Notice of Privacy Practices
How your health information may be used and disclosed, and how you can access it. Please review before scheduling your first appointment.
HIPAA Privacy Rule · 45 CFR §164.520 · Effective July 3, 2026 · Revised July 25, 2026
Our Commitment To Your Privacy
Backcountry Mental Health is committed to protecting the privacy of your health information, called Protected Health Information (PHI). PHI is information that identifies you and relates to your health, treatment, or payment. This Notice explains how we use and share your PHI, your rights, and our legal duties.
How We May Use And Disclose Your Phi Without Your Authorization
Treatment: We may use and share your PHI to provide, coordinate, and manage your psychiatric and behavioral health care — for example, with other providers involved in your treatment (your primary care provider, specialists, your pharmacy).
Payment: This is a direct-pay practice: we do not bill insurance. We may use your PHI to process your payments (card, HSA, or FSA) and to prepare superbills that you may choose to submit to your insurer for out-of-network reimbursement. A superbill contains limited PHI, including diagnosis and service codes.
Health Care Operations: We may use and share your PHI for business activities such as quality improvement, training, credentialing, audits, and business planning necessary to run the practice and ensure quality care.
Other permitted disclosures without authorization: as required by law (e.g., mandatory reporting of child abuse, elder abuse, or neglect); to public health authorities for disease control and prevention; to law enforcement under limited circumstances; in response to a court order or valid subpoena; to prevent or lessen a serious and imminent threat to health or safety (duty to warn); for workers' compensation programs as authorized by law; to the Secretary of HHS for compliance investigations; and to coroners, medical examiners, and funeral directors.
Special Protections For Certain Information
Washington State and federal law provide EXTRA protections for the following. We will not disclose these without your specific written authorization, except as required by law: mental health and psychiatric records (WAC 246-341; RCW 70.02); substance use disorder treatment records (42 CFR Part 2 — see separate consent form); HIV/AIDS status and test results (RCW 70.02.220); genetic information (GINA; RCW 49.44.180); and psychotherapy notes (45 CFR §164.508 — require separate authorization).
Uses And Disclosures That Require Your Written Authorization
We will ask for your signed authorization before using or disclosing your PHI for purposes not listed above, including marketing communications, disclosures to employers or schools (unless legally required), most disclosures of psychotherapy notes, and any sale of PHI. You may revoke an authorization at any time in writing; revocation does not affect disclosures already made in reliance on it.
Your Rights Regarding Your Health Information
To exercise any right, contact us at support@backcountrymentalhealth.com.
Access: request a copy of your records; we respond within 30 days (a reasonable fee may apply).
Amendment: request correction of PHI you believe is incorrect or incomplete.
Accounting of disclosures: request a list of certain disclosures made in the past six years.
Restrictions: request limits on how we use or share your PHI. Because you pay out of pocket in full, you have the right to require that we not disclose information about a service to any health plan.
Confidential communications: ask that we contact you only in certain ways or at certain locations.
Paper copy: request a paper copy of this Notice at any time.
Breach notification: you will be notified if your PHI is involved in a reportable breach.
Our Duties
We are required by law to maintain the privacy of your PHI, provide you with this Notice, and follow the terms of the Notice currently in effect. We reserve the right to change this Notice; changes apply to PHI we already hold. The current Notice is always available on our website and on request.
How To File A Complaint
If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services Office for Civil Rights (1-800-368-1019 · www.hhs.gov/ocr/privacy). You will not be retaliated against for filing a complaint.
Privacy Officer: Kyle Young, ARNP, PMHNP-BC · support@backcountrymentalhealth.com
Acknowledgment Of Receipt
By signing, I acknowledge that I have received and had an opportunity to review the Notice of Privacy Practices of Backcountry Mental Health. I understand this Notice describes how my health information may be used and disclosed and how I can access this information. If I decline to sign, treatment may still be provided; the practice will document that this Notice was offered.