Megan Reynolds Counseling Services, PLLC
Megan Reynolds, MA, LPC, LMHC, NCC
Notice of Privacy Policies
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.
Please, read through the information and sign below for my practice's records that you have been properly informed about my practice’s privacy policies.
Your health record contains personal information about you and your health. Information that identifies you and relates to your past, present, or future physical or mental health or condition and any other related health care services is referred to as Protected Health Information (“PHI”). This Notice of Privacy Practices describes how my, Megan Reynolds, MA, LPC, LMHC, NCC's, practice ("MRCS, PLLC") may use and disclose your PHI in accordance with applicable law, including the Health Insurance Portability and Accountability Act (“HIPAA”). It also describes your rights regarding how you may gain access to and control your PHI.
I am required by law to maintain the privacy of PHI and to provide you with notice of my practice's legal duties and privacy practices with respect to PHI. Moreover, I am required to abide by the terms of this Notice of Privacy Practices. If there is a breach of unsecured PHI concerning you, I may be required to notify you of this breach, including what happened and what you can do to protect yourself.
I reserve 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 me and my practice maintains at that time. I will provide you with a copy of the revised Notice of Privacy Practices by posting a copy on my practice websites: sanmarcostxtherapy.com, seattletherapy.me, sending a copy to you in the mail (electronic or paper) upon request, or providing one to you at your next appointment.
After you have read this Notice, you will be asked to sign this form below to authorize treatment and allow me, acting on behalf of MRCS,PLLC, to use and share your PHI. In almost all cases I intend to use your PHI within my practice's organization or share your PHI with other people or organizations to provide treatment to you, arrange for payment for services, or some other business functions called health care operations. Together, these routine purposes are called TPO and this Consent form allows me to use and disclose your PHI for TPO.
Following is a list of the categories of uses and disclosures permitted by HIPAA without an authorization. Applicable law and ethical standards permits me and my practice to disclose information about you without your authorization only in a limited number of situations. This use and disclosure may be made electronically [Texas 181.154] [RCW 70.02.050].
Emergency I may disclose your PHI if necessary to prevent or lessen a serious and imminent threat to the health or safety of you or your person in cases of immediate emergency or crisis. If information is disclosed to prevent or lessen a serious threat towards yourself or your person it will be disclosed to a person or persons reasonably able to prevent or lessen the threat.
Child Abuse or Neglect I may disclose your PHI to a state or local agency that is authorized by law to receive reports of child abuse or neglect. Texas law identifies state licensed professionals as mandated reporters that are legally bound to report suspected child abuse or neglect [Texas Section 21.11, Penal Code; Texas Family Code, Section 261.101][RCW 74.34.020].
Elder Abuse or Neglect I may disclose your PHI to a state or local agency that is authorized by law to receive reports of elder abuse or neglect. Texas and Washington State law identifies state licensed professionals as mandated reporters that are legally bound to report suspected elder abuse or neglect [Texas Human Resources Code, Chapter 48, Subchapter B, Sec. 48.051, C][RCW 74.34.020].
Persons with Disabilities Abuse or Neglect I may disclose your PHI to a state or local agency that is authorized by law to receive reports of persons with disabilities abuse or neglect. Texas law identifies state licensed professionals as mandated reporters that are legally bound to report suspected persons with disabilities abuse or neglect [Texas Human Resources Code, Chapter 48, Subchapter B, Sec. 48.051, C][RCW 74.34.020].
Judicial and Administrative Proceedings I may disclose your PHI pursuant to a subpoena (with your written consent), court order, administrative order or similar process.
Required by Law I am required to make disclosures to government agencies for the purpose of investigating or determining my compliance with the requirements of the Privacy Rule.
Health Oversight If required, I may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies and peer review organizations performing utilization and quality control.
Law Enforcement I may disclose PHI to a law enforcement official as required by law, in compliance with a subpoena (with your written consent), court order, administrative order or similar document, for the purpose of identifying a suspect, material witness or missing person, in connection with the victim of a crime, in connection with a deceased person, in connection with the reporting of a crime in an emergency, or in connection with a crime on the premises.
Specialized Government Functions I may review requests from U.S. military command authorities if you have served as a member of the armed forces, authorized officials for national security and intelligence reasons and to the Department of State for medical suitability determinations, and disclose your PHI based on your written consent, mandatory disclosure laws and the need to prevent serious harm.
Public Health If required, I may use or disclose your PHI for mandatory public health activities to a public health authority authorized by law to collect or receive such information for the purpose of preventing or controlling disease, injury, or disability, or if directed by a public health authority, to a government agency that is collaborating with that public health authority.
