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WSU Psychology Clinic Health Insurance Portability and Accountability Act Statement

Effective April 14, 2003

The Washington State University Psychology Clinic recognizes our responsibility for safeguarding the privacy of your health information. This notice provides information regarding use and disclosure of protected health information by the WSU Psychology Clinic. This notice also describes your rights and our obligations for using your health information and informs you about laws that provide special protections for your health information. It also explains how your protected health information is used and how, under certain circumstances, it may be disclosed.

Protected Health Information

This notice applies to health information—created or received by the providers at Washington State University Psychology Clinic—that identifies you and that relates to your past, present, or future physical or mental condition. For example, your protected health information (PHI) includes your treatment plan, test results, diagnoses, health information from other providers, and financial information that could identify you. The information often contained in your medical record serves as a means of communication among the health professionals who contribute to your care.

Federal and state law allows us to use and disclose your PHI for purposes of supervision, treatment, assessment results, payment, and health care operations. The Psychology Clinic is a mental health service, training, and research center operated by the Department of Psychology at Washington State University. The clinic cannot submit claims to an insurance company on your behalf. State law requires us to obtain your authorization to disclose your PHI for payment purposes from outside agencies, such as county agencies and school districts.

Use and Disclosure of Your Protected Health Information for Supervision, Treatment, Assessment, Payment, and Health Operations

Clinical Supervision

The Psychology Clinic is a mental health service, training, and research center operated by the Department of Psychology at Washington State University. The clinic is staffed by graduate student therapists in the clinical psychology Ph.D. program under the direct supervision of faculty members, and licensed psychologists.

Treatment and Assessments

Information obtained by a student therapist will be recorded in your medical record and used to help decide what treatment or assessment is right for you.


Most medical insurance will not cover the services provided by graduate student therapists. The clinic cannot submit claims to an insurance company on your behalf. We do not accept Medicare or DSHS medical coupons.

We request payment from county agencies and school districts for assessments and pre-employment evaluations. Information provided to these agencies may include your test results, diagnoses, and recommendations for services.

Health Care Operations

  • We use your medical records to assess the quality of our services for the purpose of improving them.
  • We may use medical records to review the qualifications and performance of our student therapists.
  • We may contact you to remind you about appointments and give you information about treatment alternatives or other health-related benefits and services.

Client Rights

The health and financial records we create and store are the property of the Washington State University Psychology Clinic. The protected health information in it, however, generally belongs to you. You have a right to:

  • Receive a copy, read, and ask questions about your protected health information as well as request restrictions to its use and/or disclosure. You must deliver this request to us in writing. Although we are not required to grant the request, we consider it and typically comply unless the request could pose a potential harm.
  • Request and receive a paper copy of the most current “Notice of Privacy Practices” for protected health information.
  • Request that you be allowed to see and obtain a copy of your protected health information. You may make this request in writing. Charges for copies of your medical record will apply in accordance with Washington state law.
  • Ask that your health information be given to you by another means or at another location. Please sign, date, and give us your request in writing.
  • Cancel prior authorizations to use or disclose health information by giving us a written revocation. Your revocation does not affect information that has already been released. Also, it does not affect any action taken before we have received it.
  • Please note that we do not normally include raw psychological testing materials in disclosures of information, in order to protect the security of these tests.

For help with these rights during normal business hours, please contact:

Rachelle Simons, Privacy Officer
Washington State University Psychology Clinic
P.O. Box 644820
Pullman, WA 99164-4820

Our Responsibilities

We are required to:

  • Keep your protected health information private.
  • Give you this notice.
  • Follow the terms of the notice.

We have the right to change our practices regarding the protected health information we maintain. If we make changes, we will update this notice. You may receive the most recent copy of the notice by calling and asking for it or by visiting our office.

Questions and Complaints

If you have questions, want more information, or want to report a problem about the handling of your protected health information, you may contact our privacy officer.

If you believe your privacy rights have been violated, you may discuss your concerns with the director of the clinic. Also, you may mail a written complaint to the Institutional Review Board, P.O. Box 643140, Pullman, WA 99164-3140. You may also file a complaint with the U.S. Secretary of Health and Human Services.

Use and Disclosure of Your Protected Health Information Without Your Authorization

Conduct Research

We may use and disclose your information for research under certain limited circumstances; however, most or all identifying information will be removed in order to maintain your confidentiality. We may also share non-identifying information with medical researchers preparing to conduct a research project.

For Public Health and Safety Purposes as Allowed or Required by Law

  • To prevent or reduce a serious, immediate threat to the health or safety of a person or the public.
  • To public health or legal authorities.
  • To report suspected abuse or neglect to public authorities.
  • To correctional institutions if you are in jail or prison.
  • For law enforcement purposes such as when we receive a court order.
  • To the military authorities of U.S. and foreign military personnel.
  • In the course of judicial/administrative proceedings at your request, or as directed by a court order.

Other Uses and Disclosures of Protected Health Information

  • Uses and disclosures not in the notice will be made only as allowed or required by law or with your written authorization.