When do we collect information?
Vera Dragonchuk does not collect any of your information unless you decide to schedule a counseling appointment via Office365 Bookings site or by emailing Vera 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 me, 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 Vera Dragonchuk 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, Vera Dragonchuk compiles the information to send you electronic intake forms to sign via Adobe Pro. Those forms will be stored as a copy in Office Ally 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?
Vera Dragonchuk, LMHC protects your information by using secure services like Office 365 Enterprise which is secured by Microsoft. Vera Dragonchuk also utilizes a secure billing software where your information is protected in order to submit claims for reimbursement. Vera Dragonchuk 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 – for electronic billing and 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.
If you have any questions about the privacy of your information please contact Vera at email@example.com or 425-444-5902.
PRIVACY DISCLOSURE AND HIPPA VERA DRAGONCHUK, LMHC;
Notice of Privacy Practices Effective Date: April 6, 2011
Welcome to my counseling practice. I am a licensed mental health counselor, practicing as a psychotherapist since 2003. I obtained my Master's Degree in Counseling Psychology from Northwest University in 2004 and continued my work in private practice, obtaining licensure with the state of WA in 2008. My professional experience also includes working as a crisis counselor, emergency room social worker, mental health professional in an inpatient psychiatric unit, and domestic violence counselor in a domestic violence women’s shelter. Presently, I am in training for several specialized proficiencies which include: group psychotherapist, hypnotherapist, somatic experience practitioner, feedback informed treatment, and system centered therapy. These experiences and ongoing trainings have contributed to my development as a psychotherapist. My goal and passion is to continue to offer therapy practice with a high degree of integrity, skill, and compassion.
My understanding of human behavior is informed by psychodynamic psychotherapy approach. This psychotherapy approach helps explain who we are, why we do the things we do, and what it is that is interfering with our realizing successfully in our relationships and our lives. In addition to my psychodynamic psychotherapy approach, I draw upon a wide range of therapeutic interventions to make the most effective counseling experience possible. The overall goal of my work is to focus in the present moment, influencing motivation, symptom management, and overreaching goal of improved quality of life.
The way I practice psychotherapy highly influenced by patients’ goals and motivation. With some of my patient’s therapy is a brief solution-focused treatment addressing well-articulated goals. Still, with others appointments are scheduled when they are needed during a difficult period of stress or upheaval. With many of my patients it becomes a long term ritualized conversation about yourself and your life. In those cases, the frequency of the psychotherapy is scheduled once to twice a week. In all the cases, the first few visits are set aside to do a psychological assessment and to begin building a trusting counseling relationship. You are expected to talk freely and openly about everything on your mind. My job is to listen carefully; paying attention to the emotional side of things, to understand and better resolve what might be hurting. Offering suggestions and interventions that might improve your life. Whichever therapy style we adapt there are driving and restraining energy in each modality. We can discuss and experiment with each of these approaches to make sure you are getting the best type of therapy you might need.
PRIVACY DISCLOSURE AND HIPPA VERA DRAGONCHUK, LMHC; 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: Vera Dragonchuk, LMHC. 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 Vera Dragonchuk, LMHC understands that medical information about you and your health is personal. Vera Dragonchuk, LMHC is committed to protecting medical information about you. Vera Dragonchuk, LMHC creates a record of the care and services you receive from a Provider. Vera Dragonchuk, LMHC 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 Vera Dragonchuk, LMHC may use and disclose medical information about you. Vera Dragonchuk, LMHC also describes your rights and certain obligations Vera Dragonchuk, LMHC have regarding the use and disclosure of medical information.
Vera Dragonchuk, LMHC 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 Vera Dragonchuk, LMHC May Use and Disclose Medical Information About You
The following categories describe different ways that Vera Dragonchuk, LMHC use and disclose medical information. For each category of uses or disclosures Vera Dragonchuk, LMHC will explain what Vera Dragonchuk, LMHC mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways Vera Dragonchuk, LMHC are permitted to use and disclose information will fall within one of the categories.
- For treatment: Vera Dragonchuk, LMHC may use medical information about you to provide you with medical treatment or services. Vera Dragonchuk, LMHC 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: Vera Dragonchuk, LMHC 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, Vera Dragonchuk, LMHC may need to give your health plan information about your care received so your health plan will pay Vera Dragonchuk, LMHC or reimburse you for a visit or procedure. Vera Dragonchuk, LMHC 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: Vera Dragonchuk, LMHC 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: Vera Dragonchuk, LMHC 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: Vera Dragonchuk, LMHC 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: Vera Dragonchuk, LMHC may release medical information about you to a friend or family member who is involved in your medical care. Vera Dragonchuk, LMHC may also give information to someone who helps pay for your care.
