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 AND RETAIN A COPY FOR YOUR RECORDS. 

Matter Therapy Group (MTG) keeps a record of all health care services provided.  You may ask to see and copy your record at any time.  You may also ask to correct your record at any time.  Your record will not be disclosed to others unless directed to do so by your or unless the law authorizes or compels your records to be released.  To see your record or get more information regarding your record please contact MTG staff members at:  425-998-9728 or info@mattertherapeuticgroup,com

Your health record contains personal information about you and your health.  State and Federal law protects the confidentiality of this information.  Protected Health Information (PHI) is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical and mental health, or condition, and related health care services.  If you suspect a violation of these legal protections, you may file a report to the appropriate authorities in accordance with Federal and State regulations.

This Notice of Privacy Practices describes how MTG may use and disclose your PHI in accordance with all applicable law.  It also describes your rights regarding how you may gain access to and control your PHI.  MTG is required by law to maintain the privacy of PHI and to provide you with notice of MTG’s legal duties and privacy practices with respect to your PHI.  MTG is required to abide by the terms of this Notice of Privacy Practices.  MTG 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 MTG maintains at that time.  MTG will make available a revised Notice of Privacy Practices by sending you an electronic copy, sending a copy to you in the mail upon your request, or providing one to you in person.

How MTG is permitted to Use and Disclose Your PHI

For Treatment.  MTG may use your protected PHI to provide you with treatment services.

For Payment.  MTG may use and disclose your protected PHI to receive payment for the treatment services provided to you.

For Healthcare Operations.  MTG may use and disclose your protected PHI for certain purposes in connection with the operation of professional practices, including supervision and consultation.

Without Your Authorization. State and Federal law also permits MTG to disclose information about you without your authorization in a limited number of situations, such as with a court order.

With Authorization. MTG must obtain written authorization from you for other uses and disclosures of your PHI.  You may revoke such authorizations in writing in accordance with 45 CFR. 164.508(b)(5).

Incidental Use and Disclosure.  MTG is not required to eliminate every risk of an incidental use or disclosure of your PHI.  Specifically, a use or disclosure of your PHI that occurs as a result of, or incident to an otherwise permitted use or disclosure is permitted as long as MTG has adopted reasonable safeguards to protect your PHI, and the information being shared was limited to the minimum necessary.

Examples of How MTG May Use and Disclose Your PHI

Listed below are examples of the uses and disclosures that MTG may make of your PHI.  These examples are not meant to be a complete list of all possible disclosures, rather, they are illustrative of the types of uses and disclosures that may be made.

Treatment. Your PHI may be used and disclosed by MTG for the purpose of providing, coordinating, or managing your health care treatment and any related services. This may include coordination or management of your health care with a third party, consultation or supervision activities with other health care providers, or referral to another provider for health care services.

Payment. MTG may use your PHI to obtain payment for your health care services. This may include providing information to a third-party payor, or, in the case of unpaid fees, submitting your name and amount owed to a collection agency.

Healthcare Operations. MTG may use or disclose your PHI in order to support the business activities of our professional practice including disclosures to others for health care education, or to provide planning, quality assurance, peer review, or administrative, legal, financial, or actuarial services to assist in the delivery of health care, provided MTG has a written contract with the business that prohibits it from re-disclosing your PHI and requires it to safeguard the privacy of your PHI. MTG may also contact you to remind you of your appointments.

Other Uses and Disclosures That Do Not Require Your Authorization

Required by Law. MTG 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 of this type of disclosure include healthcare licensure related reports, public health reports, and law enforcement reports.  Under the law, MTG must make certain disclosures of your PHI to you upon your request.  In addition, MTG must make disclosures to the US Secretary of the Department of Health and Human Services for the purpose of investigating or determining compliance with the requirements of privacy rules.

Health Oversight. MTG 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 organizations that provide financial assistance to the program (such as third-party payors) and peer review organizations performing utilization and quality control.  If PHI is disclosed to a health oversight agency, to the extent MTG is required by law MTG will have an agreement in place that requires the agency to safeguard the privacy of your information.

Abuse or Neglect. MTG may disclose your PHI to a state or local agency that is authorized by law to receive reports of abuse or neglect.  However, the information disclosed is limited to only that information which is necessary to make the initial mandated report.

Deceased Clients. MTG may disclose PHI regarding deceased clients for the purpose of determining the cause of death, in connection with laws requiring the collection of death or other vital statistics or permitting inquiry into the cause of death.

Research. MTG may disclose PHI to researchers if (a) an Institutional Review Board reviews and approves the research and a waiver to the authorization requirement; (b) the researchers establish protocols to ensure the privacy of your PHI; and (c) the researchers agree to maintain the security of your PHI in accordance with applicable laws and regulations.

Criminal Activity or Threats to Personal Safety. MTG may disclose your PHI to law enforcement officials if MTG reasonably believes that the disclosure will avoid or minimize an imminent threat to the health or safety of yourself or any third party.

