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1. Your Rights
You have the right to:
Receive an electronic or paper copy of your medical record
Ask us to correct your medical record
Request confidential communication
Ask us to limit certain uses or disclosures
Receive a list of certain disclosures
Receive a copy of this Notice
Choose someone to act for you
File a complaint if you believe your rights were violated
2. Receive a Copy of Your Records
You may ask to see or receive an electronic or paper copy of your medical record and other health information maintained by PsycheMD.
Contact the Privacy Officer to submit a request.
We will respond within the time required by law.
A reasonable, cost-based fee may apply where permitted.
3. Request Corrections
You may ask us to correct health information that you believe is inaccurate or incomplete.
We may deny a request in certain circumstances.
If a request is denied, we will provide an explanation as required by law.
4. Request Confidential Communication
You may ask us to contact you in a particular way or at a different address.
For example, you may ask us to:
Call a specific telephone number
Leave or not leave voicemail
Use a specific mailing address
Communicate through the secure Patient Portal
We will accommodate reasonable requests.
5. Request Restrictions
You may ask us not to use or share certain health information for treatment, payment or healthcare operations.
We are not always required to agree.
If you pay for a service in full out of pocket, you may ask us not to share information about that service with your health plan for payment or healthcare operations.
We will honor that request unless disclosure is required by law.
6. Receive a List of Disclosures
You may request a list of certain disclosures of your health information made during the six years before your request.
The list generally does not include disclosures for:
Treatment
Payment
Healthcare operations
Disclosures that you authorized
Certain disclosures permitted by law
One accounting within a 12-month period will be provided without charge. A reasonable fee may apply to additional requests.
7. Choose a Representative
A person with legal authority to act for you may exercise your privacy rights.
This may include:
A personal representative
A legal guardian
A person with a valid medical power of attorney
We will verify the person’s authority before acting on a request.
8. File a Complaint
You may complain to PsycheMD if you believe your privacy rights were violated.
Contact:
Privacy Officer
PsycheMD Psychiatry PLLC
000 Cedar Avenue, Suite 410
Seattle, WA 98101, USA
You may also submit a complaint to the U.S. Department of Health and Human Services Office for Civil Rights.
PsycheMD will not retaliate against you for filing a complaint.
9. Your Choices
For certain health information, you may tell us how you want information shared.
You may tell us whether to:
Share information with family, close friends or others involved in your care
Share information in a disaster-relief situation
Contact you regarding fundraising
Written permission is generally required for:
Marketing
Sale of health information
Most uses or disclosures of psychotherapy notes
Written permission may be revoked at any time, except where we have already relied on it.
10. Treatment, Payment and Healthcare Operations
Treatment
We may use and share health information with healthcare professionals involved in your care.
Payment
We may use and share information to bill and receive payment from health plans, patients and other responsible parties.
Healthcare operations
We may use and share information to operate the practice, improve care, manage services, review quality and perform administrative activities.
11. Other Uses and Disclosures
We may use or disclose health information when permitted or required for:
Public-health activities
Reporting suspected abuse or neglect
Preventing a serious and imminent threat
Health-oversight activities
Licensing and professional review
Workers’ compensation
Certain law-enforcement purposes
Coroners or medical examiners
Organ and tissue donation
Research that meets applicable requirements
Courts and legal proceedings
Other uses required by law
Additional protections may apply to mental-health records, psychotherapy notes, substance-use-disorder records and other specially protected information.
12. Our Responsibilities
PsycheMD is required to:
Maintain the privacy and security of protected health information
Follow the duties and practices described in this Notice
Provide this Notice
Notify affected individuals when required after a breach
Honor privacy rights as required by law
Use or disclose only the information reasonably necessary where applicable
We will not use or share health information other than as described here unless you give written permission or the law permits or requires it.
13. Changes to This Notice
PsycheMD may change this Notice.
Changes may apply to all health information maintained by PsycheMD, including information created before the change.
The current Notice will be:
Available on the website
Available at the office
Available upon request
The current effective date will appear at the top of the page.
14. Privacy Contact
Privacy Officer
PsycheMD Psychiatry PLLC
000 Cedar Avenue, Suite 410
Seattle, WA 98101, USA
Do not send medical information through general email.