ALDER CREEK COUNSELING, LLC (herein referred to here as “ALDER CREEK”). This Notice describes how medical information about you may be used and disclosed and how you can get access to this information. This information will include Protected Health Information (PHI), as that term is defined in privacy regulations issued by the United States Department of Health and Human Services pursuant to the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and, as applicable, RCW Chapter 70.02 entitled “Medical Records – Health Care Access and Disclosure.” Please review it carefully

As part of this professional practice, ALDER CREEK maintains personal information about you and your health. State and federal law protects your privacy by limiting ALDER CREEK in how we may use and disclose such information. PHI is information about you, including demographic information, that may identify you or be used to identify you, and that relates to your past, present or future physical or mental health or condition, the provision of health care services, or the past, present or future payment for the provision of health care. 

YOUR RIGHTS REGARDING YOUR PHI MAINTAINED BY ALDER CREEK ARE AS FOLLOWS:

1. RIGHT OF ACCESS TO INSPECT AND COPY. You have the right, which may be restricted only in certain limited circumstances, to inspect and receive a copy of the PHI that ALDER CREEK maintains. ALDER CREEK may charge a reasonable, cost-based fee for the copying process. Your copy request may also include transmittal directions to a third party.
2. RIGHT TO AMEND. If you feel the PHI ALDER CREEK has about you is incorrect or incomplete, you may ask ALDER CREEK in writing to amend the information although ALDER CREEK is not required to agree to the amendment. You may write a statement of disagreement if your request is denied. The statement will be maintained as part of your PHI and will be included with any disclosure.
3. RIGHT TO ACCOUNTING OFDISCLOSURES. ALDER CREEK maintains a record of disclosures we have made of your PHI. You have the right to request a copy of such an accounting.
4. RIGHT TO REQUEST RESTRICTIONS. You have the right to request in writing a restriction or limitation on the use or disclosure of your PHI for treatment, payment, or health care operations. ALDER CREEK is generally not required to agree to such a request. If ALDER CREEK has been paid in full for all of the services covered by such a request, then ALDER CREEK will honor a request to restrict disclosure to your insurance.
5. RIGHT TO REQUEST CONFIDENTIAL COMMUNICATION. You have the right to request that ALDER CREEK communicates with you in a certain way or at a certain location. ALDER CREEK will accommodate reasonable requests and will not ask why you are making the request.
6. RIGHT TO A COPY OF THIS NOTICE. You have the right to obtain a paper copy of this notice upon request.
7. RIGHT OF COMPLAINT. You have the right to file a complaint in writing with ALDER CREEK or with the Secretary of Health and Human Services if you believe ALDER CREEK has violated your privacy rights. ALDER CREEK will not retaliate against you for filing a complaint. 

ALDER CREEK USES AND DISCLOSURE OF PHI FOR TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS TREATMENT. ALDER CREEK may use your PHI, with your written authorization, for the purpose of providing you with health care treatment, including management, coordination and continuity of your care with other of your current providers.

PAYMENT. ALDER CREEK may use your PHI in connection with billing statements sent to you. ALDER CREEK may use your PHI for the purpose of tracking charges and credits to your account. Unless you have requested and ALDER CREEK has specifically agreed to restrict disclosure of your PHI to your health plan, ALDER CREEK may disclose your PHI to third party payers to obtain information concerning benefit eligibility, coverage, and remaining availability as well as to submit claims for payment. 

HEALTH CARE OPERATIONS. ALDER CREEK may use and disclose your PHI for the health care operations of professional practice in support of the functions of treatment and payment. Such disclosures would be to Business Associates for health care education, or to provide planning, quality assurance, peer review, administrative, legal, or financial services to assist ALDER CREEK in the delivery of your health care. 

APPOINTMENT REMINDERS. With your agreement, ALDER CREEK may use your PHI to contact you regarding ALDER CREEK appointments. 

USES AND DISCLOSURES THAT DO NOT REQUIRE YOUR AUTHORIZATION OR OPPORTUNITY TO OBJECT REQUIRED BY LAW. ALDER CREEK may use or disclose your PHI to the extent that the use or disclosure is required by law, made in compliance with the law, and limited to the relevant requirements of the law. Examples are public health reports, abuse and neglect reports, law enforcement reports, and reports to coroners and medical examiners in connection with investigation of deaths. ALDER CREEK also must make disclosures to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining ALDER CREEK compliance with the requirements of the Privacy Rule. 

