When do we collect information?
Renton Counseling Center does not collect any of your information unless you decide to schedule a counseling appointment via Office365 Bookings site or by emailing us directly or making a phone call. As a new patient, you enter information about you, your name, email, phone number, and address. Further, if you would like to use your health insurance your insurance information, date of birth, goal for therapy, how you found us, and your insurance ID number.
How do we use your information?
When you schedule your appointment online via Office365 Microsoft Booking the information you provide there allows RCC staff to check your insurance benefits and to let you know what you will expect to pay. This information is then stored in Electronic Medical Records called Office Ally and used to submit electronic claims to your health insurance company.
For your first appointment, your counselor compiles the information to send you electronic intake forms to sign via Adobe Pro. Those forms will be stored as a copy in Therapy Appointment and Office 365 Enterprise Cloud. Your information is only used for the purposes to comply with laws and insurance contracts. Your information is not used in any other ways including marketing. The systems in place where your information is stored are HIPPA compliant and have secure cloud access. All paperwork with identifying information is scanned and shredded.
How do we protect visitor information?
RCC protects your information by using secure services like Office 365 Enterprise which is secured by Microsoft. Telehealth via Microsoft Teams is encrypted. RCC also utilizes a secure billing software where your information is protected in order to submit claims for reimbursement. RCC maintains reasonable and appropriate administrative, technical, and physical safeguards to prevent intentional or unintentional use or disclosure of protected health information in violation of the Privacy Rule and limit its incidental use and disclosure unless it is permitted. Examples of such safeguards include: shredding documents containing protected health information before discarding them, securing medical records with lock and key or passcode, and limiting access.
Third-Party Software used to manage your information and how it is kept secure:
- Office Ally Practice Mate Security – Clearing House
- Therapy Appointment - Electronic Healthcare Records
- Microsoft Office 365 Enterprise - for email, scheduling appointments, and stored scanned documents
- Adobe Acrobat DC – for intake paperwork completion and signature
- Credit card processing companies are Paypal & Square UP.
Contact Richard Scafati, Operations Manager:
If you have any questions about the privacy of your information please contact Richard at firstname.lastname@example.org or 425-444-5902.
PRIVACY DISCLOSURE AND HIPPA RENTON COUNSELING CEN TER ;
Notice of Privacy Practices Effective Date: April 6, 2011
Introduction to Renton Counseling Center
Renton Counseling Center (RCC) is an outpatient psychotherapy clinic. Here you will find everything you need to know regarding your treatment at RCC. Of course, you can always ask us questions if you are unsure about anything!
The human experience is a complicated one and most of us, at one time or another have found ourselves overwhelmed by life. When we respond to life's struggles in ways less then successful we may experience depression and anxiety. Psychotherapy is an effective treatment for the relief of these and many other psychological symptoms. Psychotherapy works to help us understand who we are and why we do what we do. This process helps us identify the things that interfere with our personal success in our relationships and lives. The goal of psychotherapy at Renton Counseling Center is increase your self-esteem, improve your quality of life, strengthen yourself to successfully pursue happiness, achievement, and love.
At Renton Counseling Center, we believe in compassionate, transformational, and competent psychotherapy services for individuals who reside in Renton and beyond. We believe in partnering with licensed practitioners who would enjoy a collaborative team environment, while providing excellent specialized counseling to our patients. We support you in succeeding and growing your emotional, relational, and spiritual self. Psychotherapists at Renton Counseling Center are expected to comply with the code of ethics stipulated by their professional license and any other applicable laws, regulations, expectations, policies, and guidelines that apply to their role as a licensed mental health professionals.
Here at Renton Counseling Center, we work a little differently. Our priority is making sure that you get the results you want. For this reason, it is very important that you are involved in monitoring progress throughout therapy. We do this formally by using a short measuring outcome rating scale. This takes less then a minute and you fill this out before each session. A fair amount of research shows that if we are going to successful in our work together, we should see signs of improvement earlier rather then later. At the end of the session please complete a short Session Rating Scale. This tool will help improve the way you and your therapist work together.
