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. This notice is from Balanced Living Therapy LLC, 7500 212th Street SW, Suite 205, Edmonds, WA 98026. It takes effect on November 1, 2026. It covers your health information and also your substance use disorder treatment records, which have extra protection under a federal law called 42 CFR Part 2 (Part 2). You can ask us for a paper copy of this notice at any time.
Your rights
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Get an electronic or paper copy of your medical record
You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
We will give you a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct your medical record
You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
We may say no to your request. If we do, we will tell you why in writing within 60 days.
Request confidential communications
You can ask us to contact you in a specific way, for example on your home phone or your office phone. You can also ask us to send mail to a different address.
We will say yes to all reasonable requests.
Ask us to limit what we use or share
You can ask us not to use or share certain health information for treatment, payment, or our operations. We do not have to agree to your request. We may say no if it would affect your care.
If you pay for a service or health care item out of pocket in full, you can ask us not to share that information with your health insurer for payment or our operations. We will say yes unless a law requires us to share that information.
Get a list of those with whom we have shared information
You can ask for a list (called an accounting) of the times we have shared your health information in the six years before the date you ask. The list says who we shared it with and why.
We will include all the times we shared it, except for sharing about treatment, payment, and health care operations, and certain other sharing, such as anything you asked us to do. We will give you one list a year for free. If you ask for another one within 12 months, we may charge a reasonable, cost-based fee.
Your substance use disorder records have their own rules about lists of disclosures. They are explained in the section on Part 2 records below.
Get a copy of this privacy notice
You can ask for a paper copy of this notice at any time, even if you agreed to get the notice electronically. We will give you a paper copy promptly.
Choose someone to act for you
If you have given someone medical power of attorney, or if someone is your legal guardian, that person can use your rights and make choices about your health information.
We will make sure the person has this authority and can act for you before we do anything they ask.
File a complaint if you feel your rights are violated
You can complain if you feel we have violated your rights. How to do that is explained in the last section of this notice. We will not retaliate against you for filing a complaint.
Your choices
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations below, talk to us. Tell us what you want us to do, and we will follow your instructions.
You can tell us to:
- Share information with your family, close friends, or others involved in your care.
- Share information in a disaster relief situation.
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
For your substance use disorder records, Part 2 may limit this sharing further. See the section on Part 2 records below.
In these cases we never share your information unless you give us written permission:
- Marketing purposes.
- Sale of your information.
- Most sharing of psychotherapy notes.
Our uses and disclosures
We use and share your health information in the ways described in this section. Where another law, such as Part 2, limits a use or sharing more than the main federal health privacy law (HIPAA) does, we follow the stricter law. We have to meet many conditions in the law before we can share your information for these purposes.
Treat you
We can use your health information and share it with other professionals who are treating you.
Example: A professional treating you asks another professional who treats you about your overall health condition.
Run our organization
We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Example: We use health information about you to manage your treatment and services.
We keep records and handle email with TherapyNotes, our electronic health record and client portal, and with Microsoft 365. Both companies have signed business associate agreements with us. These agreements require them to protect your information.
Bill for your services
We can use and share your health information to bill and get payment from health plans or other entities.
Example: We give information about you to your health insurance plan so it will pay for your services.
Help with public health and safety issues
We can share health information about you for certain situations, such as:
- Preventing disease.
- Helping with product recalls.
- Reporting adverse reactions to medications.
- Reporting suspected abuse, neglect, or domestic violence.
- Preventing or reducing a serious threat to anyone's health or safety.
Do research
We can use or share your information for health research.
Comply with the law
We will share information about you if state or federal laws require it. This includes sharing with the U.S. Department of Health and Human Services if it wants to see that we are following federal privacy law.
Respond to organ and tissue donation requests
We can share health information about you with organ procurement organizations.
Work with a medical examiner or funeral director
We can share health information with a coroner, medical examiner, or funeral director when a person dies.
Address workers' compensation, law enforcement, and other government requests
We can use or share health information about you:
- For workers' compensation claims.
- For law enforcement purposes or with a law enforcement official.
- With health oversight agencies for activities authorized by law.
- For special government functions, such as military, national security, and presidential protective services.
Respond to lawsuits and legal actions
We can share health information about you in response to a court order, an administrative order, or a subpoena.
Uses and sharing that need your written permission
We will make other uses and disclosures of your information only with your written permission. This section explains when we need it and what is off limits.
When we need your written permission
We need your written permission for most sharing of psychotherapy notes, for marketing, and for the sale of your information. Any use or sharing that is not described in this notice also needs your written permission. If you give us permission, you can change your mind at any time. Tell us in writing that you want to take it back.
Reproductive health care: what we cannot do
We cannot use or share your health information to investigate or punish anyone for the mere act of seeking, obtaining, providing, or facilitating reproductive health care. We also cannot use or share it to identify anyone for that purpose. This rule applies when the care was lawful where it was given, or when federal law protects, requires, or allows it. It covers many kinds of help, such as getting care, giving care, paying for care, counseling about it, or helping someone get it.
Example: An agency asks us for records to investigate a person for getting lawful reproductive health care. We will not give them the records.
Reproductive health care: when we need a signed statement
Sometimes a person asks us for records that may relate to reproductive health care. This can happen when the request is for health oversight, a court or administrative case, law enforcement, or a coroner or medical examiner. Before we share anything, we must get a signed statement (called an attestation) from the person asking. In the statement, they must say the request is not for a purpose that is off limits. The statement must also name the information they want and who is asking and receiving it. It must warn that a person can face criminal penalties for knowingly getting or sharing health information in violation of the law.
