Notice of Privacy Practices

Effective date: To be established before clinical services begin

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

About This Notice
This notice describes the privacy practices that will apply to protected health information maintained by Ivory Oak Counseling & Wellness when clinical services begin.
We are committed to protecting confidential information and complying with applicable federal and Texas privacy requirements.

How Your Health Information May Be Used or Disclosed
Treatment: We may use or disclose health information to provide counseling, coordinate care, obtain appropriate clinical consultation, and participate in required professional supervision.
Payment: We may use or disclose information to collect payment, maintain financial records, and carry out authorized payment-related activities. As a private-pay practice, we may also provide documentation requested by clients for possible out-of-network reimbursement when appropriate.
Healthcare operations: We may use information for activities necessary to operate the practice, improve service quality, fulfill professional obligations, maintain records, and support appropriate supervision.
People involved in your care: When permitted by law, we may share relevant information with people involved in your care or payment after considering your preferences and the applicable confidentiality requirements.
Service providers: We may work with vendors that provide electronic records, secure communications, telehealth, billing, and other administrative services. When required, these providers must have appropriate agreements to protect health information.

Other Uses and Disclosures Allowed or Required by Law
Subject to applicable legal requirements, information may be disclosed for purposes including:
Reporting or responding to suspected abuse, neglect, or exploitation
Addressing a serious and imminent threat to health or safety
Public health and health oversight activities
Compliance with legally sufficient court orders, subpoenas, or other legal processes
Specific law enforcement or government activities
Workers' compensation matters
Research conducted under applicable privacy protections
Activities involving coroners, medical examiners, or funeral directors
Texas law and other federal privacy laws may provide additional protections for certain mental health information.

Psychotherapy Notes and Other Information Requiring Authorization
Certain uses or disclosures require your written authorization, including most disclosures of separately maintained psychotherapy notes, marketing uses for which authorization is required, and sales of protected health information.
Ivory Oak Counseling & Wellness does not intend to sell protected health information.
You may revoke an authorization in writing, subject to actions already taken in reliance on it.

Substance Use Disorder Records
Some substance use disorder treatment records receive special confidentiality protections under 42 CFR Part 2.
When Ivory Oak Counseling & Wellness receives or maintains records subject to those requirements, applicable restrictions will be honored. In particular, protected Part 2 records generally may not be used or disclosed in civil, criminal, administrative, or legislative proceedings against a patient without the required patient consent or appropriate legal authorization, including a court order and subpoena where required.
Other rights, restrictions, and notices concerning these records will be applied as required by law.

Your Privacy Rights
Subject to applicable legal requirements, you have the right to:
Access your records: Request access to or copies of your electronic or paper health information. We will generally respond within 30 days, subject to permitted limitations and fees.
Request corrections: Ask us to amend information you believe is inaccurate or incomplete. If we deny a request, we will explain the decision and applicable rights.
Request confidential communications: Ask us to contact you in a particular manner or at a particular location. We will accommodate reasonable requests.
Request restrictions: Ask us to limit particular uses or disclosures. While some restrictions are discretionary, qualifying requests to restrict disclosure to a health plan for fully self-paid services must be honored unless disclosure is required by law.
Receive an accounting of disclosures: Request information about certain disclosures made during the preceding six years, subject to statutory exclusions.
Obtain a copy of this notice: Request a paper or electronic copy.
Use a personal representative: Have a legally authorized person exercise applicable rights on your behalf, subject to appropriate verification and limitations under law.
File a complaint: Raise privacy concerns with the practice or the U.S. Department of Health and Human Services. You will not face retaliation for filing a complaint.

Our Responsibilities
We are responsible for maintaining the privacy and security of protected health information, complying with applicable privacy laws, and providing notification following a breach of unsecured health information when required.
We must follow the notice currently in effect. If material changes are made, an updated notice will be made available in accordance with applicable law.

Minors and Personal Representatives
Privacy and access rights involving adolescents, parents, guardians, and other personal representatives will be handled according to applicable Texas and federal law. The extent of parental access may vary depending on the circumstances and legal basis for the services.

Questions, Requests, and Complaints
Privacy Contact: Ivory Oak Counseling & Wellness
Email: info@ivoryoakcounseling.com
Phone: (832) 510-7866
To file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights, visit:
https://www.hhs.gov/hipaa/filing-a-complaint/index.html
You may also call 1-877-696-6775.
We will not retaliate against you for exercising your privacy rights or filing a complaint.

Updates to This Notice
This notice may be revised as necessary to comply with changes in law or practice operations. Its effective date will be displayed at the top of the final version.

Implementation note: Before use, confirm the final practice legal identity, privacy contact, clinical systems, protected-record categories, vendor agreements, required Texas-specific protections, and effective date. Compare this draft section by section against the current HHS model notice.