Provider and Contact information you can call 425-444-5902 for the directory
• Vera Dragonchuk, LMHC email@example.com direct 425-708-8466 x 1 – click here for bio
• Debra Poulsen, LMHC firstname.lastname@example.org direct 425-616-3905 x 5 - click here for bio
• Bruce Rodda, LMHC email@example.com direct 425-616-3965 x 4 - click here for bio
• Mary Lou Macarius, LMHC firstname.lastname@example.org direct 425-558-1209 x 9 - click here for bio
• Cindy Jones, MA, LMHC email@example.com direct 425-528-0047 click here for bio
• Victor Campos, MA, LMHC firstname.lastname@example.org direct 425-708-8687 click here for bio
• Rev. Kathleen Yackey, LMHC email@example.com direct 425-558-1209 x 6 - click here for bio
What new clients should expect
• New patients are asked to register with Therapy Appointment Electronic Healthcare Records cloud based program and sign these forms and complete the ‘my bio’ section.
• After initial intake assessment 1-3 visits, appointments are scheduled once a week for most counseling treatment.
• Schedule appointments, visit our booking site.
In the sessions that follow
• It is important to establish a regular time that therapist and patient meets. The time is set aside to work on emotional issues must be a safe, predictable, and caring therapeutic environment. Your therapist will work on finding a time and providing the working environment that would best meet your needs.
• Each sessions is 45-55 minutes in length, it is private and confidential. In case of a crisis or emotional emergency, the frequency and the duration of the session may be increased. The best type of therapy we provide is face to face in the office. Phone sessions are available in cases of emergency or inability to get to the office.
Client Rights Receiving Counseling Services in Washington State
• As a client receiving counseling services in the State of Washington, you have the right to refuse any treatment you do not want,
• and the right and responsivity to choose your counselor and treatment approach that best suits your needs and purposes.
• You also have the right to have full and complete knowledge of your counselor’s qualifications and training;
• be fully informed regarding the terms under which services will be provided;
• discuss your treatment with anyone you choose, including another counselor;
• have a detailed explanation of any procedure or form of treatment prior to its implementation;
• have direct access to your treatment records with a minimum notice of three working days, ask for a copy of and correct those records;
• question the practices and competence of your counselor (including a grievance to your insurance company);
• know your counselor’s state licensing number;
• request a copy of the ethics code and other guidelines/procedures that govern your counselor’s practice;
• and request a change of counselor, request a referral to another counselor, or to 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).
Your participation in therapy, the content of your sessions, and any information you provide to your counselor during your sessions is protected by legal confidentiality. Since your counselor is an employee of RCC, your treatment records may be accessed by RCC in the normal course of our healthcare operations. In such cases, the rules of confidentially still apply. Some exceptions to confidentiality are the following situations in which your counselor may choose to, or be required to, disclose this information:
• If you give your counselor written consent to have the information released to another party;
• In the case of your death or disability your counselor may disclose information to your personal representative;
• If you waive confidentiality by bringing legal action against your counselor;
• In response to a valid subpoena from a court or from the secretary of the Washington State Department of Health for records related to a complaint, report, or investigation;
• If your counselor reasonably believes that disclosure of confidential information will avoid or minimize an imminent danger to your health or safety or the health or safety of any other person; or
• If, without prior written agreement, no payment for services has been received after 90 days, the account name and amount may be submitted to a collection agency.
As mandated reporters, we are required by law to disclose certain confidential information including suspected abuse or neglect of children under RCW 26.44, suspected abuse or neglect of vulnerable adults under RCW 74.34, or as otherwise required in proceedings under RCW 71.05.
Your counselor seeks ongoing supervision and consultation from colleagues in order to provide you with the best services possible. Your counselor may disclose information about your counseling session in consultation with colleagues, in which case your counselor will withhold your name and other easily identifiable information. Another clinician at RCC may access your counselor’s client files in order to make appropriate notification and referrals in case your counselor is temporarily or permanently incapacitated.
Renton Counseling Center billing rates are the following: Intake $160, 60 Min $150, 45 Min $120.
Payment is due at the beginning of each session. If you are unable to keep your appointment, you must give us 24 hours advance notice or you will be charged $90 for the missed session. Under Washington State Law, you are not liable for any fees or charges for services rendered prior to receipt of this disclosure statement.