Example: A law enforcement officer asks for records that may relate to reproductive health care. We will not share them until we have the signed statement.
Sharing again by the person who gets your information
When we share your health information under this notice, the person who gets it may share it again. If that person is not covered by HIPAA, your information may no longer be protected by HIPAA.
Extra rules for substance use disorder records
Part 2 adds rules for substance use disorder treatment records. These rules are explained in the next section. They include limits on using records in legal cases and rules about passing on records that were shared with consent.
Substance use disorder records (42 CFR Part 2)
Notice of Privacy Practices of Balanced Living Therapy LLC
This notice describes:
- HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
- YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION
- HOW TO FILE A COMPLAINT CONCERNING A VIOLATION OF THE PRIVACY OR SECURITY OF YOUR HEALTH INFORMATION, OR OF YOUR RIGHTS CONCERNING YOUR INFORMATION
YOU HAVE A RIGHT TO A COPY OF THIS NOTICE (IN PAPER OR ELECTRONIC FORM) AND TO DISCUSS IT WITH OUR PRIVACY OFFICER, JESSE DUNN, AT (425) 977-4988 AND frontdesk@balancedlivingtherapy.com IF YOU HAVE ANY QUESTIONS.
We provide substance use disorder treatment. Federal law protects the confidentiality of substance use disorder patient records. This section tells you how we use and share those records, and what your rights are.
How we use and share these records
We use and share your substance use disorder records for treatment, payment, and health care operations, as described in the section above. Part 2 and other laws can limit these uses more than HIPAA does. When they do, we follow the stricter rule. Without your written consent, Part 2 lets us use or share these records only in these situations:
- To medical personnel in a medical emergency.
- For research, under the conditions Part 2 sets.
- For audits and evaluations of our program, by people who agree in writing to Part 2's limits.
- Under a court order that meets Part 2's requirements.
- To report a crime, or a threat to commit a crime, on our premises or against our staff.
- To report suspected child abuse or neglect, as state law requires.
- To report your cause of death, as state law requires.
- To a public health authority, with information that does not identify you.
- To a business associate or qualified service organization that helps us run the program and agrees in writing to Part 2's limits.
- In a form that does not identify you.
You can give us one written consent that covers all future uses and sharing of your records for treatment, payment, and health care operations.
When we need your written consent
We need your written consent for uses and sharing that Part 2 does not allow without it. Example: We need your written consent before we tell your employer that you are in treatment with us.
We will use and share records in ways not described in this notice only with your written consent. You can take back (revoke) your written consent, as provided in 42 CFR 2.31 and 2.35. Ask us how.
Legal proceedings
- Your records, or testimony about what is in them, will not be used or shared in any civil, administrative, criminal, or legislative case against you unless you gave specific written consent or a court ordered it.
- A court can order the use or sharing of your records only after you, or the holder of the record, are told and get a chance to be heard, where the law requires that.
- A court order must come with a subpoena or a similar legal demand that forces us to share the record before we use or share it.
This also applies to substance use disorder records that we receive from another Part 2 program, and to testimony about what is in them.
Passing on records shared with your consent
If you give written consent for treatment, payment, or health care operations, the program, covered entity, or business associate that gets your records may share them again without your consent. They may do this only as far as HIPAA allows.
Your rights over these records
- You can ask us to limit sharing that you agreed to for treatment, payment, and health care operations. This right is set out in 42 CFR 2.26.
- You can ask us not to share these records with your health plan for services you paid for in full. We handle this the same way HIPAA does for other health information.
- You can ask for a list of disclosures of your electronic records under Part 2 for the past three years, as set out in 42 CFR 2.25. For all other sharing made with your consent, you can ask for a list that meets the HIPAA rules for accountings.
- You can ask for a list of disclosures made by an intermediary (a go-between that passes records along under your consent) for the past three years, as set out in 42 CFR 2.24.
- You can ask for a paper or electronic copy of this notice.
- You can discuss this notice with our Privacy Officer.
To use any of these rights, call or write to our Privacy Officer using the contact information in the last section.
How we protect these records
We are required by law to keep your records private, to give you this notice of our legal duties and privacy practices, and to tell you if there is a breach that affects your unsecured records. We must follow the terms of this notice while it is in effect. The sections above explain the limits on sharing, consent, legal proceedings, and fundraising that protect these records.
Our responsibilities
- We are required by law to maintain the privacy and security of your protected health information.
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
- We must follow the duties and privacy practices described in this notice and give you a copy of it.
- We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
Changes to this notice
We can change the terms of this notice, and the changes will apply to all information we have about you, including information we created or received before the change. The new notice will be available on request, in our office, and on our website.
If we make a material change to how we use or share your information, your rights, or our duties, we will promptly revise this notice. We will not put a material change into use before the effective date of the notice that describes it, except when the law requires it.
Questions and complaints
For questions about this notice, or to use any of your rights, contact our Privacy Officer, Jesse Dunn, Clinical and Executive Director.
- Phone: (425) 977-4988
- Email: frontdesk@balancedlivingtherapy.com
- Mail: Balanced Living Therapy LLC, 7500 212th Street SW, Suite 205, Edmonds, WA 98026
If you believe we have violated your privacy rights, you can complain to us. To do so, call, email, or write to our Privacy Officer at the contact information above.
You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights (OCR):
- Online: OCR complaint portal
- Phone: 1-877-696-6775
- Mail: Centralized Case Management Operations, U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Room 509F HHH Bldg., Washington, D.C. 20201
We will not retaliate against you for filing a complaint.