Notice of Privacy Practices

During the course of providing services, Havencrest may create, receive, maintain, or transmit information related to your health care and services.

This may include:

• Your name, address, telephone number, email address, and other identifying information;

• Demographic information;

• Medical and behavioral health history;

• Mental health assessments and diagnoses;

• Treatment plans and individual service plans;

• Progress notes and other clinical documentation;

• Medication information;

• Appointment and scheduling information;

• Telehealth records;

• Referral and care-coordination information;

• Insurance and billing information;

• Communications concerning your care; and

• Other information related to services provided by Havencrest.

This information may constitute protected health information and may be subject to federal and Washington State confidentiality requirements.

You have important rights regarding your health information.

2. Right to access your records

You generally have the right to inspect and obtain a copy of health information maintained about you, subject to applicable federal and Washington State law.

You may submit a request to Havencrest to access your records.

When you request access to your individual service record, Havencrest will provide appropriate time and privacy for you to review your records and, when required, make appropriate clinical staff available to answer questions.

Certain information may be subject to additional restrictions, including psychotherapy notes and other specially protected behavioral health information.

If access is denied where permitted by law, Havencrest will provide information regarding the applicable rights and review process.

3. Right to request an amendment or correction

You may request that Havencrest amend or correct information in your health record that you believe is inaccurate or incomplete.

Your request should identify the information you believe should be changed and explain why you believe the information is inaccurate or incomplete.

Havencrest may deny an amendment request when permitted by law. If your request is denied, we will provide information about the denial and any rights you may have to submit a statement of disagreement.

4. Right to confidential communications

You may request that Havencrest communicate with you about your health information in a particular way or at a particular location.

For example, you may ask us to contact you:

• At a specific telephone number;

• At a specific mailing address;

• Through a particular email address;

• Through the client portal; or

• Through another reasonable communication method.

Havencrest will accommodate reasonable requests as required by applicable law.

5. Right to request restrictions

You may ask Havencrest to restrict the use or disclosure of your health information for treatment, payment, or health care operations.

Havencrest is not required to agree to every requested restriction.

However, when you pay for a health care service completely out of pocket and request that information concerning that service not be disclosed to your health plan for payment or health care operations purposes, Havencrest will comply with the request when required by applicable law, unless disclosure is otherwise required by law.

6. Right to an accounting of certain disclosures

You may request an accounting of certain disclosures Havencrest has made of your health information.

Not every disclosure is required to be included in an accounting.

For example, disclosures made for treatment, payment, or health care operations generally are not included when permitted by law.

7. Right to receive a copy of this notice

You may request a paper or electronic copy of this Notice of Privacy Practices at any time.

You may request a copy even if you previously agreed to receive the Notice electronically.

The current version of this Notice will also be available on the Havencrest website and, when applicable, through the client portal.

8. Right to have a personal representative

If you have given another person legal authority to make health care decisions or otherwise act on your behalf, that person may be able to exercise your privacy rights.

Examples may include:

• A legal guardian;

• A health care agent;

• A personal representative; or

• Another person legally authorized to act on your behalf.

Havencrest may verify the person's legal authority before providing access to information or taking action.

Special rules may apply to parents, guardians, and minors receiving behavioral health services.

9. Treatment

Havencrest may use and disclose your health information as permitted by law to provide, coordinate, or manage your treatment.

For example, your clinician may communicate with another health care professional involved in your care when the disclosure is legally permitted and clinically appropriate.

Behavioral health information may receive additional protections under Washington State law, and Havencrest will comply with those requirements when applicable.

10. Payment

Havencrest may use and disclose health information as permitted by law to obtain payment for services.

This may include information provided to your health plan for purposes such as:

• Verifying eligibility or benefits;

• Obtaining authorization for services;

• Submitting claims;

• Responding to claim inquiries;

• Determining coverage; and

• Collecting payment.

Information disclosed may include diagnosis codes, service dates, procedure codes, clinician information, and other information necessary for payment.

11. Health care operations

Havencrest may use and disclose your information for health care operations when permitted by law.

These activities may include:

• Quality assessment and improvement;

• Clinical supervision;

• Staff training;

• Credentialing;

• Compliance activities;

• Auditing;

• Billing administration;

• Business planning;

• Risk management;

• Legal and regulatory compliance; and

• Evaluating the quality and effectiveness of services.

Havencrest limits access to health information to individuals who require access to perform authorized duties.

12. Business associates and service providers

Havencrest may use outside organizations or individuals to perform certain services on our behalf.

These may include:

• Electronic health record providers;

• Billing companies;

• Technology and cloud service providers;

• Consultants;

• Attorneys;

• Accountants; and

• Other service providers.

When required by HIPAA or other applicable law, Havencrest requires appropriate contractual and security protections for protected health information.

13. Appointment reminders and care-related communications

Havencrest may use your contact information to communicate with you regarding:

• Appointments;

• Scheduling;

• Appointment reminders;

• Treatment-related communications;

• Billing or account matters;

• Client portal notifications; and

• Other communications related to your care.

Depending on your preferences and the systems available, communications may occur by telephone, voicemail, text message, email, client portal, or other approved communication methods.

Electronic communications may carry privacy and security risks. Havencrest uses reasonable safeguards consistent with applicable law and its privacy and security policies.

14. When required by law

Havencrest may use or disclose health information when federal or Washington State law requires or permits the disclosure.

When applicable law provides additional privacy protections, Havencrest will comply with those requirements.

