BELLEVUE COUNSELING

Notice of Privacy Practices

Effective Date: March 9, 2026

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. Our Commitment to Your Privacy

Bellevue Counseling (referred to throughout this Notice as "we," "us," "our," or "the Practice") is committed to protecting the privacy and confidentiality of your health information. We understand that your mental health information is deeply personal, and we take our responsibility to safeguard it seriously.

We are required by federal and state law to maintain the privacy and security of your protected health information ("PHI"), to provide you with this Notice of our legal duties and privacy practices with respect to your PHI, to notify you following a breach of your unsecured PHI, and to abide by the terms of this Notice while it is in effect.

This Notice applies to all PHI created, received, maintained, or transmitted by Bellevue Counseling, including records related to your treatment, billing, and health care operations. This Notice is provided to you in compliance with the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"), the HIPAA Privacy Rule (45 CFR Part 164), the Washington State Uniform Health Care Information Act (RCW 70.02), and all other applicable federal and state privacy laws.

II. How We May Use and Disclose Your Protected Health Information

We may use and disclose your PHI for the following purposes without your written authorization, as permitted or required by law:

A. Treatment

We may use and disclose your PHI to provide, coordinate, or manage your mental health treatment. For example, we may share relevant portions of your treatment information with another clinician within our practice who is involved in your care, or with an outside provider to whom we refer you for specialized services. When coordinating care, we apply the minimum necessary standard, disclosing only the information essential to the purpose of the disclosure.

B. Payment

We may use and disclose your PHI as necessary to obtain payment for the services we provide. For example, we may submit claims to your health insurance plan that include your diagnosis, dates of service, and the type of treatment provided. We may also disclose PHI to your insurance company to obtain prior authorization or to determine whether your plan will cover a proposed treatment.

C. Health Care Operations

We may use and disclose your PHI for our internal health care operations. These activities include, but are not limited to, quality assessment and improvement, clinical supervision, staff training, licensing and credentialing activities, compliance reviews, business planning, and administrative functions necessary to run the Practice and provide high quality care.

D. As Required by Law

We will disclose your PHI when required to do so by any applicable federal, state, or local law. This includes disclosures mandated by court orders, subpoenas, administrative requests, or other legal processes as permitted under HIPAA and Washington State law.

E. Public Health Activities

We may disclose your PHI to public health authorities for the purpose of preventing or controlling disease, injury, or disability; reporting births, deaths, and certain diseases as required by law; reporting reactions to medications or problems with medical devices or products; and notifying appropriate authorities if we believe a patient has been the victim of abuse, neglect, or domestic violence.

F. Health Oversight Activities

We may disclose your PHI to a health oversight agency for activities authorized by law, including audits, investigations, inspections, licensure, and other proceedings necessary for the government to monitor the health care system, government benefit programs, and compliance with civil rights laws.

G. Judicial and Administrative Proceedings

We may disclose your PHI in response to a court order, administrative tribunal order, or in response to a subpoena, discovery request, or other lawful process, provided that the requesting party has made reasonable efforts to notify you or to obtain a protective order, as required under HIPAA and Washington State law (RCW 70.02.060).

H. Law Enforcement Purposes

We may disclose limited PHI to law enforcement officials under narrowly defined circumstances, such as in response to a court order or warrant, to identify or locate a suspect or missing person, to report certain types of wounds or physical injuries, or to report a crime committed on our premises. Washington State law (RCW 70.02.050) may impose additional conditions on certain disclosures to law enforcement.

I. Threats to Health or Safety

We may use or disclose your PHI when we believe, in good faith, that the disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. Under Washington State law, mental health professionals have a duty to warn or take reasonable precautions when a patient has communicated an actual threat of physical violence against a reasonably identifiable victim or victims (RCW 71.05.120).

J. Coroners, Medical Examiners, and Funeral Directors

We may disclose PHI to a coroner, medical examiner, or funeral director as necessary to carry out their lawful duties.

