Notice

I keep a record of the health care services I provide you. You may ask me to see and copy that record. You may also ask me to correct that record. I will not disclose your record to others unless you direct me to do so or unless the law authorizes or compels me to do so. You may see your record or get more information about it at 320 Dayton Street, Suite 106, Edmonds, WA 98020.

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.

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.

Commitment to your privacy

Intrepid Counseling is dedicated to maintaining the privacy of your protected health information (PHI). PHI is information that may identify you and that relates to your past, present, or future physical or mental health condition and related health care services either in paper or electronic format. This Notice of Privacy Practices (“Notice”) is required by law to provide you with the legal duties and the privacy practices that Intrepid Counseling maintains concerning your PHI. It also describes how medical and mental health information may be used and disclosed, as well as your rights regarding your PHI. Please read carefully and discuss any questions or concerns with me.

Legal duty to safeguard your PHI

By federal and state law, Intrepid Counseling is required to ensure that your PHI is kept private. This Notice explains when, why, and how Intrepid Counseling would use and/or disclose your PHI. Use of PHI means when Intrepid Counseling shares, applies, utilizes, examines, or analyzes information within its practice; PHI is disclosed when Intrepid Counseling releases, transfers, gives, or otherwise reveals it to a third party outside of Intrepid Counseling. With some exceptions, Intrepid Counseling may not use or disclose more of your PHI than is necessary to accomplish the purpose for which the use or disclosure is made; however, Intrepid Counseling is always legally required to follow the privacy practices described in this Notice.

Changes to this notice

The terms of this notice apply to all records containing your PHI that are created or retained by Intrepid Counseling. Please note that Intrepid Counseling reserves the right to revise or amend this Notice of Privacy Practices. Any revision or amendment will be effective for all of your records that Intrepid Counseling has created or maintained in the past and for any of your records that Intrepid Counseling may create or maintain in the future. Intrepid Counseling will have a copy of the current Notice in the office in a visible location at all times, and you may request a copy of the most current Notice at any time. The date of the latest revision will always be listed at the end of Intrepid Counseling’s Notice of Privacy Practices.

How Intrepid Counseling may use and disclose your PHI

Intrepid Counseling will not use or disclose your PHI without your written authorization, except as described in this Notice or as described in the “Information, Authorization, and Consent to Treatment” document. Below you will find the different categories of possible uses and disclosures with some examples.

1. For Treatment: Intrepid Counseling may disclose your PHI to physicians, psychiatrists, psychologists, and other licensed healthcare providers who provide you with healthcare services or are; otherwise involved in your care. Example: If you are also seeing a psychiatrist for medication management, Intrepid Counseling may disclose your PHI to her/him to coordinate your care. Except for in an emergency, Intrepid Counseling will always ask for your authorization in writing prior to any such consultation or billing companies, claims processing companies, and others that process health care claims for Intrepid Counseling’s office if either you or your insurance carrier are not able to stay current with your account. In this latter instance, Intrepid Counseling will always do its best to reconcile this with you first prior to involving any outside agency.

2. Employees and Business Associates: There may be instances where services are provided to Intrepid Counseling by an employee or through contracts with third-party “business associates.” Whenever an employee or business associate arrangement involves the use or disclosure of your PHI, Intrepid Counseling will have a written contract that requires the employee or business associate to maintain the same high standards of safeguarding your privacy that is required of Intrepid Counseling.

Substance Use Disorder (SUD) Records

SUD records are protected by 42 CFR Part 2 (the federal law governing the confidentiality of substance use disorder treatment records) and may be subject to more stringent rules (“Part 2 Records”). Any use and/or disclosure of Part 2- records for treatment, payment or healthcare operations generally requires your written consent, unless a specific Part 2 exception applies.

Redisclosure: Some of your health information may be protected by 42 CFR Part 2. When these records are disclosed with your written consent or as otherwise permitted by law, the recipient may re-disclose the information in accordance with the HIPAA Privacy Rule. However, re-disclosure is limited to purposes permitted under HIPAA, and certain protections and restrictions may continue to apply. I will not use or disclose your substance use disorder records in a way that would violate applicable federal law.

Legal Proceedings: Part 2 records (or testimony relaying their contents) generally cannot be used or disclosed in civil, criminal, administrative, or legislative proceedings against you unless the disclosure/use is pursuant to your written consent or pursuant to a qualifying court order consistent with the standards of 42 CFR Part 2.

Fundraising and Marketing: You have the right to choose not to receive fundraising and marketing communications from me. I will not use information from your SUD records for fundraising or marketing purposes.

Use and disclosure of your PHI in certain special circumstances

Intrepid Counseling may use and/or disclose your PHI without your consent or authorization for the following reasons:

1. Law Enforcement: Subject to certain conditions, Intrepid Counseling may disclose your PHI when required by federal, state, or local law; judicial, board, or administrative proceedings; or, law enforcement. Example: Intrepid Counseling may make a disclosure to the appropriate officials when a law requires Intrepid Counseling to report information to government agencies, law enforcement personnel and/or in an administrative proceeding.

