Provider: Michelle Tobin, MA, LMHC, PMP
Practice: Sublime Online PLLC
Address: 1404 NE 134th St, Suite 290, Vancouver, WA 98685
Email: michelle@sublime.online
Phone: (360) 207-1957
Website: https://sublime.online
Practice: Sublime Online PLLC
Address: 1404 NE 134th St, Suite 290, Vancouver, WA 98685
Email: michelle@sublime.online
Phone: (360) 207-1957
Website: https://sublime.online
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. I act as my own Privacy Officer. If you have any questions or need more information about this notice, please contact me, Michelle Tobin, using the information at the top of this page.
YOUR INFORMATION. YOUR RIGHTS. MY RESPONSIBILITIES.
I keep a record of the health care services I provide you. You may ask me to see and copy that record. You may also ask me to correct that record. I will not disclose your record to others unless you direct me to do so or unless the law authorizes or compels me to do so. You may see your record or get more information about it at 1404 NE 134th St, Suite 290, Vancouver, WA 98685.
YOUR RIGHTS
You have the right to:
• Get a copy of your paper or electronic medical record
• Correct your paper or electronic medical record
• Request confidential communication
• Ask me to limit the information I share
• Get a list of those with whom I've shared your information
• Get a copy of this privacy notice
• Choose someone to act for you
• File a complaint if you believe your privacy rights have been violated
YOUR CHOICES
You have some choices in the way that I use and share information as I:
• Tell family and friends about your condition
• Provide disaster relief
• Provide mental health care
• Market my services and sell your information
MY USES AND DISCLOSURES
I may use and share your information as I:
• Treat you
• Run my organization
• Bill for your services
• Help with public health and safety issues
• Do research
• Comply with the law
• Work with a medical examiner or funeral director
• Address workers' compensation, law enforcement, and other government requests
• Respond to lawsuits and legal actions
To the extent that I have your substance use disorder patient records, subject to 42 CFR part 2, I will not share that information for investigations or legal proceedings against you without (1) your written consent or (2) a court order and a subpoena.
YOUR RIGHTS
When it comes to your health information, you have certain rights. This section explains your rights and some of my 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 I have about you. If you use my secure online patient portal, you may also access portions of your record directly through that system. Ask me how to do this.
• I will provide a copy or a summary of your health information, usually within 15 working days of your request, as required by Washington State law. I may charge a reasonable fee, legally capped by Washington State Department of Health guidelines.
Ask me to correct your medical record
• You can ask me to correct health information about you that you think is incorrect or incomplete. Ask me how to do this.
• I may say "no" to your request, but I'll tell you why in writing within 10 days (or up to 21 days for unusual circumstances), as required by Washington State law.
Request confidential communications
• You can ask me to contact you in a specific way (for example, home, office, or cell phone) or to send mail to a different address.
• I will say "yes" to all reasonable requests.
Ask me to limit what I use or share
• You can ask me not to use or share certain health information for treatment, payment, or my operations. I am not required to agree to your request, and I may say "no," for example, if it could affect your care. If I agree to your request, I may still share this information in the event that you need emergency treatment.
• If you pay for a service or health care item out-of-pocket in full, you can ask me not to share that information for the purpose of payment or my operations with your health insurer. I will say "yes" unless a law requires me to share that information.
Get a list of those with whom I've shared information
• You can ask for a list (accounting) of the times I've shared your health information for six years prior to the date you ask, who I shared it with, and why.
• I will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked me to make). I'll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice
• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. I will provide you with a paper copy promptly.
Choose someone to act for you
• If someone has authority to act as your personal representative, such as if someone has your medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
• I will make sure the person has this authority and can act for you before I take any action.
File a complaint if you feel your rights are violated
• You can complain if you feel I have violated your rights by contacting me using the information at the top of this page.
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting https://www.hhs.gov/hipaa/filing-a-complaint/index.html.
• You can also file a complaint with the Washington State Department of Health (DOH) Health Systems Quality Assurance (HSQA) division by sending a letter to Complaint Intake, P.O. Box 47857, Olympia, WA 98504-7857, calling (360) 236-4700, or emailing HSQAComplaintIntake@doh.wa.gov.