We ask that you provide a credit or debit card during your first appointment with your therapist and we will securely save it on file with TherapyAppointment our Electronic Healthcare Record management system. If using insurance, this payment method will cover any balance due after your insurance benefits are applied. If using insurance, Renton Counseling Center does not determine your payment responsibility. The health plan determines the exact payment responsibility after the claim is adjudicated.
We offer a limited number of sliding scale appointments based on client financial need. Your counselor will be happy to discuss this with your further if you feel this might apply to your situation.
Balances due that are outstanding longer than six months may be collected via collections/or small claims court. After the account is past due two months or longer there may be a late $3.00 charge added every month thereafter. Failure to make payment may be considered a termination of the counseling relationship initiated by you.
DIVORCED PARENTS: The parent bringing the child to our facility will be responsible for required co-payments, deductibles,etc. at the time of service, unless court ordered or contracted otherwise.
Assignment of Benefits if using insurance
Release of Information: Insurance companies and other third-party payers may require that we provide them with information regarding the services provided to you. This information may include the type of service provided, the dates and times of service, your diagnosis, treatment plan, a description of impairment, progress of therapy, and case notes and summaries. If you do not want RCC to provide your confidential information to your insurance company, let your counselor know so that we can discuss alternatives.
Non-covered services: If insurance company determines that the services provided by Renton Counseling Center is a non-covered service or they assess there was no medical necessity, the undersigned accepts the full financial responsibility for all items and services which are determined by insurance plan to not be covered. You agree to cooperate with Renton Counseling Center to obtain necessary healthcare service plan authorizations.
Assignment of benefits: I hereby assign Renton Counseling Center, PLLC my right to the insurance benefits that may be payable to me for the services provided, in my name or in my behalf. I further authorize those payments be made directly to Renton Counseling Center, PLLC. I understand that acceptance of insurance assignment does not relieve me from any responsibility concerning payment for medical services.
Telehealth Disclosure & Consent
This document is provided in addition to the RCC Disclosure and Consent for Treatment in order to provide you with some specific information about your participation in telehealth services with RCC.
We use Microsoft Teams for our telehealth platform. Microsoft technology allows the sessions to be end-to-end encrypted for one-to-one Microsoft Teams calls. Here is more information about Microsoft E2E encryption technology.
Risks and Benefits
At your request, and if it is therapeutically appropriate, we may make use of technology assisted distance counseling tools (“Telehealth”) such as and internet enabled video and/or audio services. It is important that you understand the benefits and limitations of such services.
• Telehealth services may improve your access to counseling, may reduce your costs associated with counseling, and my support more effective use of in-person counseling.
• If you are located outside of the State of Washington, the counseling services your clinician is allowed to provide to you may be limited or prohibited. If you are located outside of the State of Washington, we will discuss what services may be available to you.
• Telehealth services are not appropriate for all clients and all situations. If you or your clinician determines that Telehealth services are not appropriate for you, we will assist you in obtaining face-to-face counseling.
• Successful use of Telehealth services requires a reasonable level of access to computer hardware and software. If you do not have access to such resources, we can discuss available alternatives.
• At times it may become necessary for us to allow access to our computer hardware and software for purposes of system maintenance, repair, upgrades, or other similar purposes. In such cases we will make reasonable efforts to protect your confidential information.
• Telehealth services may not be reimbursed by some insurance plans. In such cases, payment for Telehealth services remains your sole responsibility.
• It is your responsibility to choose a secure location to interact with technology-assisted media and to be aware that without sufficient safeguards, third parties may overhear our communications or may gain access to the technology you are using. Some basic safeguards may include communicating only through a computer or device over which you maintain control, with a firewall and anti-virus software, password protection, and a secure private internet connection.
At the initiation of the therapeutic relationship, your clinician will ask you to provide the following contact information:
• Your local hospital emergency room phone number;
• Your local crisis line phone number;
• The phone number of a local clinician who can provide you with face-to-face counseling services in case you or I determine that Telehealth is no longer appropriate for you.
