Notice of Policies and Practices to Protect the Privacy of Your Health Care Information
THIS NOTICE DESCRIBES HOW Dan Med TMS USES AND DISCLOSES YOUR PERSONAL INFORMATION AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
I. Uses and Disclosures for Treatment, Payment, and Health Care Operations
Dan Med TMS, Inc. may use or disclose your Protected Health Information (PHI), for treatment, payment, and health care operations purposes with your consent. To help clarify these terms, here are some definitions:
- “PHI” refers to information in your health record that could identify you.
- “Treatment” is when we provide, coordinate or manage your health care and other services related to your health care. An example of treatment would be when we consult with another health care provider, such as your physician or substance abuse provider.
- “Payment” is when we obtain reimbursement for your healthcare. Examples of payment are when we disclose your PHI to your health insurer to obtain reimbursement for your health care or to determine eligibility or coverage.
- “Health Care Operations” are activities that relate to the performance and operation of our clinic. Examples of health care operations are quality assessment and improvement activities, business-related matters such as audits and administrative services, and case management and care coordination.
- “Use” applies only to activities within our clinic such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you.
- “Disclosure” applies to activities outside of our clinic such as releasing, transferring, or providing access to information about you to other parties.
II. Uses and Disclosures of PHI with Written Consent and Authorization
We may use or disclose PHI for purposes outside of treatment, payment, and health care operations when your appropriate authorization is obtained. An “authorization” is written permission above and beyond the general consent that permits only specific disclosures. In those instances, when we are asked for information for purposes outside of treatment, payment and health care operations, we will need to obtain an authorization before releasing your PHI, which includes psychotherapy notes. You may revoke all authorizations at any time, provided each revocation is in writing. You may not revoke an authorization to the extent the (1) we have relied on that authorization; 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.
III. Uses and Disclosures of PHI with Neither Consent nor Authorization
We may use or disclose PHI without your consent or authorization in the following circumstances:
- Child Abuse: If we have reasonable cause to believe that a child has suffered abuse or neglect, we are required by law to report it to the proper law enforcement agency or the Washington Department of Social and Health Services.
- Adult and Domestic Abuse: If we have reasonable cause to believe that abandonment, abuse, financial exploitation, or neglect of a vulnerable adult has occurred, we must immediately report the abuse to the Washington Department of Social and Health Services. If we have reason to suspect that sexual or physical assault has occurred, we must immediately report to the appropriate law enforcement agency and to the Department of Social and Health Services.
- Health Oversight: If the Washington Examining Board subpoenas me as part of investigations, hearings or proceedings relating to the discipline, issuance or denial of licensure, we must comply. This could include disclosing your relevant substance abuse information.
- Judicial or Administrative Proceedings: If you are involved in a court proceeding and a request is made for information about the professional services that we have provided to you and the records thereof, such information is privileged under state law, and we will not release information without the written authorization of you or your legal representative, or a subpoena of which you have been properly notified and you have failed to inform us that you are opposing the subpoena, or a court order. The privilege does not apply when you are being evaluated for a third party or where the evaluation is court ordered. You will be informed in advance if this is the case.
- Serious Threat to Health or Safety: We may disclose your confidential substance abuse information to any person without authorization if we reasonably believe that disclosure will avoid or minimize imminent danger to your health or safety, or the health or safety of any other individual.
- Worker’s Compensation: If you file a worker’s compensation claim, with certain exceptions, we must make available, at any stage of the proceedings, all substance abuse information in our possession relevant to the particular injury in the opinion of the Washington Department of Labor and Industries, to your employer, your representative, and the Department of Labor and Industries upon request.
- Qualified Service Agreement/Business Associate Agreement: Dan Med TMS
can disclose information without your consent to obtain legal or financial services, or to another medical facility to provide health care to you, as long as there is a Quality Service Organization/Business Associate Agreement in place.
IV. Patient’s Rights and Provider’s Duties as it Pertains to your PHI
- Right to Request Restrictions – You have the right to request restrictions on certain uses and disclosures of protected health information about you. However, we are not required to agree to a restriction you request.
- Right to Receive Confidential Communications by Alternative Means and at Alternative Locations – You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations. (For example, you may not want a family member to know that you are seeing us. Upon your request, we will send your bills to another address.)
- Right to Inspect and Copy – You have the right to inspect or obtain a copy (or both) of PHI in our substance abuse and billing records used to make decisions about you for as long as the PHI is maintained in the record. We may deny your access to PHI under certain circumstances, but in some cases you may have this decision reviewed. On your request, we will discuss with you the details of the request and denial process.
- Right to Amend – You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. We may deny your request. On your request, we will discuss with you the details of the amendment process.
- Right to an Accounting – You generally have the right to receive an accounting of disclosures of PHI for which you have neither provided consent nor authorization (as described in Section III of this Notice). On your request, we will discuss with you the details of the accounting process.
- Right to a Paper Copy – You have the right to obtain a paper copy of the notice from us upon request, even if you have agreed to receive the notice electronically.
- We are 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.
- We reserve the right to change the privacy policies and practices described in this notice. Unless we notify you of such changes, however, we are required to abide by the terms currently in effect.
- If we revise our policies and procedures, we will notify you by mailing you a copy of the revision with your monthly statement.
V. Questions and Complaints
If you have questions about this notice, disagree with a decision made about access to your records, or have other concerns about your privacy rights, you may contact the Dan Med TMS office in which you are attending.
If you believe that your privacy rights have been violated and wish to file a complaint with the Director you may send your written complaint to Dan Med TMS, Inc. 841 Central Ave N Suite #C208 Kent WA 98032
You may also send a written complaint to the Department of Health.
You have specific rights under the Privacy Rule. We will not retaliate against you for exercising your right to file a complaint.
This notice went into effect on April 15th 2019.
We reserve the right to change the terms of this notice and to make the new notice provisions effective for all PHI that we maintain. We will provide you with a revised notice by mail if necessary.
Washington State Federal Rules and Regulations which Dan Med TMS follows:
* 42 USC.29Odd-2 and 42 USC.290ee-3 (Federal laws)
* 42 CFR, part 2 (Federal regulations)
* RCW combined ESNB/619, SSB5469 and E25HB1793, replaces 69.54 RCW, 70.96 RCW and amends 70.96A RCW (Washington State laws)
* WAC 246.341 (2) (Washington State regulations)
* RCW 71.05.390 – WAC 275-56-240 (Washington State regulations for DV)
* HIPAA 45 CFR Parts 160& 164 (Federal laws for all healthcare)