15. Serious threats to health or safety

Havencrest may use or disclose information when permitted or required by law to prevent or lessen a serious and imminent threat to your health or safety, or the health or safety of another person or the public.

Disclosures will be limited to persons or entities reasonably able to help address the threat and will be made in accordance with applicable law.

16. Abuse, neglect, or exploitation

Havencrest may disclose information to appropriate governmental authorities when required or permitted by law concerning suspected:

• Child abuse or neglect;

• Abuse or neglect of a vulnerable adult;

• Exploitation; or

• Other circumstances subject to mandatory reporting requirements.

Havencrest will comply with applicable Washington State mandatory reporting requirements.

17. Public health and safety

When legally permitted or required, Havencrest may disclose health information for certain public health and safety purposes, including:

• Preventing or controlling disease;

• Reporting certain injuries or conditions;

• Reporting suspected abuse or neglect;

• Addressing certain medication or product safety matters; or

• Other legally authorized public health activities.

18. Health oversight activities

Havencrest may disclose health information to authorized health oversight agencies for activities permitted by law.

These activities may include:

• Audits;

• Inspections;

• Investigations;

• Licensing reviews;

• Credentialing oversight; and

• Regulatory compliance activities.

This may include authorized oversight by the Washington State Department of Health or other governmental agencies.

19. Legal proceedings

Health information may sometimes be requested through a subpoena, court order, administrative proceeding, or other legal process.

Behavioral health records may receive additional confidentiality protections.

Havencrest will evaluate legal requests and disclose information only as permitted or required by applicable federal and Washington State law.

20. Law enforcement

Havencrest may disclose health information to law enforcement only when permitted or required by applicable law.

Behavioral health information may be subject to additional restrictions.

21. Workers' compensation

Havencrest may disclose health information as authorized or required by workers' compensation laws and similar programs providing benefits for work-related injuries or illnesses.

22. Coroners and medical examiners

Havencrest may disclose information to coroners and medical examiners when permitted or required by law.

23. Mental health information

Washington State law provides additional confidentiality protections for certain information and records related to mental health services.

Havencrest will protect specially protected mental health information and will disclose such information only as authorized or permitted by applicable federal and Washington State law.

24. Psychotherapy notes

Psychotherapy notes receive special protection under federal law.

Havencrest generally will not use or disclose psychotherapy notes without your written authorization except in limited circumstances permitted or required by law.

Psychotherapy notes are maintained separately from the general clinical record when information meets the legal definition of psychotherapy notes.

25. Substance use disorder records

Certain records relating to substance use disorder diagnosis, treatment, or referral may receive additional confidentiality protections under federal law, including 42 CFR Part 2, when applicable.

Havencrest will use and disclose Part 2-protected records only as permitted by applicable federal law.

26. Minors and behavioral health information

Special Washington State and federal laws govern confidentiality and access to behavioral health information concerning minors.

Depending on the minor's age, the type of service, who consented to treatment, and other circumstances, a parent or legal guardian may or may not have access to all information concerning a minor's treatment.

Havencrest will handle requests concerning minors in accordance with applicable Washington State and federal law.

27. Written authorization

Uses or disclosures of your protected health information that are not otherwise permitted or required by law generally require your written authorization.

When an authorization is required, you may generally revoke the authorization in writing.

Revocation does not affect actions Havencrest already took in reliance upon a valid authorization before receiving the revocation.

28. Marketing

Havencrest will obtain your written authorization before using or disclosing your protected health information for marketing purposes when authorization is required by law.

29. Sale of protected health information

Havencrest will not sell your protected health information without your authorization when authorization is required by law.

30. Our legal duties

Havencrest is required to:

• Maintain the privacy and security of your protected health information;

• Follow applicable federal and Washington State privacy and confidentiality laws;

• Provide you with this Notice describing our legal duties and privacy practices;

• Follow the terms of the Notice currently in effect;

• Implement reasonable administrative, physical, and technical safeguards to protect health information; and

• Notify affected individuals following a breach of unsecured protected health information when notification is required by law.

Havencrest also maintains policies and procedures governing the protection, access, storage, retention, and release of individual service records in accordance with applicable Washington State and federal requirements.

31. Record retention

Havencrest maintains individual service records in accordance with applicable Washington State and federal law.

Individual service records are retained for the minimum period required by Washington law, including applicable extended retention requirements for children and youth.

32. Changes to this notice

Havencrest reserves the right to change this Notice and our privacy practices as permitted by law.

When a material change is made, Havencrest will update this Notice and make the revised Notice available as required by law.

The effective date will appear at the beginning of the Notice.

33. Contact Havencrest

If you have questions about this Notice, wish to exercise your privacy rights, believe your privacy rights have been violated, or wish to submit a privacy complaint, please contact:

Havencrest Wellness & Counseling LLC
Privacy Officer

Mailing address: 1700 Seventh Ave, Suite 2100, Seattle, WA 98101
Telephone: 360-474-7990
Email: info@havencrestcounseling.com

You will not be retaliated against for filing a complaint or exercising your privacy rights.

34. Complaints to the Washington State Department of Health

You may also report concerns regarding your rights or Havencrest's compliance with Washington behavioral health requirements to the Washington State Department of Health.

Information about filing a complaint with the Department of Health is available through the Department's complaint process.

Havencrest will not retaliate against you for exercising your rights or filing a complaint.

35. Complaints to the U.S. Department of Health and Human Services

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights (OCR), if you believe your HIPAA privacy rights have been violated.

Havencrest will not retaliate against you for filing a complaint with HHS or exercising your privacy rights.