III. NOTIFICATION OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Uses and Disclosures
Your health information may be used by our clinicians and staff members or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing mental health conditions, and providing treatment.
Payment. Your health information may be used to seek payment from your health plan. other sources of coverage such as an automobile insurer. or credit card companies that you may use to pay for services. For example, your health plan may request and receive information on dates of service, the services provided, and the medical condition being treated.
Health Care Operations. Your health information may be used as necessary to support the day-to-day activities and management of Spectrum Psychological/Psychiatric Associates . For example, information on the services you received ma y be used to support budgeting and financial reporting and activities to evaluate and promote quality to ensure that our practice is meeting state and federal guidelines and laws designed to protect your health care information.
Law Enforcement. Your health information may be disclosed to law enforcement agencies, without your permission, to support government audits and inspections, to facilitate law enforcement investigations, and to comply with government mandated reporting.
Public Health Reporting. Your health information may be disclosed to public health agencies as required by law. For example, our practice is required to report certain communicable diseases to the State of Washington Department of Health if your physician has not done so already.
Other uses and disclosures require your authorization. Disclosure of your health information or its use for any purpose other than those listed above requires your specific written authorization. If you change your mind after authorizing a use or disclosure of your information, you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure that occurred before you notified us of your decision.
Additional Uses of Information
Appointment reminders. Our medical notes system, Office Ally, will send an email remainder providing you have given permission for an email address to be stored on file. We have deleted most identifying information to protect your privacy.
Information about treatments. Your health information may be used to send you information on the treatment and management of your medical condition that you may find of interest. We may also send you information describing other health-related goods and services that we believe may interest you.
You have certain right under the Federal Privacy Standards. These include:
The right to request restrictions on the use and disclosure of your protected health information. The right to receive confidential communications concerning your medical condition and treatment. The right to inspect and copy your protected health information. The right to request an amendment or submit corrections to your protected health information. The right to receive an accounting of how and to whom your protected health information has been dis closed. The right to receive a printed copy of this notice.
Spectrum Psychological/Psychiatric Associates Duties. We are required by law to maintain the privacy of your protected health information and to provide you with this notice of privacy practices. We are also required to abide by the privacy policies and practices that are outlined in this notice.
Right to Revise Privacy Practices. As permitted by law, we reserve the right to amend or modify our privacy policies and practices, these changes in our policies and practices may be required by changes in federal and state laws and regulations. Whatever the rea on for these revisions, we will provide you with a revised notice on your next office visit. The revised policies and practices will be applied to all protected health information that we maintain.
Requests to Inspect Protected Health Information. As permitted by federal regulation, we require that requests to inspect or copy protected health information be submitted in writing. You may obtain a form to request access to your records by contacting your individual practitioner.
I understand and accept the Notification of Privacy Practices policy, and I consent and agree to the terms above with my initials below in place as my signature.