2. Lawsuits and Disputes: Intrepid Counseling may disclose information about you to respond to a court or administrative order or a search warrant. Intrepid Counseling may also disclose information if an arbitrator or arbitration panel compels disclosure, when arbitration is lawfully requested by either party, pursuant to subpoena duces tectum (e.g., a subpoena for mental health records) or any other provision authorizing disclosure in a proceeding before an arbitrator or arbitration panel. Intrepid Counseling will only do this if efforts have been made to tell you about the request and you have been provided an opportunity to object or to obtain an appropriate court order protecting the information requested.

3. Public Health Risks: Intrepid Counseling may disclose your PHI to public health or legal authorities charged with preventing or controlling disease, injury, disability, to report births and deaths, and to notify persons who may have been exposed to a disease or at risk for getting or spreading a disease or condition.

4. Food and Drug Administration (FDA): Intrepid Counseling may disclose to the FDA, or persons under the jurisdiction of the FDA, PHI relative to adverse events with respect to drugs, foods, supplements, products and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.

5. Serious Threat to Health or Safety: Intrepid Counseling may disclose your PHI if you are in such mental or emotional condition as to be dangerous to yourself or the person or property of others, and if Intrepid Counseling determines in good faith that disclosure is necessary to prevent the threatened danger. Under these circumstances, Intrepid Counseling may provide PHI to law enforcement personnel or other persons able to prevent or mitigate such a serious threat to the health or safety of a person or the public.

6. Minors: If you are a minor (under 18 years of age), Intrepid Counseling may be compelled to release certain types of information to your parents or guardian in accordance with applicable law.

7. Abuse and Neglect: Intrepid Counseling may disclose PHI if mandated by mandatory reporting laws. Example: If Intrepid Counseling has a reasonable suspicion of child abuse or neglect, Intrepid Counseling will report this to the appropriate state agency.

8. Coroners, Medical Examiners: Intrepid Counseling may release PHI about you to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person, determine the cause of death or other duties as authorized by law.

9. Communications with Family, Friends, or Others: Intrepid Counseling may release your PHI to the person you named in your Durable Power of Attorney for Health Care (if you have one), to a friend or family member who is your personal representative (i.e., empowered under state or other law to make health-related decisions for you), or any other person you identify, relevant to that person’s involvement in your care or payment related to your care. In addition, Intrepid Counseling may disclose your PHI to an entity assisting in disaster relief efforts so that your family can be notified about your condition.

10. Military and Veterans: If you are a member of the armed forces, Intrepid Counseling may release PHI about you as required by military command authorities. Intrepid Counseling may also release PHI about foreign military personnel to the appropriate military authority.

11. National Security, Protective Services for the President, and Intelligence Activities: Intrepid Counseling may release PHI about you to authorized federal officials so they may provide protection to the President, other authorized persons, or foreign heads of state, to conduct special investigations for intelligence, counterintelligence, and other national activities authorized by law.

12. Correctional Institutions: If you are or become an inmate of a correctional institution, Intrepid Counseling may disclose PHI to the institution or its agents when necessary for your health or the health and safety of others.

13. For Research Purposes: In certain limited circumstances, Intrepid Counseling may use information you have provided for medical/psychological research, but only with your written authorization. The only circumstance where written authorization would not be required would be if the information you have provided could be completely disguised in such a manner that you could not be identified, directly or through any identifiers linked to you. The research would also need to be approved by an institutional review board that has examined the research proposal and ascertained that the established protocols have been met to ensure the privacy of your information.

14. For Worker's Compensation Purposes: Intrepid Counseling may provide PHI in order to comply with Worker's Compensation or similar programs established by law.

15. Appointment Reminders: Intrepid Counseling is permitted to contact you, without your prior authorization, to provide appointment reminders or information about alternative or other health- related benefits and services that you may need or that may be of interest to you.

16. Health Oversight Activities: Intrepid Counseling may disclose health information to a health oversight agency for activities such as audits, investigations, inspections, or licensure of facilities. These activities are necessary for the government to monitor the health care system, government programs and compliance with laws. Example: When compelled by U.S. Secretary of Health and Human Services to investigate or assess Intrepid Counseling’s compliance with HIPAA regulations.

17. If Disclosure is Otherwise Specifically Required by Law.

18. I am also required by law to provide you with adequate notice of your rights and my legal duties if I create or maintain records protected by 42 C.F.R. Part 2 (records related to substance use disorder treatment).

19. In the Following Cases, Intrepid Counseling Will Never Share Your Information Unless You Give Us Written Permission: Marketing purposes, sale of your information, most sharing of psychotherapy notes, and fundraising. If we contact you for fundraising efforts, you can tell us not to contact you again.

