NOTICE OF PRIVACY PRACTICES

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.

Market Street Psychotherapy, PS is required by law and by our professional codes of ethics to maintain the privacy of your health information. We are also required to give you this Notice about our privacy practices, legal obligations, and your rights concerning your health information ("Protected Health Information" or "PHI"). 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.

I. USES AND DISCLOSURES OF PHI

A. 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 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 determining coverage, billing, 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 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; disclosures to military or national security agencies, coroners, medical examiners, and correctional institutions; organ and tissue donation; and disclosures to funeral directors as permitted by law.

5. Substance Use Disorder Records

If we receive or maintain substance use disorder treatment records protected by 42 CFR Part 2, those records may not be used or disclosed in civil, criminal, administrative, or legislative investigations or proceedings against you unless permitted by Part 2, including with your written consent or a qualifying court order and subpoena.

6. Additional Washington Protections

Because MSP provides mental-health services in Washington, state law may provide additional confidentiality protections beyond HIPAA. We will not disclose mental-health treatment information without your written authorization unless the disclosure is otherwise permitted or required by applicable Washington or federal law.

B. 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, 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 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.

C. Uses and Disclosures Requiring Your Written Authorization

1. Psychotherapy Notes

We generally must obtain your written authorization before using or disclosing psychotherapy notes, except as permitted or required by applicable law.

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 applicable law.

3. Other Uses and Disclosures

Uses and disclosures other than those described in this Notice will only be made with your written authorization. You may revoke a written authorization at any time in writing, except to the extent that we have already acted in reliance on it.

II. YOUR INDIVIDUAL RIGHTS

A. 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.

B. 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.

C. 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:

Market Street Psychotherapy, PS
2208 NW Market Street, Suite 513
Seattle, WA 98107

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.

D. 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.

E. 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.

F. Right to Obtain Notice

You have the right to obtain a paper copy of this Notice by submitting a request to our Practice Coordinator at office@marketstpsychotherapy.com, by calling our main office at 206-403-1374, or by mail at:

Market Street Psychotherapy, PS
2208 NW Market Street, Suite 513
Seattle, WA 98107

G. 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.

H. 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 our Clinic Director:

Market Street Psychotherapy, PS
2208 NW Market Street, Suite 513
Seattle, WA 98107
Phone: 206-403-1374
Email: jacob.markovitz@marketstpsychotherapy.com

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint with the Office for Civil Rights or with our office.

III. EFFECTIVE DATE AND CHANGES TO THIS NOTICE

A. Effective Date

This Notice is effective October 25, 2026.

B. 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 website at:

marketstpsychotherapy.com/privacy-policy-phi

You may also obtain any revised notice by contacting our Practice Coordinator at office@marketstpsychotherapy.com or by calling our main office at 206-403-1374.