NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
I. MY PLEDGE REGARDING HEALTH INFORMATION
I understand that health information about you and your care is personal. I am committed to protecting health information about you. I create a record of the care and services you receive in this practice. I need this record to provide you with quality care and to comply with legal requirements. This notice applies to all records generated by this clinical psychology practice.
This notice tells you about the ways I may use and disclose your protected health information ("PHI"). It also describes your rights regarding the PHI I maintain and my legal obligations. I am required by law to:
* Ensure that PHI that identifies you is kept private.
* Give you this notice of my legal duties and privacy practices with respect to PHI.
* Notify you promptly following a breach of your unsecured PHI in accordance with federal law and Texas Health & Safety Code § 181.202.
* Follow the terms of the Notice currently in effect.
Electronic Disclosure Notice: Pursuant to Texas Health & Safety Code Chapter 181, please be aware that your health information may be created, stored, or transmitted electronically.
I reserve the right to change the terms of this Notice. Any revised Notice will apply to all PHI I maintain. Revised notices will be posted in my office, available on my website, and provided upon request.
II. HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
Federal and state laws allow me to use and disclose your PHI without your written authorization for Treatment, Payment, and Health Care Operations:
* For Treatment: I may use your PHI to provide, coordinate, or manage your health care treatment and related services. For example, I may consult with another licensed health care provider or physician regarding your care. Treatment disclosures are not subject to the "minimum necessary" restriction.
* For Payment: I may use and disclose your PHI to bill and collect payment for the services provided to you (e.g., submitting claims to health insurance or processing payments).
* For Health Care Operations: I may use or disclose PHI to operate my practice, review treatment quality, manage clinical audits, or perform administrative functions.
Lawsuits and Disputes: If you are involved in a lawsuit or dispute, I may disclose PHI in response to a court or administrative order. I may also disclose PHI in response to a subpoena or discovery request only if specific legal requirements are met, such as receiving a valid written authorization, a court order, or formal legal assurances that steps have been taken to protect the information requested.
III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR WRITTEN AUTHORIZATION
Any disclosure not covered by this notice or state/federal law will be made only with your explicit written authorization. You have the right to revoke any written authorization at any time in writing, except to the extent that action has already been taken in reliance on it.
1. Psychotherapy Notes: "Psychotherapy notes" (as defined in 45 CFR § 164.501) are kept separate from the rest of your clinical record. Any use or disclosure of psychotherapy notes requires your explicit written authorization unless used for:
a. Treatment by the originator of the notes.
b. Training programs in which students/trainees learn under supervision.
c. Defending myself in a legal proceeding or administrative complaint instituted by you.
d. Investigations by the Secretary of Health and Human Services (HHS).
e. Requirements imposed by law or legal oversight related to the originator.
f. Duties performed by a coroner or medical examiner.
g. Averting a serious, imminent threat to health or safety (reported to law enforcement or medical personnel in accordance with Texas law).
2. Marketing: I will not use or disclose your PHI for marketing purposes without your written authorization.
3. Sale of PHI: I will not sell your PHI without your written authorization.
IV. CERTAIN USES AND DISCLOSURES WITHOUT AUTHORIZATION OR OPPORTUNITY TO OBJECT
Subject to applicable federal and Texas state laws, I may use or disclose your PHI without your authorization in the following circumstances:
1. When required by federal, state, or local law.
2. For public health activities, including mandatory reporting of suspected abuse, neglect, or exploitation of a child, an elderly person, or a person with a disability under Texas law.
3. For health oversight activities such as audits, licensing reviews, board inquiries, or disciplinary investigations by the Texas Behavioral Health Executive Council (BHEC).
4. For judicial and administrative proceedings, subject to strict legal protections under Texas Rule of Evidence 510.
5. For law enforcement purposes, such as reporting a crime committed on practice premises or a threat of violence.
6. To coroners or medical examiners performing authorized duties.
7. For research purposes, subject to institutional review board (IRB) approval and strict privacy standards.
8. Specialized government functions, such as military assessments, national security, or presidential protective services.
9. For Workers' Compensation compliance as authorized by Texas state law.
10. Appointment reminders and health-related communication: I may contact you via phone, email, or text to confirm appointments or send secure notifications as permitted.
V. USES AND DISCLOSURES REQUIRING AN OPPORTUNITY TO OBJECT
Disclosures to Family, Friends, or Others: I may share relevant PHI with a family member, close friend, or other person explicitly identified by you as involved in your care or payment for care, unless you object. In emergency situations or instances where you are unable to object, I will exercise professional judgment in your best interest.
VI. YOUR RIGHTS REGARDING YOUR PHI
1. Right to Request Restrictions: You have the right to request restrictions on how I use or disclose your PHI for treatment, payment, or health care operations. I am not required to agree to your request, except as noted below.
2. Right to Restrict Disclosures for Out-of-Pocket Payments: You have the right to restrict disclosures of PHI to a health plan if the PHI pertains solely to a health care item or service for which you (or someone on your behalf) have paid out-of-pocket in full. I must agree to this request.
3. Right to Request Confidential Communications: You have the right to ask that I communicate with you in a specific way or at a specific location (e.g., via a specific phone number or mailing address). I will accommodate reasonable requests.
4. Right to Inspect and Copy Your Records: You have the right to inspect and obtain a paper or electronic copy of your clinical record (excluding psychotherapy notes). Pursuant to Texas law, I will provide access or copies within 15 business days of receiving your written request. A reasonable, cost-based fee permitted by Texas law will apply.
5. Right to an Accounting of Disclosures: You have the right to request a list of disclosures made of your PHI for purposes other than treatment, payment, health care operations, or those authorized by you. The accounting covers up to six years prior to the request date.
6. Right to Amend Your Record: If you feel PHI in your record is incorrect or incomplete, you may submit a written request to amend it. I may deny your request under certain circumstances, but will provide a written explanation within 60 days.
7. Right to a Paper or Electronic Copy of This Notice: You have the right to receive a copy of this notice at any time upon request.
VII. QUESTIONS AND COMPLAINTS
If you believe your privacy rights have been violated, or if you have questions about this notice, please contact:
SPIRIS Group LLC
William D. Shepard, Ph.D.
10300 N. Central Expressway, Suite 325
Dallas, TX 75231-8657
(972) 392-9000
You may also file a formal complaint with the Secretary of the U.S. Department of Health and Human Services or the state regulatory body:
Office for Civil Rights
U.S. Department of Health and Human Services
1301 Young Street, Suite 1124
Dallas, TX 75202
(800) 368-1019TDD: (800) 537-7697
Texas Behavioral Health Executive Council (BHEC)
George H.W. Bush State Office Building
1801 Congress Ave., Suite 7.300
Austin, TX 78701
(512) 305-7700
*You will not be penalized or retaliated against for filing a complaint.*
TEXAS STATE LAW DISCLAIMER: Where Texas state law provides greater privacy protection than HIPAA, Texas state law will govern.
EFFECTIVE DATE OF THIS NOTICE:
This Notice is effective as of September 30, 2026.