Privacy Policy

Klinic Medical, PLLC (hereafter “we” “us” or “our”) is required by law to maintain the privacy of your health information. We are also required to give you this Notice, which summarizes our privacy practices, legal obligations, and your rights concerning your health information (“Protected Health Information” or “PHI”) and substance use disorder records. Our duties and your rights are set forth more fully in the Health Insurance Portability and Accountability Act (45 C.F.R. part 164) (“HIPAA”) and the federal law and regulations governing the confidentiality of substance abuse disorder records (42 U.S.C. § 290dd-2, 42 C.F.R. Part 2). We must follow the privacy practices that are described in this Notice (which may be amended from time to time). For more information about our privacy practices, or for additional copies of this Notice, please contact us using the information listed at the end of this Notice.

  1. USES AND DISCLOSURES OF PHI
    1. Permissible Uses and Disclosures Without Your Written Authorization.
      We may use and disclose PHI without your written authorization for certain purposes as described below. The examples provided in each category are not meant to be exhaustive, but instead are meant to describe the types of uses and disclosures that are legally permissible.

      1. Treatment: We may use and disclose PHI in order to provide diagnosis and treatment to you. For example, we may disclose PHI to other health care providers to provide you with appropriate care and treatment.
      2. Payment: We may use or disclose PHI for the purposes of billing, payment processing, claims management, and reimbursement. For example, we may disclose your PHI for the purpose of billing you for our health care services.
      3. Health Care Operations: We may use and disclose PHI in connection with our health care operations. For example, we may use PHI to evaluate the performance of our staff.
      4. Required or Permitted by Law: We may use or disclose PHI when we are required or permitted to do so by law. For example, we may disclose PHI to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes. In addition, we may disclose PHI to the extent necessary to avert a serious threat to your health or safety or the health or safety of others. Other disclosures permitted or required by law include the following: disclosures for public health activities; health oversight activities including disclosures to state or federal agencies authorized to access PHI; disclosures to judicial
        and law enforcement officials in response to a court order or other lawful process; disclosures for research when approved by an institutional review board; disclosures for workers’ compensation claims, and disclosures to military or national security agencies, coroners, medical examiners, and correctional institutions.
    2. Permissible Uses and Disclosures That May Be Made Without Your Authorization, But for Which You Have An Opportunity to Object.
      1. Family and Other Persons Involved in Your Care. We may use or disclose PHI to notify or assist in the notification of (including identifying or locating) a family member, your personal representative, or another person responsible for your care, of your location, your general condition, or death. If you are present, then we will provide you with an opportunity to object prior to such uses or disclosures. In the event of your incapacity or emergency circumstances, we will disclose PHI consistent with your prior expressed preference that is known to us, and in your best interest as determined by our professional judgment.
      2. Disaster Relief Efforts. We may use or disclose protected PHI to a public or private entity authorized by law or its charter to assist in disaster relief efforts for the purpose of coordinating notification of family members of your location, general condition, or death.
    3. Uses and Disclosures Requiring Your Written Authorization.
      1. Psychotherapy Notes. If we obtain your psychotherapy notes, we have your written authorization prior to disclosing your psychotherapy notes, subject to the exceptions set forth in HIPAA.
      2. Marketing Communications; Sale of PHI. We must obtain your written authorization prior to using or disclosing PHI for marketing or the sale of PHI, consistent with the related definitions and exceptions set forth in HIPAA.
      3. Other Uses and Disclosures. Uses and disclosures other than those described in this Notice will only be made with your written authorization.
      4. Substance Use Disorder Records. Klinic, Medical, PLLC. is a substance use disorder treatment program that is subject to the federal statute (42 U.S.C. 290dd-2) and regulations (42 CFR Part 2) governing the confidentiality of substance use disorder records. Notwithstanding anything to the contrary in this Notice, this statute and the regulations prohibit us from disclosing your substance use disorder treatment records without your consent, except in the following limited circumstances:
        • Pursuant to court order and subpoena
        • Medical personnel in an emergency
        • Suspected incidents of child abuse or neglect
        • To agencies that provide regulatory authority
        • Audit and evaluation activities
        • To report crime (or threat of crime) on premises or against program personnel. Information is limited to circumstances, name and address, and last known whereabouts
  2. YOUR INDIVIDUAL RIGHTS
    1. Right to Inspect and Copy. You may request access to your PHI maintained by us to inspect and request copies of the records. All requests for access must be made in writing. Under limited circumstances, we may deny access to your records. We may charge a cost-based fee for the costs of copying and sending you any records requested.
    2. Right to Alternative Communications. You may request, and we will accommodate, any reasonable written request for you to receive PHI by alternative means of communication or at alternative locations.
    3. Right to Request Restrictions. You have the right to request a restriction on PHI we use or disclose for treatment, payment or health care operations. You must request any such restriction in writing addressed to 1201 2nd Ave, Ste 900, Seattle, WA 98101. We are not required to agree to any such restriction you may request, except if your request is to restrict disclosing PHI to a health plan for the purpose of carrying out payment or health care operations, the disclosure is not otherwise required by law, and the PHI pertains solely to a health care item or service which has been paid in full by you or another person or entity on your behalf.
    4. Right to Accounting of Disclosures. Upon written request, you may obtain an accounting of disclosures of PHI made by us in the last six years, subject to certain restrictions and limitations.
    5. Right to Request Amendment: You have the right to request that we amend your PHI. Your request must be in writing, and it must explain why the information should be amended. We may deny your request under certain circumstances.
    6. Right to Request Amendment: You have the right to request that we amend your PHI. Your request must be in writing, and it must explain why the information should be amended. We may deny your request under certain circumstances.
    7. Right to Obtain Notice. You have the right to obtain a paper copy of this Notice by submitting a request to 1201 2nd Ave, Ste 900, Seattle, WA 98101 or (206) 495-0724.
    8. Right to Receive Notification of a Breach. We are required to notify you if we discover a breach of your unsecured PHI, according to requirements under federal law.
    9. Questions and Complaints. If you desire further information about your privacy rights or are concerned that we have violated your privacy rights, you may contact 1201 2nd Ave, Ste 900, Seattle, WA 98101 or (206) 495-0724. You may also file a written complaint with the Director, Office for Civil Rights of the U.S. Department of Health and Human Services. We will not retaliate against you if you file a complaint with the Director or with our office.
      Klinic Medical, PLLC’s violation of the federal law and regulations governing the confidentiality of substance abuse disorder treatment records is a crime, and you may report suspected violations to the U.S. Attorney for the judicial district in which the violation occurs. Contact information for the U.S. Attorney office where we operate is below:
      Washington
      U.S. Attorney for the Western District of Washington
      700 Stewart Street, Suite 5220
      Seattle, WA 98101-1271
      Phone: 206-553-7970
      support@klinic.care
      Suspected violations by an opioid treatment program may be reported to the Substance Use and Mental Health Services Administration
      (SAMHSA), Opioid Treatment Program Compliance Office by phone at 204-276-2700 or online at OTP-extranet@opiod.samhsa.gov.
  3. EFFECTIVE DATE AND CHANGES TO THIS NOTICE
    1. Effective Date. This Notice is effective on September-01-2021.
    2. Changes to this Notice. We may change the terms of this Notice at any time. If we change this Notice, we may make the new notice terms effective for all PHI that we maintain, including any information created or received prior to issuing the new notice. If we change this Notice, we will post the revised notice on our web site at https://klinic.care. You may also obtain any revised notice by contacting support@klinic.care.