K. Workers' Compensation

We may disclose your PHI as authorized by, and to the extent necessary to comply with, laws relating to workers' compensation or similar programs.

L. Specialized Government Functions

We may disclose your PHI to authorized federal officials for the conduct of lawfully authorized intelligence, counterintelligence, national security activities, or for the provision of protective services to the President or other individuals as authorized by law.

M. Appointment Reminders, Treatment Alternatives, and Health Benefits

We may contact you to provide appointment reminders, information about treatment alternatives, or other health related benefits and services that may be of interest to you.

III. Uses and Disclosures Requiring Your Written Authorization

Except as described above, we will not use or disclose your PHI without your prior written authorization. You may revoke any authorization you have given us at any time by submitting a written revocation to our Privacy Officer, except to the extent that we have already taken action in reliance on your authorization.

The following uses and disclosures of PHI require your specific written authorization:

• Most uses and disclosures of psychotherapy notes (session notes maintained separately from the medical record), except for certain treatment, oversight, and legal defense purposes as permitted by HIPAA

• Uses and disclosures of your PHI for marketing purposes

• Disclosures that constitute a sale of your PHI

• Any other uses or disclosures not described in this Notice

IV. Special Protections for Mental Health Records Under Washington State Law

Washington State provides heightened confidentiality protections for mental health records beyond those required by HIPAA. Under RCW 70.02.230, the fact of your admission to a provider for mental health services and all information and records compiled, obtained, or maintained in the course of providing mental health services are confidential and may not be disclosed except as specifically authorized by law or pursuant to a valid written authorization signed by you.

Disclosures of mental health records without your authorization are limited to narrow circumstances defined by statute, including (but not limited to): disclosures necessary to provide treatment in an emergency; disclosures to other treatment providers as necessary for continuity of care; disclosures pursuant to lawful court orders; disclosures required by mandatory reporting obligations; and disclosures necessary to avert a serious and imminent threat as described in Section II(I) above.

Where Washington State law provides greater protection for your mental health information than HIPAA, we will follow the more protective standard.

V. Special Protections for Substance Use Disorder (SUD) Treatment Records

If we receive records from a federally assisted substance use disorder (SUD) treatment program governed by 42 CFR Part 2, those records are subject to heightened federal confidentiality protections. Under the 2024 Final Rule aligning Part 2 with HIPAA (effective February 16, 2026), we are permitted to use and disclose Part 2 records for treatment, payment, and health care operations purposes in accordance with HIPAA, provided we have received those records pursuant to a valid general authorization or as otherwise permitted by law.

Part 2 records may not be used to investigate or prosecute any patient in connection with a criminal matter. Such records received by us retain their Part 2 protections and may not be further disclosed except as permitted by Part 2 and HIPAA. We will clearly identify any Part 2 records in our systems and apply the required additional safeguards.

You have the right to request restrictions on the use and disclosure of SUD treatment records for which you have previously provided consent. To exercise this right, please contact our Privacy Officer in writing.

VI. Privacy Practices Regarding Minors

Under Washington State law, minors aged 13 and older may consent to their own outpatient mental health treatment without parental consent (RCW 71.34.530). When a minor has independently consented to treatment, the minor's records are confidential and may not be disclosed to the minor's parents or guardians without the minor's authorization, except in limited circumstances defined by law (such as when disclosure is necessary to avert a serious threat to the minor's health or safety).

For minors under age 13, or for minors whose treatment was initiated with parental consent, a parent or guardian generally has the right to access the minor's treatment records, subject to applicable law and clinical judgment regarding the minor's best interests.

We are committed to navigating these complex requirements with care, and we will discuss applicable confidentiality boundaries with both minors and their families at the outset of treatment.

VII. Your Rights Regarding Your Protected Health Information

You have the following rights with respect to the PHI that we maintain about you:

A. Right to Inspect and Copy

You have the right to inspect and obtain a copy of your PHI contained in a designated record set, which includes your clinical and billing records. You must submit your request in writing to our Privacy Officer. We may charge a reasonable, cost based fee for copies as permitted by HIPAA and Washington State law (RCW 70.02.080). We will respond to your request within 15 working days. In very limited circumstances, we may deny your request. If access is denied, we will provide a written explanation of the basis for the denial and information about how to request a review of the denial.

