Health Psychology Texas PLLC
516 E. Byron Nelson #1076
817-587-1641
Health Insurance Portability and Accountability Act (HIPAA) – Privacy Notice
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION, YOUR RIGHTS CONCERNING YOUR HEALTH INFORMATION AND OUR RESPONSIBILITIES TO PROTECT YOUR HEALTH INFORMATION. PLEASE REVIEW IT CAREFULLY.
Federal law requires Health Psychology Texas PLLC to make this Notice of Privacy Practices (“Notice”) available to all persons and to make a good faith effort to obtain a signed document acknowledging patients’ receipt of this Notice. If you have any questions about this notice, please call 817-587-1641.
In this Privacy Notice, “medical information” and “psychological information” mean the same as “health information.” Health information includes any information that relates to:
- your past, present, or future physical or mental health or condition;
- providing health care to you; or
- the past, present, or future payment for your health care.
WHEN IS THE NOTICE EFFECTIVE?
This notice became effective on December 17, 2024. Health Psychology Texas reserves the right to change this notice after the effective date. We reserve the right to make the revised notice apply for all health information that we already have about you, as well as any information we receive in the future. The current notice is available by contacting Health Psychology Texas. Please do not hesitate to raise any questions or concerns you might have about your confidentiality.
Who will observe these rules?
In our practice, the following individuals are required by HIPAA to comply with the privacy rules:
Health Psychology Texas clinic(s) providers.
Any Health Psychology Texas staff who may help you while you are seeking care at Health Psychology Texas.
Any billing agency or collection agency that handles information about you (name and address, diagnostic codes, treatment codes, and consultation dates…but not actual clinical records)
WHAT ARE OUR RESPONSIBILITIES TO YOU?
Your health information is personal. We are required by law to protect the privacy of your health information. This means that we will not use or disclose your health information without your authorization except in the ways we tell you in this notice.
If we wish to use or disclose your health information in ways other than those stated in this notice, we will ask you for your written authorization. If you give such an authorization, you may revoke it at any time, but we will not be liable for uses or disclosures made before you revoked your authorization.
We use the minimal amount of information needed to do our work. Only those who need your health information to provide services are allowed to use it.
HOW DO WE USE AND DISCLOSE YOUR HEALTH INFORMATION?
Health Psychology Texas primarily maintains your health information in a secure electronic format. Your health information will most often be used, shared or disclosed electronically. The following section explains some of the ways we are permitted to use and release health information.
TREATMENT PURPOSES
While we are providing you with health care services, we typically will not share this information with other health care professionals unless you specifically request it or agree to it, and will typically sign a consent form to that effect. There may be some circumstances in which we may need to share your health information with other health care providers or other individuals who are involved in your treatment, as aligned with your goals to help coordinate care (e.g., referrals of a patient for health care from one health care provider to another, in contractual roles to confirm completion of services).
Limits to Confidentiality:
There are circumstances when a clinician may break confidentiality, or is required to break confidentiality and thus disclose your mental health information. This is accounted for under section 164.512 of the Privacy Rule and the state’s confidentiality law. If a therapist believes you are the victim of abuse or neglect, or perceives you to be a danger to yourself or others, he/she may disclose health information about you to the appropriate agency or individual (e.g., government agency, police, family members, relevant healthcare providers who may assist in taking protective action). Please refer to our Consent and Office Policies for a more detailed description of the limits of confidentiality. Should such a circumstance arise, we will make every reasonable effort to discuss with you our ethical or legal obligations to disclose confidential information before doing so.
PAYMENT PURPOSES
Health Psychology Texas may need to share a limited amount of your health information to obtain or provide payment for the health care services provided to you. Examples include:
Eligibility – Health Psychology Texas may contact the insurance company, government, or program that will be paying for your health care. This helps us determine if you are eligible for benefits, and if you are responsible for payment.
Claims – Health Psychology Texas and businesses we work with share health information for billing and payment purposes. For example, your provider may need to submit a claim form to get paid, and the claim form must contain certain health information. Although our preference is to obtain an Authorization from you, we may disclose your health information in order to comply with workers’ compensation laws.