• I will not retaliate against you for filing a complaint.
YOUR CHOICES
For certain health information, you can tell me your choices about what I share. If you have a clear preference for how I share your information in the situations described below, talk to me. Tell me what you want me to do, and I will follow your instructions.
In these cases, you have both the right and choice to tell me to:
• Share information with your family, close friends, or others involved in your care or payment for your care
• Share information in a disaster relief situation
If you are not able to tell me your preference, for example if you are unconscious, I may go ahead and share your information if I believe it is in your best interest. I may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases I never share your information unless you give me written permission:
• Marketing purposes
• Sale of your information
• Most sharing of psychotherapy notes
MY USES AND DISCLOSURES
How do I typically use or share your health information?
I typically use or share your health information in the following ways.
Treat you
I can use your health information and share it with other professionals who are treating you.
Example: A doctor treating you for an injury asks another doctor about your overall health condition.
Run my organization
I can use and share your health information to run my practice, improve your care, and contact you when necessary.
Example: I use health information about you to manage your treatment and services.
Bill for your services
I can use and share your health information to bill and get payment from health plans or other entities.
Example: I give information about you to your health insurance plan so it will pay for your services.
How else can I use or share your health information?
I am allowed or required to share your information in other ways - usually in ways that contribute to the public good, such as public health and research. I have to meet many conditions in the law before I can share your information for these purposes.
In all cases, including those listed below, if I have substance use disorder patient records about you, subject to 42 CFR part 2, I cannot use or share information in those records in civil, criminal, administrative, or legislative investigations or proceedings against you without (1) your consent or (2) a court order and a subpoena.
Help with public health and safety issues
I 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
I can use or share your information for health research.
Comply with the law
I will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that I'm complying with federal privacy law.
Work with a medical examiner or funeral director
I can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Address workers' compensation, law enforcement, and other government requests
I 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
• I can share health information about you in response to a court or administrative order, or in response to a subpoena.
MY RESPONSIBILITIES
• I am required by law to maintain the privacy and security of your protected health information.
• I will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• I must follow the duties and privacy practices described in this notice and give you a copy of it.
• I will not use or share your information other than as described in this notice unless you tell me I can in writing. If you tell me I can, you may change your mind at any time. Let me know in writing if you change your mind.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
STATE LAW PROTECTIONS: WASHINGTON STATE RESTRICTIONS
The Privacy Rule requires me to describe any state or other laws that require greater limits on disclosures. As a Licensed Mental Health Counselor in Washington State, I adhere to both federal HIPAA regulations and Washington State laws, which provide stricter privacy protections for your health information:
• Substance Use, Mental Health, and AIDS/HIV Records: I will not disclose information related to substance use disorder treatment (RCW 70.02, RCW 71.24, 42 CFR Part 2), mental health treatment (RCW 70.02, RCW 71.05, RCW 71.34), or AIDS/HIV status (RCW 70.24) without your specific written consent, except as strictly required by law.
• Minor's Rights: I comply with all Washington State laws regarding the privacy and consent of minors, including the right of minors age 13 and older to consent to outpatient behavioral health treatment without parental disclosure in certain circumstances (RCW 71.34).
• Reproductive and Gender-Affirming Care: I will protect your health information regarding reproductive and gender-affirming care in strict accordance with the Uniform Health Care Information Act (RCW 70.02), which strictly limits when such information can be shared, including prohibitions on sharing this data for out-of-state investigations or subpoenas.
• Court Orders and Subpoenas: I will only disclose your health information in response to court orders and subpoenas when legally compelled, protecting your privacy to the fullest extent possible under Washington law (RCW 70.02).
• Mandatory Reporting: I will report suspected child abuse, vulnerable adult abuse, and certain communicable diseases strictly as mandated by Washington State law (RCW 26.44, RCW 74.34, RCW 70.24).
• Electronic Information and Telehealth: I will protect your health information shared through electronic exchanges and telehealth sessions in accordance with Washington State regulations (RCW 70.02).
CHANGES TO THE TERMS OF THIS NOTICE
I can change the terms of this notice, and the changes will apply to all information I have about you. The new notice will be available upon request, in my office, and on my website.
Effective Date: May 1, 2026