Sophia Rath, PhD

Licensed Psychologist

(206) 552-8491

sophiarathphd@gmail.com

3245 Fairview Ave E, Suite 210

Seattle WA 98102

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© 2019 by Sophia Rath, PhD, PLLC

Disclosures & Privacy Practices

Disclosures
  • I am a licensed psychologist in the state of Washington. I received my Master's degree in counseling with an emphasis on marriage and family therapy from the California State University in Fullerton and have a Ph.D. in counseling psychology from Western Michigan University in Kalamazoo. 

  • I may occasionally find it helpful to consult other health and mental health professionals about a case. If I consult with a professional who is not involved in your treatment, I make every effort to avoid revealing your identity. These professionals are legally bound to keep the information confidential.  If you don’t object, I will not tell you about these consultations unless I feel that it is important to our work together. I will note all consultations in your Clinical Record (which is called “PHI” in my Notice of Psychologist’s Policies and Practices to Protect the Privacy of Your Health Information).  

  • I practice primarily from the Interpersonal Process Therapy orientation and draw clinical interventions from evidence-based modalities that complement each client's needs and multicultural identity. 

  • As a consumer, you have a say in your treatment and have the right to refuse treatment at any time. Please note that you are always responsible for the payment of services rendered. It is also your responsibility to choose a provider and treatment modality that best suits your needs. I will do my best to assist you in making this decision, which may include referral to other providers for alternative and/or auxiliary healthcare providers.

 

Minors and Parents

Patients under 18 years of age who are not emancipated and their parents should be aware that the law may allow parents to examine their child’s treatment records. Since privacy in psychotherapy is often crucial to successful progress, particularly with teenagers, it is usually my policy to request an agreement from the parents that they consent to give up access to their child’s records. If they agree, during treatment I will provide them only with general information about the progress of the child’s treatment, and his/her attendance at scheduled sessions. I will also provide parents with a summary of their child’s treatment when it is complete. Any other communication will require the child’s Authorization, unless I feel that the child is in danger or is a danger to someone else, in which case, I will notify the parents of my concern. Before giving parents any information, I will discuss the matter with the child, if possible, and do my best to handle any objections he/she may have.  

 

Notice of Psychologists’ Policies and Practices to Protect the Privacy of Your Health Information
This notice describes how psychological and medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. 

 

I.  Uses and Disclosures for Treatment, Payment, and Health Care Operations  

I may use or disclose your protected health information (PHI), for treatment, payment, and health care operations purposes with your consent. To help clarify these terms, here are some definitions: 

  • "PHI” refers to information in your health record that could identify you. 

  • “Treatment, Payment and Health Care Operations”

  • Treatment is when I provide, coordinate or manage your health care and other services related to your health care. An example of treatment would be when I consult with another health care provider, such as your family physician or another psychologist.

  • Payment is when I obtain reimbursement for your healthcare.  Examples of payment are when I disclose your PHI to your health insurer to obtain reimbursement for your health care or to determine eligibility or coverage.

  • Health Care Operations are activities that relate to the performance and operation of my practice.  Examples of health care operations are quality assessment and improvement activities, business-related matters such as audits and administrative services, and case management and care coordination.

  • “Use” applies only to activities within my practice, such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you.

  • “Disclosure” applies to activities outside of my practice, such as releasing, transferring, or providing access to information about you to other parties. 

 

II.  Uses and Disclosures Requiring Authorization 

I may use or disclose PHI for purposes outside of treatment, payment, and health care operations when your appropriate authorization is obtained. An “authorization” is written permission above and beyond the general consent that permits only specific disclosures.  In those instances when I am asked for information for purposes outside of treatment, payment and health care operations, I will obtain an authorization from you before releasing this information.  I will also need to obtain an authorization before releasing your psychotherapy notes. “Psychotherapy notes” are notes I have made about our conversation during a private, group, joint, or family counseling session, which I have kept separate from the rest of your medical record.  These notes are given a greater degree of protection than PHI.

 

You may revoke all such authorizations (of PHI or psychotherapy notes) at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that (1) I have relied on that authorization; or (2) if the authorization was obtained as a condition of obtaining insurance coverage, and the law provides the insurer the right to contest the claim under the policy.