- As required by law: Vera Dragonchuk, LMHC 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: Vera Dragonchuk, LMHC 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: Vera Dragonchuk, LMHC may release medical information about you pursuant to a written authorization signed by you. If you give Vera Dragonchuk, LMHC such an authorization, you may, nevertheless, revoke it by a written revocation delivered to Vera Dragonchuk, LMHC, except to the extent Vera Dragonchuk, LMHC have acted in reliance upon the authorization.
- Military and veterans: If you are a member of the armed forces, Vera Dragonchuk, LMHC may release medical information about you as required by military command authorities. Vera Dragonchuk, LMHC may also release medical information about foreign military personnel to the appropriate foreign military authority.
- Workers' compensation: Vera Dragonchuk, LMHC 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: Vera Dragonchuk, LMHC 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 if Vera Dragonchuk, LMHC believe a patient has been the victim of abuse, neglect or domestic violence. Vera Dragonchuk, LMHC will only make this disclosure if you agree or when required or authorized by law.
- Health oversight activities: Vera Dragonchuk, LMHC 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, Vera Dragonchuk, LMHC may disclose medical information about you in response to a court or administrative order. Vera Dragonchuk, LMHC 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: Vera Dragonchuk, LMHC may 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, Vera Dragonchuk, LMHC are unable to obtain the person's agreement. About a death Vera Dragonchuk, LMHC 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: Vera Dragonchuk, LMHC 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. Vera Dragonchuk, LMHC may also release medical information about patients to funeral directors as necessary to carry out their duties.
- National security and intelligence activities: Vera Dragonchuk, LMHC 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: Vera Dragonchuk, LMHC 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, Vera Dragonchuk, LMHC 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 Vera Dragonchuk, LMHC 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, Vera Dragonchuk, LMHC may charge a fee for the costs of copying, mailing, or other supplies associated with your request. Vera Dragonchuk, LMHC 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. Vera Dragonchuk, LMHC will comply with the outcome of the review.
- Right to amend: If you feel that medical information Vera Dragonchuk, LMHC have about you is incorrect or incomplete, you may ask Vera Dragonchuk, LMHC 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. Vera Dragonchuk, LMHC 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, Vera Dragonchuk, LMHC may deny your request if you ask Vera Dragonchuk, LMHC to amend information that: Was not created by Vera Dragonchuk, LMHC, 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 Vera Dragonchuk, LMHC 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 Vera Dragonchuk, LMHC made of medical information about you. To request this list or accounting of disclosures, you must submit your request in writing to 1300 114th Ave Se Ste 130, Bellevue WA 98004. 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, Vera Dragonchuk, LMHC may charge you for the costs of providing the list. Vera Dragonchuk, LMHC 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 Vera Dragonchuk, LMHC 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 Vera Dragonchuk, LMHC 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 Vera Dragonchuk, LMHC not use or disclose information about treatment you had.
- Vera Dragonchuk, LMHC is not required to agree to your request. If Vera Dragonchuk, LMHC does agree, Vera Dragonchuk, LMHC 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 Vera Dragonchuk, LMHC (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 Vera Dragonchuk, LMHC communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that Vera Dragonchuk, LMHC 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. Vera Dragonchuk, LMHC will not ask you the reason for your request. Vera Dragonchuk, LMHC 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 Vera Dragonchuk, LMHC to give you a copy of this notice at any time, or you may obtain a copy at my website at www.veraakulov.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 Vera Dragonchuk 425-444-5902 or email firstname.lastname@example.org.
- Changes to This Notice Vera Dragonchuk, LMHC reserve the right to change this notice. Vera Dragonchuk, LMHC reserve the right to make the revised or changed notice effective for medical information Vera Dragonchuk, LMHC already have about you as well as any information Vera Dragonchuk, LMHC receive in the future. Vera Dragonchuk, LMHC 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 telephone Email: COUNSELING@VERADRAGONCHUK.COM WWW.VERADRAGONCHUK.COM
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 Vera Dragonchuk, LMHC will be made only with your written permission. If you provide Vera Dragonchuk, LMHC permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, Vera Dragonchuk, LMHC will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that Vera Dragonchuk, LMHC is unable to take back any disclosures Vera Dragonchuk, LMHC have already made with your permission, and that Vera Dragonchuk, LMHC is required to retain my records of the care that Vera Dragonchuk, LMHC 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, Vera Dragonchuk, LMHC 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, Vera Dragonchuk, LMHC 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