NOTICE OF PRIVACY PRACTICES
Summit Mind Psychiatry, PLLC
Effective Date: August 25, 2026
THIS NOTICE DESCRIBES HOW MEDICAL AND MENTAL HEALTH INFORMATION ABOUT YOU MAY BE
USED AND DISCLOSED, HOW YOU CAN ACCESS THIS INFORMATION, AND YOUR RIGHTS REGARDING
YOUR HEALTH INFORMATION. PLEASE REVIEW IT CAREFULLY.
Summit Mind Psychiatry, PLLC (“Summit Mind Psychiatry,” “we,” “our,” or “us”) is committed to protecting the privacy and confidentiality of your health information.
We are required by law to maintain the privacy and security of your Protected Health Information (“PHI”), provide you with this Notice of our legal duties and privacy practices, and follow the terms of the Notice currently in effect.
This Notice applies to health information created, received, maintained, or transmitted by Summit Mind Psychiatry in connection with the healthcare services we provide, including services provided through telehealth and in person.
YOUR RIGHTS
You have certain rights regarding your health information.
Get an Electronic or Paper Copy of Your Medical Record
You may ask to inspect or receive an electronic or paper copy of your medical record and other health information we maintain about you.
We will provide access within the time required by applicable federal and Washington law.
We may charge a reasonable, cost-based fee when permitted by law.
In limited circumstances, access to certain information may be denied as permitted by law. When applicable, you may have the right to request review of that decision.
Ask Us to Correct Your Medical Record
If you believe information in your medical or billing record is incorrect or incomplete, you may ask us to amend or correct it.
1We may deny your request in certain circumstances permitted by law. If we deny your request, we will provide an explanation and information regarding any additional rights you may have.
Request Confidential Communications
You may ask us to communicate with you about your healthcare in a particular way or at a particular location.
For example, you may request that we use a particular telephone number, email address, or mailing address.
We will accommodate reasonable requests as required by law.
Ask Us to Limit What We Use or Share
You may ask us not to use or disclose certain health information for treatment, payment, or healthcare operations.
We are generally not required to agree to these requests unless otherwise required by law.
If you pay for a healthcare service or item entirely out of pocket, you may ask us not to disclose information about that service or item to your health plan for payment or healthcare operations. We will honor such requests when required by law.
Receive an Accounting of Disclosures
You may request an accounting of certain disclosures we have made of your health information.
An accounting generally does not include certain disclosures for treatment, payment, healthcare operations, disclosures you authorized, or other disclosures excluded by applicable law.
Receive a Copy of This Notice
You may request a paper or electronic copy of this Notice at any time, even if you previously agreed to receive it electronically.
The current Notice is also available through our website.
Choose Someone to Act for You
If you have given someone medical power of attorney or another person is legally authorized to act on your behalf, that person may exercise your privacy rights when permitted by law.
We may verify the person's legal authority before acting on a request.
Special rules apply to parents, guardians, minors, and other personal representatives under Washington and federal law.
Be Notified of Certain Breaches
You have the right to be notified if a breach occurs that may have compromised the privacy or security of your unsecured PHI, as required by law.
File a Privacy Complaint
You may file a complaint if you believe your privacy rights have been violated.
Contact:
Summit Mind Psychiatry, PLLC
Lacey, Washington
Email: admin@summitmindpsychiatry.com
Website: summitmindpsychiatry.com
You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights.
Summit Mind Psychiatry will not retaliate against you for filing a complaint or exercising your privacy rights.
YOUR CHOICES
For certain health information, you may tell us your preferences regarding what we share.
In circumstances in which you have a choice, such as sharing certain information with family members, friends, caregivers, or others involved in your care, we will follow your instructions as required by applicable law.
If you are unable to communicate your preference, such as during an emergency or period of incapacity, we may disclose limited information when permitted by law and when, in our professional judgment, disclosure is appropriate.
Washington law may provide additional protections for mental-health information, and we will follow those requirements when they apply.
HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION
Federal and Washington law permit us to use or disclose health information in certain circumstances without obtaining a separate written authorization.
Treatment
We may use and disclose health information to provide, coordinate, or manage your healthcare when permitted by applicable law.
For example, we may communicate relevant information to another healthcare professional involved in your care, such as your primary care provider, therapist, pharmacy, specialist, hospital, or other treating clinician.
Washington law provides additional protections for mental-health records, and those requirements will be followed when applicable.
Payment
We may use and disclose health information as permitted by law to obtain payment for healthcare services. This may include providing information to an insurance company, health plan, billing service, or other entity involved in processing payment for your care.
When applicable, billing and claims processing may be performed through Headway or other contracted billing or healthcare administration services.
