The Red JayCounseling & Guidance

Notice of Privacy Practices

Ida Villavicencio wants to ensure you are informed about the processes involved in accessing your medical and mental health information and in filing a complaint.

THIS NOTICE DESCRIBES HOW MEDICAL AND MENTAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. IT ALSO REVIEWS YOUR RIGHT AS A CLIENT TO FILE A COMPLAINT. PLEASE REVIEW THIS DOCUMENT CAREFULLY.

Uses and disclosures for treatment, payment, and health care operations

I may use or disclose your Protected Health Information (PHI) for treatment, payment, and health care operations purposes with your consent. To help clarify these terms:

  • PHI refers to information in your health record that could identify you.
  • Treatment is when I provide, coordinate, or manage your health care and other related services. An example is when I consult with another health care provider, such as your family physician or psychiatrist.
  • Payment is when I obtain reimbursement for your health care, for example by disclosing your PHI to your health insurer to obtain reimbursement or to determine eligibility or coverage.
  • Health Care Operations are activities that relate to the performance and operation of this practice, such as quality assessment and improvement, business matters like audits and administrative services, and case management and care coordination.
  • Use applies to activities within this practice, such as sharing, employing, applying, examining, and analyzing information that identifies you.
  • Disclosure applies to activities outside this practice, such as releasing, transferring, or providing access to information about you to other parties.

Uses and disclosures requiring authorization

I may use or disclose PHI for purposes outside of treatment, payment, and health care operations only when your appropriate authorization is obtained. An authorization is written permission, above and beyond general consent, that permits only specific disclosures. When I am asked for information for purposes outside of treatment, payment, and health care operations, I will obtain an authorization from you before releasing it. I will also obtain an authorization before releasing your psychotherapy notes. Psychotherapy notes are notes I have made about conversations during a private, group, joint, or family counseling session, kept separate from the rest of your medical record and given a greater degree of protection than PHI. You may revoke any such authorization at any time, provided the revocation is in writing. You may not revoke an authorization to the extent that (1) I have relied on it, or (2) it was obtained as a condition of obtaining insurance coverage and the law provides the insurer the right to contest the claim under the policy.

Uses and disclosures with neither consent nor authorization

I may use or disclose PHI without your consent or authorization in the following circumstances:

  • Child Abuse: If I have cause to believe that a child has been, or may be, abused, neglected, or sexually abused, I must make a report within 48 hours to the Texas Department of Family and Protective Services or to any local or state law enforcement agency.
  • Adult and Domestic Abuse: If I have cause to believe that an elderly or disabled person is in a state of abuse, neglect, or exploitation, I must immediately report it to the Texas Department of Family and Protective Services.
  • Health Oversight: If a complaint is filed against me with the Texas Behavioral Health Executive Council, it has the authority to subpoena confidential mental health information relevant to that complaint.
  • Judicial or Administrative Proceedings: If you are involved in a court proceeding and a request is made for information about your diagnosis and treatment, that information is privileged under state law, and I will not release it without written authorization from you or your legally appointed representative, or a court order. The privilege does not apply when you are being evaluated for a third party or where the evaluation is court ordered. You will be informed in advance if this is the case.
  • Serious Threat to Health or Safety: If I determine there is a probability of imminent physical injury by you to yourself or others, or a probability of immediate mental or emotional injury to you, I may disclose relevant confidential mental health information to medical or law enforcement personnel.
  • Worker’s Compensation: If you file a worker’s compensation claim, I may disclose records relating to your diagnosis and treatment to your employer’s insurance carrier.

Your rights

  • Right to Request Restrictions: You have the right to request restrictions on certain uses and disclosures of PHI about you. However, I am not required to agree to a restriction you request.
  • Right to Receive Confidential Communications by Alternative Means and at Alternative Locations: You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations. For example, upon your request I will send information to another address.
  • Right to Inspect and Copy: Except in unusual circumstances that involve danger to yourself or others, you may examine and receive a copy of your Clinical Record if you request it in writing. Pursuant to Texas law, psychological test data are not part of a patient’s record. Because these are professional records that can be misinterpreted by untrained readers, I recommend you initially review them in my presence or have them forwarded to another mental health professional. In most circumstances I am allowed to charge a copying fee. If I refuse your request for access, you have a right of review, which I will discuss with you upon request.
  • Right to Amend: You have the right to request an amendment of PHI for as long as it is maintained in the record. I may deny your request, and I will discuss the details of the amendment process with you upon request.
  • Right to an Accounting: You generally have the right to receive an accounting of disclosures of PHI for which you have neither provided consent nor authorization. I will discuss the details of the accounting process with you upon request.
  • Right to a Paper Copy: You have the right to obtain a paper copy of this notice from me upon request, even if you have agreed to receive it electronically.

My duties

  • I am required by law to maintain the privacy of PHI and to provide you with a notice of my legal duties and privacy practices with respect to PHI.
  • I reserve the right to change the privacy policies and practices described in this notice. Unless I notify you of such changes, I am required to abide by the terms currently in effect.
  • If I revise my policies and procedures, I will provide you a revised copy at your next visit or by mail.

Questions and complaints

If you are concerned that your privacy rights have been violated, or you disagree with a decision made about access to your records, please discuss these concerns with me. You may also send a written complaint to the Texas Behavioral Health Executive Council at 333 Guadalupe St, Ste. 3-900, Austin, Texas 78701, or by calling (512) 305-7700.

The BHEC discipline and complaints page at bhec.texas.gov/discipline-and-complaints contains links to complaint and general release forms and the instructions to complete them. You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services.

Effective date and changes to this notice

I reserve the right to change the terms of this notice and to make the new provisions effective for all PHI that is maintained. If this policy changes, you will be notified of a revised notice at your next visit or by mail or email.