HEALTHCARE OPERATIONS PURPOSES
Health Psychology Texas may need to share your health information in the course of conducting health care business activities that are related to providing health care to you. Examples include:
Marketing Purposes – As a psychologist, I will not use or disclose your PHI for marketing purposes.
Business Associates – There are some services provided at Health Psychology Texas through contracts with Business Associates such as legal, medical transcription services, and record storage companies. In this case, there will be a written contract in place with the agency, requiring that it maintain the security of your information in compliance with the rules of HIPAA.
Audits – Health Psychology Texas may use or release your health information to make sure that its business practices comply with the law and with our policies. Examples include audits involving quality of care, billing, or patient confidentiality.
Business Activities – We may use or release your health information to perform internal business activities. Examples include business planning, computer systems maintenance, staff training, legal services, financial/tax and customer service. We may use and disclose your health information to contact you for business purposes (for example, to remind you that you have an appointment with us).
OTHER PURPOSES
As Required By Law – Sometimes we must report some of your health information to legal officials or authorities, such as law enforcement officials, court officials, governmental agencies or attorneys. Examples include reporting suspected abuse or neglect of a child, dependent adult, or elderly individual, or responding to a court order, subpoena, warrant or lawsuit request. We may disclose certain health information in the process of preventing or reducing a serious threat to anyone’s health or safety.
It is possible (but unlikely) that the Department of Health and Human Services may review how our office complies with the regulations of HIPAA. In such a case, your personal health information could be revealed as a part of providing evidence of compliance.
If you are involved in a lawsuit, we may disclose health information in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but our preference is to attempt to tell you about the request or to obtain an order protecting the information requested.
Public Health Activities – We may be required to report your health information to authorities to help prevent or control disease, injury or disability. Examples include reporting certain information related to child, disabled, or elderly abuse or neglect.
Activities Related to Death –We may release health information to family members and others who were involved in your care or payment for care after your death.
To Avoid a Serious Threat to Health or Safety – As required by standards of ethical conduct, we may release your health information to the proper authorities if we believe, in good faith, that such release is necessary to prevent or minimize a serious and/or approaching threat to anyone’s health or safety.
Military, National Security or Incarceration/ Law Enforcement Custody – We may be required to release your health information to the proper authorities so they may carry out their duties under the law. This may involve the military, national security or intelligence activities, or if you are in the custody of law enforcement officials.
Worker’s Compensation – We may be required to release your health information to the appropriate persons to comply with the laws related to workers’ compensation or other similar programs that provide benefits for work-related injuries or illness.
Persons Involved in Your Care – In certain situations, we may release health information about you to persons involved in your care, such as friends or family members, or those who help pay for your care. You have the right to approve such releases, unless you are unable to function, or if there is an emergency.
WHEN IS YOUR WRITTEN AUTHORIZATION REQUIRED?
Except for the types of situations listed above, we must obtain your written permission, known as an authorization, for any other types of releases of your health information. An authorization is required for most uses and disclosures of psychotherapy notes.
We keep “psychotherapy notes”, and any use or disclosure of such notes requires your Authorization unless the use or disclosure is: a. For our use in treating you. b. For our use in training or supervising mental health practitioners to help them improve their skills in group, joint, family, or individual counseling or therapy. c. For our use in defending ourselves in legal proceedings instituted by you. d. For use by the Secretary of Health and Human Services to investigate our compliance with HIPAA. e. Required by law and the use or disclosure is limited to the requirements of such law. f. Required by law for certain health oversight activities pertaining to the originator of the psychotherapy notes. g. Required by a coroner who is performing duties authorized by law. h. Required to help avert a serious threat to the health and safety of others.
Other uses and disclosures of your health information not described in this Notice may be made only with your written authorization, and you have the right to cancel (revoke) your authorization.
WHAT ARE YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION?
The Right to a Copy of This Notice Upon Request
You have the right to request and obtain a copy of this notice. You may obtain a copy of the current notice by contacting Health Psychology Texas.
