Dyad Mental Health, PLLC
NOTICE OF PRIVACY PRACTICES
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.
I respect your privacy. I understand that your personal health information is very sensitive. I will not disclose your information to others unless you tell me to do so, or unless the law authorizes or requires me to do so.
The law protects the privacy of the health information I create and obtain in providing care and services to you. For example, your protected health information includes your symptoms, test results, diagnoses, treatment, health information from other providers, and billing and payment information relating to these services. Federal and state law allows me to use and disclose your protected health information for purposes of treatment and health care operations. State law requires me to get your authorization to disclose this information for payment purposes.
Use and Disclosures of Protected Health Information for Treatment, Payment, and Health Operations
Under the law, I may use or disclose your protected health information under certain circumstances without your permission. The following categories describe the different ways I may use and disclose your protected health information without your permission. For each category, I will explain what I mean and give some examples. Not every use or disclosure in a category will be listed. However, all of the ways I am permitted to use and disclose health information will fall within one of the categories.
Below are examples of uses and disclosures of protected health information for treatment, payment, and health care operations.
For health care operations:
Your Health Information Rights
The health and billing records I create and store are the property of the practice, Dyad Mental Health, PLLC. The protected health information in it, however, generally belongs to you. You have a right to:
For help with these rights during normal business hours, please contact:
Catherine Davies, MD
PO Box 11744
Bainbridge Island, WA 98110
I am required to:
I have the right to change my practices regarding the protected health information I maintain. If I make changes, I will update this Notice. You may receive the most recent copy of this Notice by calling and asking for it or by visiting my website at: www.dyadmentalhealth.com
To Ask for Help or Complain
If you have questions, want more information, or want to report a problem about the handling of your protected health information, you may contact:
Catherine Davies, MD at 206-954-3195
If you believe your privacy rights have been violated, you may discuss your concerns with me. You may also deliver a written complaint to Catherine Davies, MD at Dyad Mental Health, PLLC at 727 Ericksen Ave NE, Suite 3, Bainbridge Island, WA 98110. You may also file a complaint with the U.S. Secretary of Health and Human Services Office for Civil Rights.
I respect your right to file a complaint with me or with the U.S. Secretary of Health and Human Services (OCR). If you complain, I will not retaliate against you.
Other Disclosures and Uses of Protected Health Information
Required by Law: I must make any disclosure required by state, federal, or local law
Business Associates: I may contract with individuals and entities to perform jobs for me or to provide certain types of services that may require them to create, maintain, use, and/or disclose your health information. I may disclose your health information to a business associate, but only after they agree in writing to safeguard your health information. Examples include billing services, accountants, IT professionals, pharmacists and others who perform health care operations for me.
Notification of Family and Others
I may use and disclose your protected health information without your authorization as follows:
Other Uses and Disclosures of Protected Health Information Requiring Patient Authorization
Certain uses and disclosures of your health information require your written authorization. The following list contains the types of uses and disclosures that require your written authorization:
In addition, other uses and disclosures of your health information that are not described in this Notice will be made only with your written authorization. You have the right to cancel prior authorizations for these uses and disclosures of your health information by giving me a written revocation. Your revocation does not affect information that has already been released. It also does not affect any action taken before I receive the revocation.
Effective Date: This notice is effective as of January 1, 2022