Notice of Privacy Practices

How I Protect Your Health Information

• Treating all health information I collect as confidential, subject to the exceptions described in Sections B through D.
• Restricting access to your health information to those who need it to provide services to you.
• Disclosing only the minimum information necessary when an outside service provider (a “business associate”) performs a function on my behalf, under a written agreement requiring it to protect your information.
• Maintaining physical, electronic, and procedural safeguards — covering the office, telehealth sessions, and electronic records — to comply with federal and state law.
• Maintaining your electronic health record within the United States, as required by Texas law.

Uses and Disclosures for Treatment, Payment, and Health Care Operations

Once you have consented to receive services, I may use or disclose your PHI for the following purposes:

• Treatment — providing, coordinating, or managing your care, for example by consulting with your physician.
• Payment — obtaining payment for the services you receive, including preparing a superbill at your request.
• Health Care Operations — activities related to running the practice, such as quality assessment, business management, and training.

Uses and Disclosures Requiring Your Authorization

Other uses and disclosures will be made only with your written authorization. In particular, your written authorization is required for most uses and disclosures of psychotherapy notes, for uses and disclosures for marketing, and for any disclosure that constitutes a sale of PHI.

You may revoke an authorization in writing at any time, except to the extent I have already acted in reliance on it. Records relating to couples or families seen jointly will not be released without authorization from all participating adults.

Uses and Disclosures Without Consent or Authorization

I may use or disclose PHI without your consent or authorization in limited circumstances permitted or required by law, including:

• Abuse or neglect — reporting suspected abuse, neglect, or exploitation of a child, elderly person, or person with a disability to the appropriate authorities.
• Health oversight — disclosures to the Texas Behavioral Health Executive Council or another oversight body, such as in an investigation arising from a complaint.
• Judicial or administrative proceedings — disclosures pursuant to a valid court order or other lawful process. I will not release information without your written authorization or a binding order from a court of competent jurisdiction.
• Serious threat to health or safety — disclosure to prevent or lessen a serious and imminent threat to you or to an identifiable person, including notifying the potential victim and law enforcement. I disclose only the minimum necessary.
• Workers’ compensation, as authorized by law.
• Specialized government functions, such as certain military, national security, or correctional situations.
• Other disclosures required by law.

Your Rights

• Right to request restrictions — you may request limits on certain uses and disclosures. I am not always required to agree, but I will honor a request to restrict disclosure to a health plan for an item or service that you paid for in full, out of pocket.
• Right to confidential communications — you may ask to be contacted by alternative means or at an alternative location.
• Right to inspect and copy — you may inspect or obtain a copy of your records, including in an electronic format where readily producible. Records maintained in my electronic record system will be provided within 15 business days of a written request. Full instructions are on the Consumer Notice page. Access may be limited in certain circumstances, with a right to request review.
• Right to amend — you may request in writing that I amend your health information. If the request is denied, you will receive a written explanation and may submit a statement of disagreement.
• Right to an accounting of disclosures — you may request a list of certain disclosures made in the six years before your request, excluding disclosures for treatment, payment, operations, those you authorized, and certain others. I will respond within 60 days. More than one request in a 12-month period may incur a reasonable fee.
• Right to be notified of a breach — you have the right to be notified following a breach of your unsecured protected health information.
• Right to a paper copy — you may request a paper copy of this Notice at any time.

Changes to This Notice

I may change my privacy practices and the terms of this Notice at any time, as permitted by law, and make the changes effective for all health information I maintain. The current Notice will always be available on this page and provided upon request.

Questions and Complaints

For questions about this Notice or my privacy practices, contact Nathaniel D. Smith at [email protected] or (214) 205-0237.

If you believe your privacy rights have been violated, you may file a complaint with me or with any of the following. You will not be retaliated against for filing a complaint.

Acknowledgment

Clients acknowledge receipt of this Notice as part of the intake packet completed before the first session. Posting this Notice online does not replace that acknowledgment. You may request a paper copy at any time.