The Right to Withdraw Permission to Disclose Health Information
You have the right to withdraw permission you have given us to use or disclose health information that identifies you, unless we have already taken action based on your permission. In order to take effect, your request to withdraw permission must be submitted to our office in writing.
The Right to Request Confidential Communications – You have the right to ask that Health Psychology Texas communicate your health information to you in different ways or places. For example, you can ask that we only contact you by telephone, or that we only contact you by mail at home or at a post office box. We will do this whenever it is reasonably possible. We prefer you submit such requests in writing, and be specific with respect to how/when/where to contact you.
The Right to Request Restrictions on How Your Information is Used
You have the right to request restrictions on certain uses or disclosures of your mental health information, beyond what the law requires. These requests must be in writing, and most likely will be honored, although in some cases they may be denied. We do not use or release your protected health information for marketing purposes or any other purpose aside from treatment, payment, and other exceptions specified in this notice.
Right to Restrict Disclosures When You Have Paid for Your Care Out-of-Pocket – You have the right to restrict certain disclosures of PHI to a health plan when you pay out-of-pocket in full for our services. We must honor your request to restrict your health information from being disclosed to your health plan for purposes of payment or health care operations unless the disclosure is required by law.
The Right to Inspect and Obtain a Copy of Your Mental health Record
With a few exceptions, you have the right to inspect and obtain a copy of your Clinical Record (which may include the date of your consultations, your reasons for seeking therapy, your diagnosis, therapeutic goals, treatment plan, progress, medical and social history, treatment history, functional status, any past records from other providers, and any reports to your insurance carrier). You (your personal representative or a person chosen by you) also have a right to request a copy of your completed test results.
Some of the exceptions may include:
• Psychotherapy notes (which consist of specific content or analyses of therapy conversations, some of which may include sensitive information you have revealed that is not required to be included in your Clinical Record) and therapist’s notes that may assist in treatment. Psychotherapy Notes are kept separate from your clinical record in order to maximize privacy and security.
• Test materials or data considered trade protected;
• Information gathered for court proceedings; and
• Any information your provider feels may cause you serious harm to yourself or to others.
To receive a copy of your record or completed test results, or to direct your health information or completed test results to be sent to another person chosen by you, contact Health Psychology Texas. You may request and receive an electronic copy of your electronic record or completed test results. We may charge you a cost-based fee which may include copying and/or mailing your health record or completed test results to you. If you are denied access to your health record or to your completed test results for any reason, Health Psychology Texas will tell you the reasons.
The Right to Request a Correction or Add an Addendum to Your Mental health Record Correction
If you believe there is an inaccuracy in your clinical record, you may request a correction in writing. If the information is accurate, however, if it has been provided by a third party (e.g., previous therapist, primary care physician, etc.), if we do not keep the information, if you are not allowed to see and copy the information, it may remain unchanged, and the request denied. In this case, you will receive an explanation with a full description of the rationale. Additionally, you may request to place a copy of your written disagreement in your records. Addendum: You also have the right to make an addition to your record, if you think that it is incomplete.
The Right to an Accounting of Disclosures of Your Mental health Information to Third Parties
You have the right to know if, when, and to whom your mental health information has been disclosed. You have the right to ask for a list of releases of your health information by sending a request in writing to Health Psychology Texas. Your request may not include dates earlier than the six years prior to the date of your request. This list will not include releases for treatment, payment, health care operations or releases that you have authorized.
Right to be Notified of Disclosure of Unsecured Health Information – You have a right to be notified if: (a) there is a breach (a use or disclosure of your PHI in violation of the HIPAA Privacy Rule) involving your PHI; (b) that PHI has not been encrypted to government standards.
The Right to File a Complaint
If you believe that your privacy rights have been violated, you may file a complaint in writing with Health Psychology Texas (817-587-1641) or with the Secretary of Health and Human Services. You will not be denied treatment or penalized in any way if you file a complaint.
Office of Civil Rights (OCR):
200 Independence Avenue, S.W. Washington, D.C. 20201
1-877-696-6775