HEALTH OVERSIGHT. ALDER CREEK may disclose your PHI to a health oversight agency for activities authorized by law, such as for professional licensure. Oversight agencies also include government agencies and organizations that audit their provision of financial assistance to ALDER CREEK, such as third-party payers. 

THREAT TO HEALTH OR SAFETY. ALDER CREEK may disclose your PHI when necessary to minimize an imminent danger to the health or safety of you or any other individual. 

DISASTER OR EMERGENCY RELIEF PURPOSES. In situations of your absence, incapacity or emergency and in accordance with good professional practice, ALDER CREEK may disclose your PHI minimally necessary to a public or private entity authorized by law or by its charter to assist in disaster relief efforts, which are directly relevant to your identification and care. 

CHILD ABUSE OR NEGLECT. If your therapist has reasonable cause to believe that a child has suffered abuse or neglect, he/she is required by law to report it to the proper law enforcement agency or the Washington Department of Social and Health Services. 

ADULT ABUSE. If your therapist has reasonable cause to believe that abandonment, sexual or physical abuse, financial exploitation, or neglect of a vulnerable adult has occurred, he/she must report the abuse to the Washington Department of Social and Health Services.​

CRIMINAL ACTIVITY. Your therapist may disclose your healthcare information to law enforcement officials if you have committed a crime on my premises or against him/her. 

BUSINESS ASSOCIATES. ALDER CREEK may disclose your PHI to the extent minimally necessary to Business Associates that are contracted by ALDER CREEK to perform health care operations or payment activities on behalf of ALDER CREEK, which may involve their collection, use, or disclosure of your PHI. To safeguard the privacy of your PHI, such contracts are regulated by the Department of Health and Human Services and must contain provisions designed to limit the use and re-disclosure of your PHI, to require compliance by the Business Associate with your individual rights, to subject the Business Associate to specified security obligations, and to require the Business Associate to require such obligations of a subcontractor. 

COMPULSORY PROCESS. ALDER CREEK will disclose your PHI if a court issues an appropriate order. ALDER CREEK will also disclose your PHI if (1) you and ALDER CREEK have each been notified in writing at least fourteen days in advance of a subpoena or other legal demand, identifying the PHI sought, and the date by which a protective order must be obtained to avoid compliance, (2) no qualified judicial or administrative protective order has been obtained, (3) ALDER CREEK has received satisfactory assurances that you received notice of your right to seek a protective order, and (4) the time for your doing so has elapsed.

PSYCHOTHERAPY NOTES. If kept as separate records, I must obtain your authorization to use or disclose psychotherapy notes with the following exceptions. I may use the notes for your treatment. I may also use or disclose, without your authorization, the psychotherapy notes for my own training, to defend myself in legal or administrative proceedings initiated by you, as required by the Washington Department of Health or the US Department of Health and Human Services to investigate or determine my compliance with applicable regulations, to avert a serious and imminent threat to public health or safety, to a health oversight agency for lawful oversight, for the lawful activities of a coroner or medical examiner or as otherwise required by law.

USES AND DISCLOSURES OF PHI WITH YOUR WRITTEN AUTHORIZATION. ALDER CREEK will make other uses and disclosures of your PHI only with your written authorization. You may revoke this authorization in writing at any time, unless ALDER CREEK has taken a substantial action in reliance on the authorization such as providing you with health care services for which ALDER CREEK must submit subsequent claim(s) for payment.

SPECIAL AUTHORIZATIONS. Certain federal and state laws that provide special protections for certain kinds of personal health information call for specific authorizations from you to use or disclose information. When your personal health information falls under these special protections, we will contact you to secure the required authorizations to comply with federal and state laws such as:

• Uniform Health Care Information Act (RCW 70.02)
• Sexually Transmitted Diseases (RCW 70.24.105)
• Drug and Alcohol Abuse Treatment Records (RCW 70.96A.150)
• Mental Health Services for Minors (RCW 71.05.390-690)
• Communicable and Certain Other Diseases Confidentiality (WAC 246-100-016)
• Confidentiality of Alcohol and Drug Abuse Patients (42 CFR Part2)

If we need your health information for any other reason that has not been described in this notice, we will ask for your written authorization before using or disclosing any identifiable health information about you. Most important, if you choose to sign an authorization to disclose information, you can revoke that authorization at a later time to stop any future use and disclosure.