 

III.  Uses and Disclosures with Neither Consent nor Authorization

I may use or disclose PHI without your consent or authorization in the following circumstances: 

 

  • Child Abuse: If I have reasonable cause to believe that a child has suffered abuse or neglect, I am required by law to report it to the proper law enforcement agency or the Washington Department of Social and Health Services.

  • Adult and Domestic Abuse: If I have reasonable cause to believe that abandonment, abuse, financial exploitation, or neglect of a vulnerable adult has occurred, I must immediately report the abuse to the Washington Department of Social and Health Services. If I have reason to suspect that sexual or physical assault has occurred, I must immediately report to the appropriate law enforcement agency and to the Department of Social and Health Services.   

  • Health Oversight: If the Washington Examining Board of Psychology subpoenas me as part of its investigations, hearings or proceedings relating to the discipline, issuance or denial of licensure of state licensed psychologists, I must comply with its orders.  This could include disclosing your relevant mental health information.

  • Judicial or Administrative Proceedings: If you are involved in a court proceeding and a request is made for information about the professional services that I have provided to you and the records thereof, such information is privileged under state law, and I will not release information without the written authorization of you or your legal representative, or a subpoena of which you have been properly notified and you have failed to inform me that you are opposing the subpoena, or a court order. The privilege does not apply when you are being evaluated for a third party or where the evaluation is court ordered. You will be informed in advance if this is the case.

  • Serious Threat to Health or Safety: I may disclose your confidential mental health information to any person without authorization if I reasonably believe that disclosure will avoid or minimize imminent danger to your health or safety, or the health or safety of any other individual.

  • Worker’s Compensation: If you file a worker's compensation claim, with certain exceptions, I must make available, at any stage of the proceedings, all mental health information in my possession relevant to that particular injury in the opinion of the Washington Department of Labor and Industries, to your employer, your representative, and the Department of Labor and Industries upon request.

 

IV.  Patient's Rights and Psychologist's Duties

Patient’s Rights:

  • Right to Request Restrictions –You have the right to request restrictions on certain uses and disclosures of protected health information about you. However, I am not required to agree to a restriction you request. 

  • Right to Receive Confidential Communications by Alternative Means and at Alternative Locations – You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations. (For example, you may not want a family member to know that you are seeing me.  Upon your request, I will send your bills to another address.)  

  • Right to Inspect and Copy – You have the right to inspect or obtain a copy (or both) of PHI and psychotherapy notes in my mental health and billing records used to make decisions about you for as long as the PHI is maintained in the record. I may deny your access to PHI under certain circumstances, but in some cases you may have this decision reviewed. On your request, I will discuss with you the details of the request and denial process.

  • Right to Amend – You have the right to request an amendment of PHI for as long as the PHI is maintained in the record. I may deny your request.  On your request, I will discuss with you the details of the amendment process.

  • Right to an Accounting – You generally have the right to receive an accounting of disclosures of PHI for which you have neither provided consent nor authorization (as described in Section III of this Notice).  On your request, I will discuss with you the details of the accounting process. 

  • Right to a Paper Copy – You have the right to obtain a paper copy of the notice from me upon request, even if you have agreed to receive the notice electronically.

 

Psychologist’s Duties:

  • I am required by law to maintain the privacy of PHI and to provide you with a notice of my legal duties and privacy practices with respect to PHI.

  • I reserve the right to change the privacy policies and practices described in this notice. Unless I notify you of such changes, however, I am required to abide by the terms currently in effect.

  • If I revise my policies and procedures, I will notify you by mail with a revised version of this document.

 

V.  Complaints

If you are concerned that I have violated your privacy rights, or you disagree with a decision I made about access to your records, please contact me at my business address.

 

You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services. Office of Civil Rights, 200 Independence Ave. SW, Washington, D.C.  20201 (877-696-6775 toll free).

 

VI. Effective Date, Restrictions and Changes to Privacy Policy

This notice will go into effect on August 1, 2015. I reserve the right to change the terms of this notice and to make the new notice provisions effective for all PHI that I maintain.  I will provide you with a revised notice by mail.