At the beginning of each session your clinician will ask you to provide the following information:
• Your physical location and address;
• A phone number to contact you in case of technology failure or other loss of internet connection during the telehealth session;
• An email address to contact you as an alternative if you cannot connect via phone.
Electronic Communications and Social Media Policy
In the regular conduct of our practice, we may make use of a cellular phone, or other portable communication device, to communicate with clients. In such cases, we will limit the information we store in any portable communication device to the least necessary. Please be aware that such forms of communication do have inherent risks to client confidentiality. If you would prefer that we do not store you name and telephone number in a portable communication device, or if you would prefer that we do not communicate with you via cellular phone, please inform your counselor so that we can make alternative arrangements.
In order to best protect your confidentiality, your counselor typically will communicate with clients via email or text for the purposes of scheduling or canceling appointments only. Your counselor cannot guarantee the security or confidentially of information sent via email or text. If you need to communicate with your counselor via email or text for any other purpose, please discuss that with your counselor in person.
Professional ethics standards do not permit us to communicate with clients via social media. For this reason, we cannot accept any client requests to connect on Facebook, or other similar social media platforms. RCC does maintain a professional social media presence that may used to provide general information to clients. Please do not use any professional social media platform as a mode of communication with your counselor. In addition, please understand that your decision to connect to RCC’s professional social media presence may result in the disclosure of your clinical relationship.
We ask that you do not record all or any part of our sessions without first discussing that with your therapist.
If, without having made prior arrangements, we have not heard from you in 30 days your counselor will assume that you would like to terminate your current episode of care and close your active clinical file. In such cases, we may re-open the file and initiate a new episode of care once you meet with your counselor in person.
If you are experiencing an emergency or crisis, please call 911 or the Crisis Line at (206) 461-3222, (253) 396-5180, or (800) 244-5767. In such situations, you may also go to the nearest hospital Emergency Room.
Assurance of Professional Conduct
Thousands of people in the counseling profession practice with competence and treat their clients in a professional manner, however, the State of Washington requires that we provide you with the following information.
Counselors practicing counseling for a fee must be credentialed or licensed with the Department of Health for the protection of public health and safety. Credentialing of an individual with the Department of Health does not include a recognition of any practice standards, nor necessarily imply the effectiveness of any treatment. A copy of the acts of unprofessional conduct can be found in RCW 18.130.180. If you have any concerns about your counselor, you may want to first share your concerns directly with the counselor. Many times, issues can be resolved by open communication. You may also contact: Washington State Department of Health at:
Health Systems Quality Assurance Complaint Intake
Post Office Box 47857
Olympia, WA 98504-7857
PRIVACY DISCLOSURE AND HIPPA RENTON COUNSELING CENTER; Notice of Privacy Practices Effective Date: April 6, 2011
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. If you have any questions, please contact: Vera Dragonchuk, LMHC 425-444-5902
Who Will Follow This Notice This Notice will describe the privacy practices of the following entities: staff of Renton Counseling Center. These entities may be referred to this Notice individually as a "Provider" or collectively as the "Providers". This notice describes privacy practices of the Providers and that of: Any health care professional authorized to enter information into your chart. All departments of the Providers. Any member of a volunteer group allowed helping you while you are at any of the Providers. All employees, staff and other Provider personnel.
Client Disclosure: State of Washington Law
Client’s Rights As a client receiving counseling services in the State of Washington, you have the right to:
- choose your counselor and treatment approach that best suits your needs and purposes;
- have full and complete knowledge of your counselor’s qualifications and training;
- be fully informed regarding the terms under which services will be provided;
- discuss your treatment with anyone you choose, including another counselor;
- have a detailed explanation of any procedure or form of treatment prior to its implementation;
- have direct access to your treatment records with a minimum notice of three working days,
- ask for a copy of and correct those records;
- question the practices and competence of your counselor (including a grievance to your insurance company);
- know your counselor’s state licensing number which is LH00011247;
- request a copy of the ethics code and other guidelines/procedures that govern your counselor’s practice;
- and request a change of counselor,
- request a referral to another counselor,
- or to 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).