Public Safety I may disclose your PHI if necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. If information is disclosed to prevent or lessen a serious threat it will be disclosed to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat.
Verbal Permission I may also use or disclose your information to family members that are directly involved in your treatment with your verbal permission.
Uses and disclosures not specifically permitted by applicable law will be made only with your written authorization, which may be revoked at any time, except to the extent that I have already made a use or disclosure based upon your authorization. This use and disclosure may be made electronically and I can provide you a paper copy [Texas 181.154].
Right to Request Restrictions You have the right to request a restriction or limitation on the use or disclosure of your PHI for treatment, payment, or health care operations. I am not required or legally bound to agree to your request. If I do agree with your request, I will obtain consent from you in writing, outline the request in detail, and include the agreement within your record on file with my practice. Excepting uses or disclosures without your consent as mentioned above, I will abide by the written agreement.
Right to Request Confidential Communication You have the right to request that I communicate with you about health matters in a certain way or at a certain location. I will accommodate reasonable requests. I may require information regarding how payment will be handled or specification of an alternative address or other method of contact as a condition for accommodating your request. I will not ask you for an explanation of why you are making the request.
Right of Access to Inspect and Copy Unless your information was compiled in reasonable anticipation of, or for use in a civil, criminal, or administrative action or proceeding, you have the right, which may be restricted only in exceptional circumstances, to inspect and copy PHI that is maintained in a “designated record set”. A designated record set contains mental health/medical and billing records and any other records that are used to make decisions about your care. Your right to inspect and copy PHI will be restricted only in those situations where a licensed professional believes it is reasonably likely that access would endanger the life or physical safety of, or cause substantial harm to the individual or another person. I may charge a reasonable fee for copies. If your records are maintained electronically, you may also request an electronic copy of your PHI. You may also request that a copy of your PHI be provided to another person.
Right to Amend If you feel that the PHI I have about you is incorrect or incomplete, you may ask to amend the information although I am not required to agree to the amendment. If I deny your request for amendment, you have the right to file a statement of disagreement with my practice. I may prepare a rebuttal to your statement and will provide you with a copy. Please contact me, the practice owner, if you have any questions.
Right to an Accounting of Disclosures You have the right to request an accounting of certain of the disclosures that I make of your PHI. I may charge you a reasonable fee if you request more than one accounting in any 12-month period.
Right to a Copy of this Notice You have the right to a paper copy or email copy of this notice.
If you believe me or my practice has violated your privacy rights, you have the right to file a complaint in writing with the options below. I will not retaliate against you for filing a complaint.
I will notify you following the discovery of any “breach” of your unsecured PHI as defined in the HITECH Act (the “Notice of Breach”). Your Notice of Breach will be in writing and provided via first-class mail, or alternatively, by email if you have previously agreed to receive such notices electronically. If the breach involves:
Your Notice of Breach shall be provided without unreasonable delay and in no case later than 60 days following the discovery of a breach and shall include, to the extent possible:
Additionally, for any substitute Notice of Breach provided via web posting or major print or broadcast media, the Notice of Breach shall include a toll-free number for you to contact my practice to determine if your protected health information was involved in the breach.
I am committed to maintaining and staying informed on best privacy practices when using or disclosing PHI. I have set in place procedures to maintain and secure PHI to the best of my ability.
However, electronic communication platforms (i.e. email, text, direct messages, voicemail, etc.) do have inherent limitations to privacy, such as (but not limited to): possible breach of privacy or confidentiality of sensitive PHI; data that contains sensitive PHI security risks; difficulties in verifying the identity of the parties when communicating electronically; and the potential impact of delayed responses during emergency situations.
Knowing the inherent risks mentioned above, please note the types of PHI that may be electronically communicated between me acting on behalf of my practice, MRCS, PLLC, and you, a client:
From Me or entities acting on behalf of MRCS, PLLC that I have obtained written contract requires these entities to safeguard the privacy of your PHI:
From you to me or entities acting on behalf of MRCS, PLLC of the above types of PHI
Note: I recommend and will follow a best practice's guideline to send as limited PHI as possible or more administrative in nature PHI for most of my electronic communication.
Please, send any new contact information to me so that I can be updated as soon as possible if your information should change.
I have read and given consent to MRCS, PLLC's privacy practices outlined in this Notice of Privacy Practices. I acknowledge that I have had the opportunity and will continue to have the option to ask questions of Megan Reynolds, MA, LPC, LMHC, NCC to gain clarity and understanding of these practices to my satisfaction.
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Updated: August 16, 2024