Healthcare Operations
We may use and disclose health information for activities necessary to operate our practice, including:
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Quality assessment and improvement
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Care coordination
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Credentialing
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Compliance activities
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Auditing
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Business administration and planning
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Legal services
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Information technology and security
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Reviewing the quality of care and services
Business Associates
We may provide PHI to companies or individuals that perform services on behalf of Summit Mind Psychiatry when access to PHI is necessary for those services.
When required by HIPAA, these organizations are considered business associates and are contractually required to appropriately safeguard PHI.
Public Health, Safety, and Mandatory Reporting
We may use or disclose health information when permitted or required by law for certain health and safety
purposes, including:
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Reporting suspected abuse or neglect when required by law
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Reporting certain diseases or public-health concerns
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Preventing or reducing certain serious threats to health or safety
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Responding to certain medical or psychiatric emergencies
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Complying with other legally mandated reporting requirement
Any disclosure will be made in accordance with applicable federal and Washington law.
Legal and Regulatory Requirements
We may disclose health information when specifically permitted or required by federal or Washington law.
Examples may include certain:
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Health oversight activities
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Judicial or administrative proceedings
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Law enforcement requests
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Workers' compensation matters
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Government functions
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Coroner or medical examiner activities
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Court orders, subpoenas, or other legal processes
Mental-health information may receive greater protection than other medical information. We will apply applicable Washington confidentiality requirements before disclosing such information.
SPECIAL PRIVACY PROTECTIONS FOR MENTAL HEALTH SERVICES IN WASHINGTON
Washington law provides additional confidentiality protections for mental-health information.
The fact that an individual receives mental-health services, as well as information and records compiled, obtained, or maintained in connection with those services, may be protected from disclosure except when the patient authorizes disclosure or disclosure is otherwise specifically permitted or required by law.
Summit Mind Psychiatry will use and disclose mental-health information only as permitted or required by applicable federal and Washington law.
When Washington law provides greater privacy protection than HIPAA and is not preempted by federal law, we will follow the more protective applicable requirement.
Exceptions to confidentiality may apply in circumstances specifically authorized or required by law, including certain treatment and care coordination activities, emergencies, health or safety concerns, mandatory reporting obligations, judicial proceedings, and other legally authorized disclosures.
MINORS AND MENTAL HEALTH INFORMATION
Washington law provides specific confidentiality protections for minors receiving mental-health services.
Depending on factors including the minor's age, the type of healthcare involved, how treatment was initiated, who consented to treatment, and other circumstances, a minor may have confidentiality rights concerning healthcare information that differ from those applicable to other medical information.
Parents and legal guardians do not necessarily have unrestricted access to all mental-health information concerning a minor in every circumstance.
Summit Mind Psychiatry evaluates requests to access, use, or disclose a minor's health information in accordance with applicable Washington and federal law.
When permitted or required by law, information may be shared with a parent, guardian, personal representative, healthcare professional, or another appropriate person. Any disclosure will be limited as required by applicable law.
FAMILY MEMBERS, CAREGIVERS, AND OTHERS INVOLVED IN YOUR CARE
When permitted by law, we may share limited information with family members, caregivers, or others involved in your care or payment for your care.
The information disclosed will be limited to information permitted by applicable law and reasonably related to the person's involvement in your care.
Additional restrictions may apply to mental-health information, substance use disorder information, psychotherapy notes, and information involving minors.
AUTHORIZATION AND RELEASE OF INFORMATION
You may authorize Summit Mind Psychiatry to disclose your health information to another person or organization by completing a valid written Authorization for Release of Information (“ROI”) or other legally sufficient authorization.
A valid authorization will identify, as required by applicable law:
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The patient
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The information authorized for disclosure
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The person or organization authorized to disclose the information
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The person, organization, or class of persons authorized to receive it
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The purpose of the disclosure when required
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An expiration date or expiration event
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The patient's or authorized representative's signature and date
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Other information required by applicable federal or Washington law
An authorization may be limited to particular information, providers, recipients, purposes, or dates. You generally may revoke an authorization in writing at any time, except to the extent that we have already acted in reliance on it or as otherwise provided by law.
Summit Mind Psychiatry will disclose only the information authorized by the ROI unless disclosure without authorization is otherwise permitted or required by law.
Signing an authorization for disclosure generally is not a condition of receiving treatment, except in limited circumstances permitted by law.
Certain information may require additional or more specific authorization.
PSYCHOTHERAPY NOTES
HIPAA provides additional protection to psychotherapy notes, as that term is specifically defined by federal
law.
Psychotherapy notes are legally distinct from ordinary psychiatric progress notes and the medical record. Information such as diagnoses, medication prescriptions and monitoring, treatment plans, symptoms, clinical summaries, and ordinary documentation of psychiatric medication-management visits generally does not become psychotherapy notes merely because it concerns mental health.
