1. My Legal Duty to Protect Your Information

Federal law (HIPAA) and Washington State law require me to:

• Keep your Protected Health Information (PHI) private
• Provide you with this Notice
• Follow the terms of this Notice
• Notify you if a breach occurs that may have compromised your information

“Protected Health Information” (PHI) includes information that identifies you and relates to your mental health, physical health, treatment, or payment for services. This includes paper, electronic, and verbal information.

When Washington State law provides greater privacy protection than federal law, I follow Washington law.

 

2. How I May Use and Share Your Information

For Treatment

I may use and share your information to provide therapy services.
Examples:

• Consulting with another healthcare provider

• Referring you to another provider

For Payment

If you use insurance, I may share necessary information to:

• Bill your insurance company

• Verify coverage

• Receive payment

For Healthcare Operations

I may use your information for:

• Practice management

• Supervision or consultation

• Quality improvement

• Legal and ethical compliance

Appointment Reminders

I may contact you by phone, text, or email to:

• Remind you of appointments

• Communicate about scheduling

You may request a preferred method of contact.

 

3. Uses That Require Your Written Permission

I will obtain your written authorization before:

• Releasing psychotherapy notes
• Using your information for marketing
• Selling your PHI (I do not sell PHI)
• Sharing information for purposes not described in this Notice

You may revoke your authorization in writing at any time.

Psychotherapy Notes

Psychotherapy notes are personal notes I keep separate from your main record.

They will not be released without your written permission except:

• For my own treatment use
• For supervision or training
• If required by law
• For health oversight investigations
• To prevent serious and imminent harm
• For legal defense if necessary

 

4. When I May Share Information Without Your Permission

I may share your information without written authorization when required by federal or Washington law, including:

• Suspected child or vulnerable adult abuse
• Serious threat to your safety or someone else's
• Court orders or legal proceedings
• Health oversight audits
• Public health reporting
• Workers’ compensation claims
• Reporting crimes on the premises

 

5. Sharing With Family or Others

In emergencies, I may share relevant information with a family member or person involved in your care (e.g., If I reasonably believe 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). I may use professional judgment to determine what is appropriate.

 

6. Your Rights

You have the right to:

• Access Your Records

  • Request a copy of your record (excluding psychotherapy notes).

  • I will respond within 30 days.

• Request a Correction

  • Request corrections if you believe information is incorrect or incomplete.

• Request Confidential Communication

  • Ask me to contact you at a specific phone number, address, or method.

• Request Restrictions

  • Ask me to limit how your information is used or shared.

  • If you pay in full out-of-pocket for a service, you can require that I not share information about that service with your insurance company.

• Receive an Accounting of Disclosures

  • Request a list of certain disclosures made in the past six years.

• Receive a Copy of This Notice

  • You may request a paper or electronic copy at any time.

 

7. Additional Washington State Protections

Washington law provides additional protections for:

• Mental health records
• Substance use disorder treatment records
• HIV/AIDS-related information
• Reproductive health information
• Certain minor records

When Washington law is stricter than federal law, I follow Washington law.

 

8. Complaints

If you believe your privacy rights have been violated, you may contact:

Tiffany Classen, MA, LMFT, RPT
Tandem Psychotherapy
22725 44th Ave W, Suite 209

Mountlake Terrace, WA 98043

Tiffany@tandempsychotherapy.com

Phone: (425) 616-2383

Fax: (425) 616-2395

 

You may also file a complaint with:

• U.S. Department of Health & Human Services – Office for Civil Rights

• Washington State Department of Health

You will not be penalized for filing a complaint.