Other Uses and Disclosures Require Your Prior Written Authorization

In any other situation not covered by this notice, Intrepid Counseling will ask for your written authorization before using or disclosing medical information about you. If you chose to authorize use or disclosure, you can later revoke that authorization by notifying Intrepid Counseling in writing of your decision. Intrepid Counseling is unable to take back any disclosures it has already made with your permission, Intrepid Counseling will continue to comply with laws that require certain disclosures, and Intrepid Counseling is required to retain records of the care that has been provided to you.

Rights you have regarding your PHI

1. The Right to See and Get Copies of Your PHI Either In Paper or Electronic Format: In general, you have the right to see your PHI that is in Intrepid Counseling’s possession, or to get copies of it; however, you must request it in writing. If Intrepid Counseling does not have your PHI, but knows who does, you will be advised how you can get it. You will receive a response from Intrepid Counseling within 30 days of receiving your written request. Under certain circumstances, Intrepid Counseling may feel it must deny your request, but if it does, Intrepid Counseling will give you, in writing, the reasons for the denial. Intrepid Counseling will also explain your right to have its denial reviewed. If you ask for copies of your PHI, you will be charged a reasonable fee per page and the fees associated with supplies and postage. Intrepid Counseling may see fit to provide you with a summary or explanation of the PHI, but only if you agree to it, as well as to the cost, in advance.

2. The Right to Request Limits on Uses and Disclosures of Your PHI: You have the right to ask that Intrepid Counseling limit how it uses and discloses your PHI. While Intrepid Counseling will consider your request, it is not legally bound to agree. If Intrepid Counseling does agree to your request, it will put those limits in writing and abide by them except in emergency situations. If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. You do not have the right to limit the uses and disclosures that Intrepid Counseling is legally required or permitted to make.

3. The Right to Choose How Intrepid Counseling Sends Your PHI to You: It is your right to ask that your PHI be sent to you at an alternate address (for example, sending information to your work address rather than your home address) or by an alternate method (for example, via email instead of by regular mail). Intrepid Counseling is obliged to agree to your request providing that it can give you the PHI, in the format you requested, without undue inconvenience.

4. The Right to Get a List of the Disclosures: You are entitled to a list of disclosures of your PHI that Intrepid Counseling has made. The list will not include uses or disclosures to which you have specifically authorized (i.e., those for treatment, payment, or health care operations, sent directly to you, or to your family; neither will the list include disclosures made for national security purposes, or to corrections or law enforcement personnel. The request must be in writing and state the time period desired for the accounting, which must be less than a 6-year period and starting after April 14, 2003. Intrepid Counseling will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list will include the date of the disclosure, the recipient of the disclosure (including address, if known), a description of the information disclosed, and the reason for the disclosure. Intrepid Counseling will provide the list to you at no cost, unless you make more than one request in the same year, in which case it will charge you a reasonable sum based on a set fee for each additional request.

5. The Right to Choose Someone to Act for You: If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.

6. The Right to Amend Your PHI: If you believe that there is some error in your PHI or that important information has been omitted, it is your right to request that Intrepid Counseling correct the existing information or add the missing information. Your request and the reason for the request must be made in writing. You will receive a response within 60 days of Intrepid Counseling’s receipt of your request. Intrepid Counseling may deny your request, in writing, if it finds that the PHI is: (a) correct and complete, (b) forbidden to be disclosed, (c) not part of its records, or (d) written by someone other than Intrepid Counseling. Denial must be in writing and must state the reasons for the denial. It must also explain your right to file a written statement objecting to the denial. If you do not file a written objection, you still have the right to ask that your request and Intrepid Counseling’s denial will be attached to any future disclosures of your PHI. If Intrepid Counseling approves your request, it will make the change(s) to your PHI. Additionally, Intrepid Counseling will tell you that the changes have been made and will advise all others who need to know about the change(s) to your PHI.

7. The Right to Get This Notice by Email: You have the right to get this notice by email. You have the right to request a paper copy of it as well.

8. Submit all Written Requests: Brianna White is Intrepid Counseling’s director and privacy officer. Submit requests to Brianna either by email at brianna@intrepidcounseling.org or by mail, at the office address listed below.

Complaints

If you believe I have violated your privacy rights, you may file a complaint in writing with me, as my own 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. I will not retaliate against you in any way for filing a complaint. Please discuss any questions or concerns with me.

INTREPID COUNSELING’S RESPONSIBILITIES: We are required by law to maintain the privacy and security of your PHI. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. We must follow the duties and privacy practices described in this notice and give you a copy of it. We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

Contact Information

I act as my own Privacy and Security Officer. If you have any questions about this Notice of Privacy Practices, please contact me. My contact information is:

Email: brianna@intrepidcounseling.org
Phone: +1 833-825-9991

Office address: 320 Dayton Street, Suite 106, Edmonds, WA 98020

Mailing address: 320 Dayton Street, Suite 106, Edmonds, WA 98020

Effective Date

Effective date of this notice: August 7, 2026