All issues discussed in the course of counseling are held in strict confidence. The legal exceptions are:
- The counselor may discuss client issues with immediate family members, a close friend or healthcare providers. However, you may sign a written statement that your counselor does not have any contact with these people, including your physician;
- The counselor may discuss suspected suicidal intent or harm to others;
- indication of child abuse, neglect or molestation as required by law to federal, state or local law enforcement authorities and other specific situations as outlined in RCW 70.02.050 (Disclosure Without Patient’s Authorization).
Other exceptions where your counselor may or must release confidential information under RCW 18.19.180 (Confidential Communications) are:
- With the written consent of the client;
- or, in the case of death or disability,
- the written consent of the client’s personal representative, or other person authorized to sue;
- or the beneficiary of an insurance policy on the client’s life, health, or physical condition;
- If the client reveals the contemplation or commission of a crime or harmful act;
- If the client is a minor who is the victim or subject of a crime, the counselor may testify fully upon examination, trial or other proceedings;
- If the client waives the privilege by bringing charges against the counselor;
- In response to a subpoena from a court of law, or the secretary may subpoena the records (Chapter 26.44 RCW).
Assurance of Professional Conduct Thousands of people in the counseling profession practice with competence and treat their clients in a professional manner. The following situations are not intended to alarm you but are specified so you can be an informed consumer of counseling services.
The Washington State Department of Health requires all counselors to inform their clients that the following are violations of the law (RCW 18.130.180):
The commission of any act involving moral turpitude, dishonesty, corruption relating to the practice of the person’s profession, whether the act constitutes a crime or not;
- Misrepresentation in obtaining a license;
- Advertising that is false, fraudulent or misleading;
- Incompetence, negligence, or malpractice which results in injury to a patient;
- Suspension, revocation, or restriction to practice counseling;
- The possession, use, prescription for use, or distribution of controlled substances or illegal drugs;
- Violation of a state or federal statute or rule that regulates counselors and hypnotherapists, including rules defining standards of practice for certified counselors;
- Failure to cooperate with the disciplining authority;
- Failure to comply with an order issued by the disciplining authority;
- Aiding or abetting an unlicensed person to practice when a license is required;
- Violations of rules established by any health agency;
- Practice beyond the scope of practice as defined by law or rule;
- Misrepresentation or fraud in any aspect of the conduct of the business or profession;
- Failure to adequately supervise auxiliary staff to the extent that the consumer’s health or safety is at risk;
- Practicing counseling or hypnotherapy while suffering from a contagious or infectious disease in a way that would pose a serious risk to public health;
- Promotion for personal gain of any drug, device, treatment, procedure or service that is unnecessary or has no acceptable benefit to the client;
- Conviction of any gross misdemeanor or felony relating to the practice of the person’s profession;
- The procuring, or aiding or abetting in procuring, a criminal abortion;
- The offering, undertaking, or agreeing to cure or treat disease by a secret method, procedure, or treatment;
- The willful betrayal of a practitioner-patient privilege as recognized by law;
- Violation of Chapter 19.68 RCW;
- Interference with an investigation or disciplinary proceeding by willful misrepresentation of facts before the disciplining authority or its authorized representative;
- Misuse of alcohol, controlled substances, or illegal drugs;
- Abuse of a client or sexual contact with a client;
- Acceptance of more than a nominal gratuity where a conflict of interest is presented and based on recognized ethical standards.
- Also, the Washington State Department of Health wants you to know that: “Counselors practicing counseling for a fee must be registered or certified with the Department of Health for the protection of the public health and safety. Registration of an individual with the department does not include a recognition of any practice standards, nor necessarily implies the effectiveness of any treatment, does not include a recognition of any practice standards, nor necessarily implies the effectiveness of any treatment.” (WAC 246-810-031)
- The purpose of the Counselor Credentialing Act that regulates counselors is: “(A) To provide protection for public health and safety; and (B) to empower the citizens of the state of Washington by providing a complaint process against those counselors who would commit acts of unprofessional conduct.” (WAC 246-810-030j)
- If you have any concerns about your counselor, you may want to first share your concerns directly with the counselor. Many times, issues can be resolved by open communication. You may also contact: Washington State Department of Health Counselor Programs P.O. Box 47869 Olympia, WA 98504-7869 Telephone (360) 664-9098
My Pledge Regarding Medical Information RCC understands that medical information about you and your health is personal. RCC is committed to protecting medical information about you. RCC creates a record of the care and services you receive from a Provider. RCC need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by my physician and other personnel. This notice will tell you about the ways in which RCC may use and disclose medical information about you. RCC also describes your rights and certain obligations RCC have regarding the use and disclosure of medical information.
