Notice of Privacy Practices
This notice describes how medical and clinical information about you may be used and disclosed, and how you can get access to this information.
Effective Date: May 2026 · This notice is required by law.
Please review this notice carefully. Fulcra Center for Change, LLC is required by federal law (HIPAA) to maintain the privacy of your Protected Health Information (PHI) and to provide you with this notice of our legal duties and privacy practices. We are required to follow the terms of this notice while it is in effect.
Who does this notice apply to
This notice applies to all services provided by Fulcra Center for Change, LLC, including domestic violence assessments, domestic violence intervention treatment (DVIT), mental health evaluations, parenting evaluations, Guardian ad Litem services, and individual, couples, and family therapy.
All clinicians, staff, and contractors working on behalf of Fulcra Center for Change are required to follow the privacy practices described in this notice.
How we may use and disclose your information
We use and disclose Protected Health Information (PHI) for purposes related to your treatment, operations, and as required or permitted by law. The following describes the ways we may use or share your information.
Treatment
We may use your PHI to provide, coordinate, and manage your clinical services. This includes sharing relevant information with other providers involved in your care, with your written authorization.
Healthcare operations
We may use your PHI for internal operational purposes, including quality assurance, clinical supervision, training, and administrative functions necessary to run our practice.
Court-ordered disclosures
If we receive a valid court order or subpoena, we may be required to disclose your PHI as directed by the court. We will notify you of such orders to the extent permitted by law.
Legal and regulatory requirements
We may disclose your PHI when required by federal, state, or local law, including mandatory reporting obligations under Washington State law.
Mandatory reporting
As licensed clinicians, Fulcra's providers are mandated reporters. We are required by law to report suspected abuse or neglect of a child, vulnerable adult, or dependent person, and credible threats of imminent harm to an identifiable individual. These disclosures are made without your authorization when required by law.
To avert a serious threat to health or safety
We may use or disclose your PHI when necessary to prevent or lessen a serious and imminent threat to the health or safety of you or another person. Disclosure would be made only to individuals reasonably able to help prevent the threat.
With your written authorization
All other uses and disclosures of your PHI not described in this notice require your written authorization via a signed Release of Information (ROI) form. You may revoke that authorization at any time in writing, except where we have already acted in reliance upon it.
Uses and disclosures we will never make
We will not sell your PHI or use it for marketing without your written authorization
We will not share psychotherapy notes without your explicit written consent, except as required by law
We will not use or disclose your PHI in a way that is not described in this notice without your written authorization
Your rights regarding your health information
You have the following rights with respect to your Protected Health Information. To exercise any of these rights, submit a written request to our office.
Right to access
You may request a copy of your clinical records and PHI. We will respond within 30 days. We may charge a reasonable fee for copies.
Right to amend
You may request that we correct or update information in your records. We may deny the request if the information is accurate and complete.
Right to restrict disclosures
You may request that we limit how we use or share your PHI. We are not always required to agree, but will consider all requests in good faith.
Right to confidential communications
You may request that we contact you in a specific way or at a specific location. We will accommodate reasonable requests.
Right to an accounting of disclosures
You may request a list of instances in which we have disclosed your PHI, other than for treatment, payment, or operations.
Right to a copy of this notice
You may request a paper copy of this notice at any time, even if you have agreed to receive it electronically.
Our duties
We are required by law to maintain the privacy and security of your Protected Health Information
We will notify you 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 provide you with a copy upon request
We will not use or share your information other than as described here unless you authorize it in writing
We reserve the right to change the terms of this notice. Changes will apply to information we already hold about you as well as new information. The current notice will always be available on our website and in our office.
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. You will not be penalized or retaliated against for filing a complaint.
File a complaint with Fulcra Center for Change:
Submit your complaint in writing to admin@fulcracenter.com or mail to:
1901 Cornwall Ave, Suite 1051 · Bellingham, WA 98225
File a complaint with the U.S. Department of Health and Human Services:
Office for Civil Rights
www.hhs.gov/ocr/privacy/hipaa/complaints
Toll-free: 1-800-368-1019
Contact our privacy officer
For questions about this notice or to exercise any of your rights, please contact our office:
If you have questions about this privacy policy or how your information is handled, please reach out:
Fulcra Center for Change, LLC
1901 Cornwall Ave, Suite 1051 · Bellingham, WA 98225
Mon–Fri · 9:30 AM – 5:00 PM