E. Janet MacGillivray M.Ed, LMHC

18605 98 Ave NW Stanwood, WA 98292

360-652-9808

NOTICE:

I keep a record of the healthcare services I provide you. You may ask me to see and copy that record. You may also ask me to correct that record. I will not disclose your record to others unless you direct me to do so or unless the law authorizes or compels me to do so. You may see your record and get more information about it by contacting me at MacGillivray Counseling, 18605 98th Ave NW, Stanwood, WA. 98292. RCW 70.02.120

Your Rights in Regards to your Medical Record:

• You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you.

• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

• You can ask us to correct health information about you that you think is incorrect or incomplete. Your request must be in writing.

• We may say “no” to your request, but we’ll tell you why in writing within 60 days.

• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.

• We will say “yes” to all reasonable requests.

• You can ask us not to use or share certain health information for treatment, payment, or our operations or to family members involved in your care. Your request for restrictions must be in writing.

• We are not required to agree to your request, and we may say “no” if it would affect your care.

• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer.

• We will say “yes” unless a law requires us to share that information. 

• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.

• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.

• We will make sure the person has this authority and can act for you before we take any action.

• You can complain if you feel we have violated your rights.

Your Choices:

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions. In these cases, you have both the right and choice to tell us to:

• Share information with your family, close friends, or others involved in your care • Share information in a disaster relief situation • Include your information in a hospital directory  • Contact you for fund raising efforts

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases we never share your information unless you give us written permission:

• We will not make any other uses or disclosures of your psychotherapy notes, we will not use or disclose your PHI for marketing purposes, and we will not sell your PHI without your authorization.

• You have the right to choose not to receive fundraising communications. However, we will not contact you for fundraising purposes.

• You have the right to be notified of any breach of your unsecured PHI.

We typically use or share your health information in the following ways:

• We can use your health information and share it with other professionals who are treating you.

• We use and share your health information to run our practice, improve your care, and contact you when necessary.

• We use and share your health information to bill and get payment from health plans or other entities.

Our Uses and Disclosures:

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Help with public health and safety issues:

• We can share health information about you for certain situations such as:

• Preventing disease • Helping with product recalls

• Reporting adverse reactions to medications • Reporting suspected abuse, neglect, or domestic violence

• Preventing or reducing a serious threat to anyone’s health or safety

• We can use or share your information for health research.

• We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

• We can share health information about you with organ procurement organizations.

• We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests:

• We can use or share health information about you:

• For workers’ compensation claims• For law enforcement purposes or with a law enforcement official

• With health oversight agencies for activities authorized by law

• For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions:

• We can share health information about you in response to a court or administrative order, or in response to a subpoena.

For Licensed Mental Health Counselors in The State of Washington there are further restrictions on the release of your private heath information.  These are outlined in the confidentiality  section of the counseling contract signed at the beginning of treatment.

Our Responsibilities:

• We are required by law to maintain the privacy and security of your protected health information.

• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

• We must follow the duties and privacy practices described in this notice and give you a copy of it.

• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Contact Information:

I act as my own Privacy and Security Officer. If you have any questions about this Notice of Privacy Practices, please contact me. Contact information is:

E. Janet MacGillivray, 18605 98th Ave NW, Stanwood, WA 98292, 360-652-9808

Complaints:

• If you believe that we have violated your privacy rights you can complain by contacting me at E. Janet MacGillivray, 18605 98th Ave NW, Stanwood, WA 98292, 360-652-9808

• You also have the right to file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.

• We will not retaliate against you for filing a complaint.

Changes to the Terms of This Notice:

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.

Revised: November 28, 2017

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