RCC are required by law to: Make sure that medical information that identifies you is kept private. Give you this notice of my legal duties and privacy practices with respect to medical information about you. Follow the terms of the notice that is currently in effect.
How RCC May Use and Disclose Medical Information About You
The following categories describe different ways that RCC use and disclose medical information. For each category of uses or disclosures RCC will explain what RCC mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways RCC are permitted to use and disclose information will fall within one of the categories.
- For treatment: RCC may use medical information about you to provide you with medical treatment or services. RCC may disclose medical information about you to other doctors, nurses, technicians, or medical students who are involved in taking care of you. Different departments of a Provider also may share medical information about you in order to coordinate the different things you need, such as prescriptions and lab work.
- For payment: RCC may use and disclose medical information about you so that the treatment and services you receive from a Provider may be billed to and payment may be collected from you, an insurance company, or a third party. For example, RCC may need to give your health plan information about your care received so your health plan will pay RCC or reimburse you for a visit or procedure. RCC may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
- For operations: RCC may use and disclose your medical information to assess and improve the quality of my services, to review the performance and qualifications of my staff, to arrange for treatment and services you require and other purposes relating t my operations.
- Treatment alternatives: RCC may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
- Health-related benefits and services: RCC may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
- Individuals involved in your care or payment for your care: RCC may release medical information about you to a friend or family member who is involved in your medical care. RCC may also give information to someone who helps pay for your care.
- As required by law: RCC will disclose medical information about you when required to do so by federal, state, or local law.
- To avert a serious threat to health or safety: RCC may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
Special Situations Authorization / Revocation: RCC may release medical information about you pursuant to a written authorization signed by you. If you give RCC such an authorization, you may, nevertheless, revoke it by a written revocation delivered to RCC except to the extent RCC have acted in reliance upon the authorization.
- Military and veterans: If you are a member of the armed forces, RCC may release medical information about you as required by military command authorities. RCC may also release medical information about foreign military personnel to the appropriate foreign military authority.
- Workers' compensation: RCC may release medical information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.
- Public health risks: RCC may disclose medical information about you for public health activities. These activities generally include the following: To prevent or control disease, injury or disability. To report births and deaths. To report child abuse or neglect. To report reactions to medications or problems with products. To notify people of recalls of products they may be using. To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition. To notify the appropriate government authority i RCC believe a patient has been the victim of abuse, neglect or domestic violence. RCC will only make this disclosure if you agree or when required or authorized by law.
- Health oversight activities: RCC may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
- Lawsuits and disputes: If you are involved in a lawsuit or a dispute, RCC may disclose medical information about you in response to a court or administrative order. RCC may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
- Law enforcement: RCC release medical information if asked to do so by a law enforcement official: In response to a court order, subpoena, warrant, summons, or similar process. To identify or locate a suspect, fugitive, material witness, or missing person. About the victim of a crime if, under certain limited circumstances, RCC are unable to obtain the person's agreement. About a death RCC believes may be the result of criminal conduct. About criminal conduct at the practice. In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
- Coroners, medical examiners and funeral directors: RCC may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. RCC may also release medical information about patients to funeral directors as necessary to carry out their duties.
- National security and intelligence activities: RCC may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
- Protective Services for the President and others: RCC may disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.
- Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, RCC may release medical information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
Your Rights Regarding Medical Information About You You have the following rights regarding medical information RCC maintains about you:
- Right to inspect and copy: You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes. To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing 15 S GRADY WAY STE 500, RENTON WA 98057. If you request a copy of the information, RCC may charge a fee for the costs of copying, mailing, or other supplies associated with your request. RCC may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by the Provider will review your request and the denial. The person conducting the review will not be the person who denied your request. RCC will comply with the outcome of the review.
