Effective Date: 04/19/2025

Emolumin Therapium, PLLC

wonder@emolumintherapium.com | (425) 900-4044

Lynnwood, WA 98037

THIS NOTICE DESCRIBES HOW YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED, AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

1. Our Responsibilities

Emolumin Therapium, PLLC is committed to protecting your privacy. We are required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Washington Uniform Health Care Information Act (RCW 70.02) to maintain the privacy of your health information and provide you with this notice of our legal duties and privacy practices.

We must:

• Maintain the confidentiality of your health information

• Give you this Notice of Privacy Practices

• Follow the terms of this notice currently in effect

2. How We May Use and Disclose Your Health Information

We may use or share your health information in the following ways:

For Treatment

To provide, coordinate, or manage your care with other providers or agencies involved in your treatment.

For Payment

To bill and receive payment from health plans, third-party payers (e.g., Headway, SonderMind), or sending billing statements directly to you for services provided to you.

For Health Care Operations

To evaluate and improve the quality of services, business management, and administrative activities.

As Required by Law

We may share your information when required by federal, state, or local laws (e.g., court orders, subpoenas, mandated reporting of abuse).

To Prevent Serious Harm

If there is a serious threat to your safety or the safety of others, we may share your information to prevent harm.

With Your Written Authorization

For any uses or disclosures not listed above (e.g., marketing, releasing records to outside parties), we will obtain your written permission. You may revoke your authorization at any time in writing.

3. Your Rights Regarding Your Health Information

You have the right to:

• Request access to your records (RCW 70.02.080; 45 CFR § 164.524)

• Request corrections if you believe your records are incorrect (RCW 70.02.100; 45 CFR § 164.526)

• Request confidential communications via specific channels (e.g., no voicemail) (45 CFR § 164.522(b))

• Request restrictions on what information we share (45 CFR § 164.522(a))

• Receive an accounting of disclosures (i.e., who we’ve shared your data with, 45 CFR § 164.528)

• Receive a paper or electronic copy of this Notice at any time

To exercise any of these rights, contact us using the information at the top of this Notice.

4. Breach Notification

We are required by federal and Washington State law to notify you in the event of a breach of your protected health information that may compromise your privacy or security. You will be notified in writing no later than 30 days after the breach is discovered, as required by RCW 19.255.010 and 45 CFR § 164.404.

5. Electronic Communication and Telehealth

If you choose to receive services via telehealth, we use secure, HIPAA-compliant platforms for video, secure messaging, documentation, and forms. These include:

• Spruce Health (telehealth video, voicemail, secure communication)

• ProtonMail (encrypted email communication)

• ProtonDrive / ProtonCalendar (record storage and scheduling for direct-pay clients)

• FormHippo (HIPAA-compliant platform for intake forms and electronic signatures)

• Headway and SonderMind (scheduling, billing, secure messaging, and documentation for referred clients)

Please note that you are responsible for maintaining your privacy when using personal devices or internet connections. We will not send confidential information to unsecured accounts without your written request or consent.

6. Changes to This Notice

We may update this Notice of Privacy Practices as needed. If we make material changes, a revised copy will be provided to you and posted on our website. You may request a current version at any time.

7. Questions or Complaints

If you believe your privacy rights have been violated, you may contact:

Emolumin Therapium, PLLC

wonder@emolumintherapium.com

(425) 900-4044

Or file a complaint with:

Office for Civil Rights, U.S. Department of Health and Human Services

www.hhs.gov/ocr/privacy/hipaa/complaints/

We will not retaliate against you for filing a complaint.