B. Right to Amend

You have the right to request an amendment to your PHI if you believe the information is inaccurate or incomplete. Your request must be in writing, must be directed to our Privacy Officer, and must include a reason supporting the requested amendment. We may deny the request under certain circumstances (for example, if we did not create the information, or if we determine that the information is accurate and complete). If we deny your request, we will provide a written explanation and inform you of your right to submit a written statement of disagreement (RCW 70.02.100).

C. Right to an Accounting of Disclosures

You have the right to request a list (accounting) of certain disclosures of your PHI that we have made. This accounting will not include disclosures made for treatment, payment, or health care operations; disclosures made with your authorization; disclosures made directly to you; or certain other disclosures as permitted by law. Your request must be in writing and must specify the time period for the accounting (which may not exceed six years). The first accounting in any twelve month period will be provided at no charge. We may charge a reasonable fee for subsequent requests within the same period.

D. Right to Request Restrictions

You have the right to request that we restrict or limit how we use or disclose your PHI for treatment, payment, or health care operations, or to individuals involved in your care. We are not generally required to agree to your request, except when the restriction involves disclosure to a health plan for payment or health care operations purposes and the PHI pertains solely to a service for which you have paid out of pocket in full. Please submit restriction requests in writing to our Privacy Officer.

E. Right to Request Confidential Communications

You have the right to request that we communicate with you about your health matters in a certain manner or at a certain location. For example, you may ask that we contact you only by mail or at a specific phone number. We will accommodate all reasonable requests. Your request must be made in writing and must specify how or where you wish to be contacted.

F. Right to a Paper Copy of This Notice

You have the right to obtain a paper copy of this Notice at any time, even if you have previously agreed to receive it electronically. You may request a copy from our Privacy Officer or from any member of our administrative staff.

G. Right to Be Notified of a Breach

You have the right to be notified in the event that we (or one of our business associates) discover a breach of your unsecured PHI. We will notify you in accordance with the HIPAA Breach Notification Rule (45 CFR Part 164, Subpart D) and any applicable Washington State breach notification requirements.

VIII. Our Duties

We are required by law to maintain the privacy and security of your PHI, to provide you with this Notice of our legal duties and privacy practices, and to notify you following a breach of your unsecured PHI. We are required to abide by the terms of this Notice currently in effect.

We reserve the right to change the terms of this Notice and to make the new provisions effective for all PHI that we maintain, including information we created or received before the effective date of the revised Notice. If we make a material change to this Notice, we will make the revised Notice available upon request, post the revised Notice in our office, and post it on our website.

IX. Other Uses and Disclosures

Any uses and disclosures of your PHI not described in this Notice will be made only with your written authorization. If you provide us with an authorization to use or disclose your PHI, you may revoke that authorization in writing at any time. Revocation of an authorization will not affect any use or disclosure permitted by the authorization while it was in effect. We do not engage in fundraising activities using your PHI, and we do not use or disclose your PHI for research purposes without your explicit written authorization and the approval of an appropriate review body.

X. Complaints

If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer at the contact information listed below. You may also file a complaint directly with the U.S. Department of Health and Human Services, Office for Civil Rights.

You will not be retaliated against in any way for filing a complaint.

U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Toll Free: (877) 696-6775
Website: www.hhs.gov/ocr/privacy/hipaa/complaints

You may also file a complaint with the Washington State Attorney General's Office if you believe your rights under Washington State privacy law (RCW 70.02) have been violated.

XI. Privacy Officer Contact Information

PRIVACY OFFICER
Daniel Arteaga, MS, LMFT
Bellevue Counseling
15446 Bel-Red Rd., Suite 401
Redmond, WA 98052
Phone: (206) 438-9994
Email: daniel@bellevue-counseling.com

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