- Right to amend: If you feel that medical information RCC have about you is incorrect or incomplete, you may ask RCC to amend the information. You have the right to request an amendment for as long as the information is kept by the Provider.To request an amendment, your request must be made in writing and submitted to the 15 S GRADY WAY STE 500 RENTON WA 98057. In addition, you must provide a reason that supports your request. RCC may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, RCC may deny your request if you ask RCC to amend information that: Was not created by RCC , unless the person or entity that created the information is no longer available to make the amendment. Is not part of the medical information kept by a Provider. Is not part of the information, which you would be permitted to inspect and copy. Is accurate and complete.
- Right to an accounting of disclosures: You have the right to request an "accounting of disclosures" (a list of the disclosures of medical information about you RCC have made) for disclosure other than for treatment, payment or operation, disclose to you or disclosure made pursuant to an authorization given by you. This is a list of the disclosures RCC made of medical information about you. To request this list or accounting of disclosures, you must submit your request in writing to 15 S Grady Way Ste 500 Renton WA 98057. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper, electronically). The first list you request within a 12-month period will be free. For additional lists, RCC may charge you for the costs of providing the list. RCC will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
- Right to request restrictions: You have the right to request a restriction or limitation on the medical information RCC use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the medical information RCC disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that RCC not use or disclose information about treatment you had.
- RCC is not required to agree to your request. If RCC does agree,RCC will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you must make your request in writing to 15 S Grady Way Ste 500, Renton WA 98057. In your request, you must tell RCC (1) what information you want to limit; (2) whether you want to limit my use, disclosure, or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.
- Right to request confidential communications: You have the right to request that RCC communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that RCC only contact you at work or by mail. To request confidential communications, you must make your request in writing to 15 S Grady Way Ste 500, Renton WA 98057. RCC will not ask you the reason for your request. RCC will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
- Right to a paper copy of this notice: You have the right to a paper copy of this notice. You may ask RCC to give you a copy of this notice at any time, or you may obtain a copy at my website at www.rentoncounselingcenter.com. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. To obtain a paper copy of this notice contact RCC 425-444-5902 or email firstname.lastname@example.org
- Changes to This Notice RCC reserve the right to change this notice. RCC reserve the right to make the revised or changed notice effective for medical information RCC already have about you as well as any information RCC receive in the future. RCC will post a copy of the current notice in the office of each Provider. The notice will contain the effective date on the first page in the top right-hand corner.
- Complaints If you believe your privacy rights have been violated, you may file a complaint with the Provider. All complaints must be submitted in writing. You will not be penalized for filing a complaint. To file a concern, complaint, or to request more information, contact your counselor, who is also your Privacy Officer. Many times your concerns can be resolved by open communication and by direct feedback. Contact information: Vera Dragonchuk, M.A. 15 SOUTH GRADY WAY STE 500 425-444-5902
To file a complaint with the Secretary of Health and Human Services, write to: Secretary of Health and Human Services 200 Independence Ave., SE Washington, D.C. 20201 1-877-696 6775 telephone
Other Uses of Medical Information
Other uses and disclosures of medical information not covered by this notice or the laws that apply to RCC will be made only with your written permission. If you provide RCC permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, RCC will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that RCC is unable to take back any disclosures RCC have already made with your permission, and that RCC is required to retain my records of the care that RCC provided to you.
More Restrictive Laws
This Notice describes my privacy practices as required under the federal Health Insurance Portability and Accountability Act of 1996 and regulations issued pursuant thereto. Portions of the Washington Uniform Healthcare Information Act restrict use and disclosure of your health information to a greater degree than current federal laws may. To that extent, RCC will follow the more restrictive law.
Other persons may require access to your medical information to perform necessary functions on my behalf. If any of your medical information is disclosed to such persons, RCC will first require that such persons agree to use your information solely for the agreed-upon functions and in a manner consistent with this Notice
MORE DETAILS OF THE SUMMARY OF THE HIPAA PRIVACY RULES CAN BE FOUND HERE ON THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES