Notice of Privacy Practices.

Your information. Your rights. Our responsibilities.

This notice explains how medical information about you may be used or disclosed and how you can access it. Please review it carefully. For questions or a paper copy, contact the Office Manager at 866-512-5121 or write to 11851 Jollyville Road, Suite 104, Austin, TX 78759. This notice applies to the practice and people acting on its behalf in handling protected health information.

Treatment, payment and healthcare operations

We may use and share information to provide and coordinate care, obtain payment and operate the practice as permitted by law. Examples include sharing relevant information with another treating clinician, submitting information to your health plan and reviewing the quality of services. We may contact you about appointments or care-related services. Business associates handling information for us must meet applicable privacy obligations.

Other uses and disclosures permitted by law

The law may permit or require disclosures for public health, health oversight, reporting abuse or neglect, judicial or administrative proceedings, certain law-enforcement purposes, workers’ compensation and serious threats to health or safety. Research disclosures require applicable legal safeguards. Disclosures concerning deceased individuals, organ donation or specialized government functions may also be permitted. More protective federal or state rules apply when relevant.

When you have a choice or authorization is required

Where permitted, you may tell us whether to share relevant information with family or others involved in your care. Most uses of psychotherapy notes, marketing uses that require authorization and sale of protected health information require your written authorization. Other uses not described here require authorization unless the law permits them. You may revoke an authorization in writing; revocation does not undo actions already taken in reliance on it.

Access, copies and corrections

You may request inspection or a copy of your medical and billing records, including an electronic copy when applicable. Reasonable, legally permitted fees may apply. You may request a correction if information is inaccurate or incomplete; if a request is denied, we explain the decision and applicable rights. Contact the office for the request process and identity verification.

Restrictions, confidential contact and disclosure history

You may request limits on uses or disclosures and request reasonable confidential communications at another number or address. We are not required to agree to every restriction, but generally must honor a request not to disclose a service to your health plan for payment or operations when you paid for that service in full, unless disclosure is required by law. You may request an accounting of certain disclosures and a paper copy of this notice. A legally authorized personal representative may exercise applicable rights on your behalf.

Our responsibilities and changes to this notice

We are required to protect the privacy and security of protected health information, provide notice of our practices and follow the notice in effect. We notify affected individuals when a breach of unsecured protected health information requires notification. We may revise this notice and apply revised provisions to information we maintain as allowed by law. The current notice is available from our office.

Questions or complaints

You may complain to our Office Manager or to the U.S. Department of Health and Human Services, Office for Civil Rights, if you believe your privacy rights were violated. We will not retaliate against you for making a complaint. Visit hhs.gov/ocr/privacy/hipaa/complaints for current federal complaint instructions.

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