Compulsory Process. MTG may be required to disclose your PHI if a court of competent jurisdiction issues an appropriate order, if MTG haS been notified in writing at least fourteen days in advance of a subpoena or other legal demand, if required, if no protective order has been obtained, and if a competent judicial officer has determined that the rule of privilege does not apply.

Essential Government Functions. MTG may be required to disclose your PHI for certain essential government functions.  Such functions include assuring proper execution of a military mission, conducting intelligence and national security activities that are authorized by law, providing protective services to the President, making medical suitability determinations for U.S. State Department employees, protecting the health and safety of inmates or employees in a correctional institution, and determining eligibility for or conducting enrollment in certain government benefit programs.

Law Enforcement Purposes.  MTG may be authorized to disclose your PHI to law enforcement officials for law enforcement purposes under the following six circumstances, and subject to specified conditions: (1) as required by law (including court orders, court-ordered warrants, and subpoenas) and administrative requests; (2) to identify or locate a suspect, fugitive, material witness, or missing person; (3) in response to a law enforcement official’s request for information about a victim or suspected victim of a crime; (4) to alert law enforcement of a person’s death, if MTG suspectS that criminal activity caused the death; (5) when MTG believes that protected health information is evidence of a crime that occurred on MTG premises; and (6) in a medical emergency not occurring on MTG premises, when necessary to inform law enforcement about the commission and nature of a crime, the location of the crime or crime victims, and the perpetrator of the crime.

Psychotherapy Notes.  MTG must obtain your authorization to use or disclose psychotherapy notes with the following exceptions.  MTG may use the notes for your treatment.  MTG may use or disclose, without your authorization, the psychotherapy notes for training, to defend MTG employees 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

Other uses and disclosures of your PHI will be made only with your written authorization.  MTG will not make any other uses or disclosures of your psychotherapy notes, MTG will not use or disclosure your PHI for marketing proposes, and MTG will not sell your PHI without your authorization.  You may revoke your authorization in writing at any time.  Such revocation of authorization will not be effective for actions MTG may have taken in reliance on your authorization of the use or disclosure.

Your Rights Regarding Your PHI

You have the following rights regarding PHI that MTG maintains about you.  Any requests with respect to these rights must be in writing.  A brief description of how you may exercise these rights is included. 

Right of Access to Inspect and Copy.  You may inspect and obtain a copy of your PHI that is contained in a designated record set for as long as MTG maintains the record.  A “designated record set” contains medical and billing records and any other records that MTG uses for making decisions about you.  Your request must be in writing.  MTG may charge you a reasonable cost-based fee for the copying and transmitting of your PHI.  MTG can deny you access to your PHI in certain circumstances.  In some of those cases, you will have a right of recourse to the denial of access.  Please contact MTG if you have questions about access to your medical record.

Right to Amend. You may request, in writing, that MTG amend your PHI that has been included in a designated record set.  In certain cases, MTG may deny your request for an amendment.  If MTG denies your request for amendment, you have the right to file a statement of disagreement.  MTG may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.

Right to an Accounting of Disclosures. You may request an accounting of disclosures other than those made to you, for treatment purposes, or made as a result of your authorization, for a period of up to six years.  MTG may charge you a reasonable fee if you request more than one accounting in any 12-month period.  Please contact MTG if you have questions about accounting of disclosures.

Right to Request Restrictions. You have the right to ask MTG not to use or disclose any part of your PHI for treatment, payment or health care operations or to family members involved in your care.  Your request for restrictions must be in writing and MTG is not required to agree to such restrictions.  You also have the right to restrict certain disclosures of your PHI to your health plan if you pay out of pocket in full for the healthcare provided to you.  Please contact MTG if you would like to request restrictions on the disclosure of your PHI.

Right to Request Confidential Communication.  You have the right to request to receive confidential communications from MTG by alternative means or at an alternative location.  MTG will accommodate reasonable written requests.  MTG may also condition this accommodation by asking you for information regarding how payment will be handled or specification of an alternative address or other method of contact.  Please contact MTG if you would like to make this request.

Right to a Copy of this Notice.  You have the right to obtain a copy of this notice.  Any questions you have about the contents of this document should be directed to MTG.

Right to Opt Out.  You have the right to choose not to receive fundraising communications.  MTG does not contact clients for fundraising purposes.

Right to Notice of Breach.  You have the right to be notified of any breach of your unsecured PHI.

Contact Information

Beth Meyer acts as Privacy and Security Officer for MTG.  If you have any questions about this Notice of Privacy Practices, please contact her at:

Matter Therapy Group

Beth Meyer, MA LMFT

14201 SE Petrovitsky Rd

Ste A3 #251

Renton, WA 98058

(425)998-9728

Complaints

If you believe MTG has violated your privacy rights, you may file a complaint in writing with Beth Meyer as Privacy Officer, as specified above.  You also have the right to file a complaint in writing to the Washington Department of Health or to the US Secretary of Health and Human Services.  MTG will not retaliate against you in any way for filing a complaint. Complaints may be filed at:

Washington State Department of Health
Health Systems Quality Assurance
Complaint Intake
P.O. Box 47857
Olympia, WA 98504-7857