Electronic Records Disclosure
I keep and store records for each client in a record-keeping system produced and maintained by SimplePractice LLC, an electronic health record (EHR). This system is “cloud-based,” meaning the records are stored on servers which are connected to the Internet. I have entered into a HIPAA Business Associate Agreement with SimplePractice LLC. Because of this agreement, SimplePractice LLC is obligated by federal law to protect these records from unauthorized use or disclosure.

I have my own security measures for protecting the devices that I use to access these records:

On computers, I employ firewalls, antivirus software, and passwords to protect the computer from unauthorized access and thus to protect the records from unauthorized access.

Here are things to keep in mind about my record-keeping system:

• While my record-keeping company and I both use security measures to protect these records, their security cannot be guaranteed.
• As a HIPAA Business Associate, SimplePractice LLC is obligated by law to train their staff on the proper maintenance of confidential records and to prevent misuse or unauthorized disclosure of these records. This protection cannot be guaranteed, however.

SimplePractice LLC keeps a log of my transactions with the system for various purposes, including maintaining the integrity of the records and allowing for security audits. These transactions are kept for as long as Alder Creek Counseling LLC has an account with SimplePractice LLC.

Disclosure Regarding Third-Party Access to Communications
Please know that if we use electronic communications methods, such as email, texting, online video, and possibly others, there are various technicians and administrators who maintain these services and may have access to the content of those communications. In some cases, these accesses are more likely than in others. Of special consideration are work email addresses. If you use your work email to communicate with me, your employer may access our email communications. There may be similar issues involved in school email or other email accounts associated with organizations that you are affiliated with. Additionally, people with access to your computer, mobile phone, and/or other devices may also have access to your email and/or text messages. Please take a moment to contemplate the risks involved if any of these persons were to access the messages we exchange with each other.

Communications Policy
When you need to contact Alder Creek Counseling LLC for any reason, these are the most effective ways to get in touch in a reasonable amount of time:

• By secure email: richard@aldercreekcounseling.com.
• By phone: (360) 401-3051.
• Texting: Note that text messages are not encrypted. Please email if you would like to contact me in writing.
• If you need to send a file such as a PDF or other digital document, please send using the secure email service. At times I may send you documents through the SimplePractice LLC portal or secure email.
• Please speak with me about any concerns you have regarding my preferred communication methods

This Notice of Privacy Practices informs you how ALDER CREEK may use and disclose your PHI and your rights regarding your PHI. ALDER CREEK is required by law to maintain the privacy of your PHI and to provide you with notice of our legal duties and privacy practices with respect to your PHI, and to notify you following a breach of unsecured PHI related to you. ALDER CREEK is required to abide by the terms of this Notice of Privacy Practices. ALDER CREEK reserves the right to change the terms of this Notice of Privacy Practices at any time. Any new Notice of Privacy Practices will be effective for all PHI that ALDER CREEK maintains at that time. ALDER CREEK will make available a revised Notice of Privacy Practices by providing you a copy upon your request and it will be made available on the ALDER CREEK website. 

CONTACT INFORMATION AND COMPLAINTS
Richard VanCleave is the ALDER CREEK designated Privacy Officer, so, if you have any questions about this Notice of Privacy Practices or complaints about how your PHI has been utilized, please contact:

Alder Creek Counseling, LLC
Privacy Officer: Richard VanCleave
200 Israel Rd SE #14404
Tumwater, WA 98501

richard@aldercreekcounseling.com
(360) 401-3051

To Ask for Help or Complain
If you have questions, want more information, or want to report a problem about the handling of your protected health information, you may contact our Privacy Officer at the above address. 

If you believe your privacy rights have been violated, you may discuss your concerns with the Privacy Officer. You may send a written complaint to the Washington State Department of Health at:

510 4th Ave. W, Ste. 404
Seattle, WA 98119

You may also file a complaint with the U.S. Secretary of Health and Human Services Office for Civil Rights at:

200 Independence Ave. SW
Washington, D.C. 20201
1-877-696-6775
hhs.gov/ocr/privacy/hipaa/complaints/

Alder Creek Counseling, LLC will not retaliate against you for filing a complaint.

This Notice is effective on July 1, 2022.

I read and understand the information provided above.

Contact

richard@aldercreekcounseling.com