If Summit Mind Psychiatry creates or maintains records meeting the legal definition of psychotherapy notes, we generally must obtain specific written authorization before using or disclosing those notes except in limited circumstances permitted by law.
A general ROI may not authorize disclosure of psychotherapy notes when a separate authorization is required.
SUBSTANCE USE DISORDER INFORMATION
Certain substance use disorder (“SUD”) records may receive additional confidentiality protections under federal law, including 42 CFR Part 2, when applicable.
When information is protected by Part 2, Summit Mind Psychiatry will use and disclose that information in accordance with applicable federal requirements.
Part 2-protected information may be subject to additional restrictions regarding its use or disclosure in civil, criminal, administrative, and legislative proceedings against a patient.
When specific patient consent or authorization is required, we will obtain it as required by law.
USES AND DISCLOSURES REQUIRING WRITTEN AUTHORIZATION
Certain uses and disclosures generally require your written authorization, including when applicable:
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Most uses and disclosures of psychotherapy notes
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Certain uses and disclosures for marketing
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Certain disclosures involving the sale of PHI
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Uses or disclosures otherwise requiring authorization under federal or Washington law
If you authorize a use or disclosure, you generally may revoke that authorization in writing.
Revocation will not affect actions already taken in reliance on a valid authorization.
We will not use or disclose your health information for purposes not described in this Notice unless you authorize us to do so or the use or disclosure is otherwise permitted or required by law.
MENTAL HEALTH ADVANCE DIRECTIVES
Washington law recognizes Mental Health Advance Directives, through which an individual may document instructions and preferences concerning future mental-health treatment.
If you have a valid Mental Health Advance Directive, please provide Summit Mind Psychiatry with a copy so it can be included in your health record when appropriate.
We will recognize and follow a valid Mental Health Advance Directive as required by applicable Washington law.
ELECTRONIC COMMUNICATIONS AND TELEHEALTH
Summit Mind Psychiatry may provide healthcare through telehealth and may communicate electronically with patients when appropriate.
The privacy protections described in this Notice apply to healthcare provided through telehealth as well as healthcare provided in person.
We use reasonable administrative, technical, and physical safeguards intended to protect PHI maintained or transmitted electronically.
Established patients should use designated secure patient communication methods, including the secure patient portal when available, for detailed clinical communications and sensitive health information.
Email, portal messages, and other routine electronic communications are not continuously monitored and should not be used for emergencies.
If you are experiencing a medical or psychiatric emergency, call 911 or go to the nearest emergency department. If you are experiencing a suicidal, mental-health, or substance-use crisis, call or text 988 to reach the 988 Suicide & Crisis Lifeline.
WASHINGTON NOTICE REGARDING YOUR HEALTHCARE RECORDS
Summit Mind Psychiatry keeps a record of the healthcare services we provide to you.
You may ask to see or obtain a copy of that record. You may also ask us to correct information in that record.
We will not disclose your healthcare record to others unless you direct us to do so or unless disclosure is authorized or required by law.
To request access to your records, request a correction, submit an authorization, or obtain additional information regarding our privacy practices, contact:
admin@summitmindpsychiatry.com
OUR RESPONSIBILITIES
Summit Mind Psychiatry is required to:
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Maintain the privacy and security of your PHI
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Provide you with this Notice describing our legal duties and privacy practices
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Follow the terms of the Notice currently in effect
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Notify affected individuals following certain breaches of unsecured PHI as required by law
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Honor your privacy rights as required by applicable federal and Washington law
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Apply additional protections to specially protected health information when required
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We will not use or disclose your information in a manner inconsistent with this Notice unless permitted or
required by law or authorized by you.
CHANGES TO THIS NOTICE
We reserve the right to change this Notice and our privacy practices as permitted by law.
Changes may apply to PHI we already maintain as well as information we receive in the future.
When a material change is made, we will make the revised Notice available as required by law and update its effective date.
The current version will be available on our website and upon request.
QUESTIONS, RECORD REQUESTS, OR PRIVACY COMPLAINTS
For questions about this Notice, requests to exercise your privacy rights, requests for health records, release of Information requests, or privacy complaints, contact:
Summit Mind Psychiatry, PLLC
Lacey, Washington
Email: admin@summitmindpsychiatry.com
Website: summitmindpsychiatry.com
You may also submit a privacy complaint to the U.S. Department of Health and Human Services Office for Civil Rights.
Summit Mind Psychiatry will not retaliate against you for filing a complaint or exercising a privacy right.
© 2026 Summit Mind Psychiatry, PLLC. All rights reserved.