information or records you supply, as well as any records received from other treatment providers.

Billing records contain patient and billing information forms, insurance company authorization forms, and explanations of benefits, along with any other billing or administrative information pertaining to your account. In addition to the paper portion of your billing record, we use a medical billing company, Liberty Billing. Liberty Billing maintains a computer-based billing record which contains basic account information, such as name, address, phone numbers, insurance information, as well as dates of service, diagnosis, and payment history. This information is shared with Liberty Billing for the purpose of billing your insurance company and generating patient statements. Liberty Billing submits insurance claims electronically, whenever possible, otherwise a paper claim form is used. All computer-based information is encrypted and password protected. Liberty Billing conforms to all state and federal laws regarding privacy practices and protecting health information.

Uses and Disclosures of PHI for Treatment, Payment, and Health Care Operations

In general, “use” of PHI is defined as activities by your therapist or within our group practice, such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you. Additionally, “disclosure” of PHI constitutes activities by your therapist or our group practice, that involve releasing, transferring, or providing access to information about you to other outside parties.

By consenting to receive assessment, evaluation, and/or treatment services at SVPS, you are also authorizing us to use and/or disclose your PHI, for treatment, payment, and health care operations purposes. These are defined below:

1) Treatment – is when we provide, coordinate, manage, or conduct other services related to your treatment. An example would be when your therapist consults with another health care provider, such as your primary care physician or another mental health professional.

2) Payment – is when we work to obtain reimbursement for the services you received. An example is when we disclose PHI to your health insurer to determine eligibility or coverage, as well as securing authorization or reimbursement for services.

3) Health Care Operations – are activities that relate to the performance and operation of our practice. Examples include: quality assurance activities and clinical case conferences among our staff.

Uses and Disclosures Without Your Consent or Written Authorization

PHI is typically used and/or disclosed with your consent and written authorization. However, there are times when PHI is used and/or disclosed without your consent and written authorization. These are mandatory exceptions, as stipulated in Washington State and Federal laws.

1) If your therapist has reasonable cause to believe that disclosure will avoid or minimize imminent danger to your health and safety (e.g., self-harm or suicide), or the health and safety of another individual (e.g., violent attack, homicide, etc.). Under these circumstances, required disclosures are made to appropriate law enforcement or public health authorities, or other persons necessary to avoid or minimize imminent danger to health and society.

2) If your therapist has reasonable cause to believe that either:

– A child has suffered abuse (e.g., physical assault, sexual molestation or other form of sexual abuse or assault) or neglect/abandonment.

– A vulnerable adult has suffered abuse (e.g., physical assault, sexual molestation or other form of sexual abuse or assault), or neglect/abandonment, or financial exploitation.

– Domestic violence or abuse (e.g., physical or sexual assault) has occurred.

Under these circumstances, required disclosures are made to appropriate law enforcement or public health authorities, or other persons necessary to avoid or minimize imminent danger to health and society (e.g., Department of Social and Health Services).

3) When directed by a court or court official if you are involved in civil litigation or criminal case, or in the absence of a protective order when involved in a compulsory legal process. Additionally, your records would be subject to compulsory release if you file a complaint and your therapist is subpoenaed by the Washington Examining Board of Psychology or Social Work as part of its investigations, hearings or proceedings relating to the discipline, issuance or denial of licensure. Your records would also be subject to release if you file a worker’s compensation claim.

Uses and Disclosures Requiring Your Consent and Written Authorization

Uses and disclosures of your PHI outside of treatment, payment and health care operations, requires your consent and written authorization. In those instances when we are asked for information for other purposes, written authorization will be obtained from you before releasing this information. You may withdraw your consent and revoke your authorization at any time by doing so in writing. You may not revoke an authorization to the extent that (1) we have relied on that authorization and released PHI; or (2) if the authorization was obtained as a condition of obtaining insurance coverage, and the law provides the insurer the right to contest the claim under the policy.

Patient’s Rights

      • Have full and complete knowledge of your therapist’s qualifications and training.
      • Be fully informed regarding the financial terms under which services will be provided.
      • Discuss your treatment with anyone you choose, including another therapist.
      • Have a detailed explanation of any procedure or form of treatment prior to their initiation.
      • Inspect and/or obtain a copy of protected health information contained in your treatment and billing records for as long as we maintain them.
      • Amend and/or correct protected health information contained in your treatment and billing records.
      • Request restrictions on certain uses and disclosures of protected health information contained in your treatment and billing records.
      • Request and receive confidential communications of protected health information by alternative means at alternative locations (e.g., you may want to be called on a cell phone and not at home or work, you may want bills sent to another address, etc.).
      • Request and receive an accounting of disclosures of protected health information for which you have neither provided consent or authorization.
      • Revoke authorizations to release protected health information.
      • Specify in writing that no treatment records are to be maintained. We are not required to provide services under this condition and it is our policy to not provide treatment without maintaining a record.
      • Have pertinent information shared with another therapist, or any other party, provided you sign a release of information.
      • Specify in writing that information is not to be released to certain individuals.
      • Question the practice and competence of your therapist, and if you desire, to file a formal complaint with appropriate professional or legal bodies.
      • Request a review copy of the ethics code and other guidelines/procedures that govern your therapist’s practice.
      • Terminate treatment at any time or, in the case of court-ordered treatment, refuse to participate (recognizing that you may face legal consequences as a result).

Psychologist’s Duties

      • SVPS is required by law to maintain the privacy of PHI and to provide you with a notice of our legal duties and privacy practices with respect to PHI.
      • SVPS reserves the right to change our privacy policies and practices as laws, regulations, and requirements are updated and revised.
      • In the event SVPS revises our privacy policies and practices, we will make new copies available in our offices and post the changes on our website: svps-wa.com.

Questions and Complaints

 Please feel free to let either Dr. Monica Bristow or Dr. Gregg Schimmel know if you have questions about our privacy policies and practices, disagree with a decision we make about access to your PHI, or have other concerns about your privacy rights.

If you believe that your privacy rights have been violated and wish to file a complaint with us, you may send your written complaint to Dr. Monica Bristow or Dr. Gregg Schimmel at our office mailing address: 15446 Bel-Red Road, Suite 350, Redmond, WA 98052.

You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services.

You have specific rights under state and federal laws. SVPS will not retaliate against you for exercising your right to file a complaint.

Effective Date

These privacy practices went into effect on February 1, 2010 and were amended January, 2014.