Privacy

• Your health information is used to provide your care, to bill for it, and to operate the practice.
• Nearly every other use requires your written permission, which you may withdraw at any time.
• Psychotherapy notes, marketing, and any sale of your information always require written permission.
• Records relating to substance use treatment carry additional protection, including protection from being used against you in a legal proceeding.
• You have the right to review your record, obtain a copy, request corrections, request confidential communication, request limits on sharing, and receive a list of certain disclosures.
• If you pay for a service in full yourself, you may direct us not to share information about that service with your health plan.
• Your information is maintained electronically and may be disclosed electronically.
• Questions and complaints go to the Privacy Officer, using the contact information at the end of this notice. Raising a concern will not affect your care.

How we use and share your information without asking you first

To treat you

We use your information to provide your care and to coordinate it with others involved in it. For example, we may send a prescription to your pharmacy, order lab work, share information with your therapist or primary care physician, or send records to a hospital or emergency department treating you.

To be paid for your care

We use your information to bill your insurance company and to be paid for your care. This usually includes your diagnosis, the type and length of the visit, and the services provided. If your plan requires approval before a treatment such as TMS or Spravato, we share what the plan needs to make its decision.

To operate the practice

We use your information for the ordinary work of running a practice — scheduling, quality review, staff and vendor management, and business planning.

Sharing we may do in limited situations without your permission

The law allows or requires us to share information in specific circumstances. The ones most likely to arise are:

• When there is a serious and immediate threat to your safety or to someone else's.
• When we are required to report suspected abuse, neglect, or exploitation of a child, an elderly person, or a person with a disability.
• For public health purposes, such as reporting a communicable disease or a problem with a medication.
• In response to a court order, subpoena, or other legal process that meets the requirements of the law.
• To law enforcement, in the narrow circumstances the law allows.
• To agencies that oversee the health care system, such as licensing boards and auditors.
• For workers' compensation claims.
• To medical examiners, coroners, and funeral directors after a death.
• For specialized government functions, such as military or national security purposes.

Sharing that always requires your written permission

We will not use or share your information for any of the following without your signed authorization:

• Psychotherapy notes, which are the private notes a clinician keeps about a counseling session and are held separately from the rest of your record.
• Marketing.
• Any sale of your information.
• Any other purpose not described in this notice.

You may withdraw your permission at any time by notifying us in writing. Withdrawing it stops future sharing, but it cannot undo sharing that has already occurred.

Records related to substance use treatment

If your care with us includes treatment for a substance use disorder, those records carry protections beyond the ones described above.

• They cannot be used against you in a civil, criminal, administrative, or legislative proceeding unless you give written consent or a court orders it.
• When we release them, we notify whoever receives them that they may not pass them along further without your permission.
• Anyone who receives them is bound by those same limits.

Mental health records

Texas law generally requires your signed consent before we release mental health records, including to family members, employers, and schools. We apply that standard to all of your records.

Your rights

Review your record and obtain a copy

You may ask to review your record or obtain a copy, on paper or electronically. Ask in writing and we will normally respond within 15 business days. In limited situations we may decline part of a request; if we do, we will tell you why in writing.

Request a correction

If you believe something in your record is inaccurate or incomplete, you may ask us in writing to correct it.

If we disagree, we will tell you why, and you may add a written statement of your own to the record.

Request confidential communication

You may ask us to reach you a particular way or at a particular place — a specific phone number, no voicemail, mail to an address other than your home. We will accommodate reasonable requests and will not ask you why.

Request limits on what we share

You may ask us not to share certain information for treatment, payment, or practice operations. We are not required to agree, with one exception: if you pay for a service in full yourself, you may direct us not to share information about that service with your health plan, and we will honor that.

Receive a list of disclosures

You may request a list of certain times we shared your information during the previous six years. The list does not include sharing for treatment, payment, practice operations, or sharing you authorized. The first list in a twelve-month period is provided at no charge.

Receive a paper copy of this notice

You may request a paper copy at any time, including if you agreed to receive it electronically. It is also available through your patient portal at lakeridge.intakeq.com.

Name someone to act for you

If you have given someone medical power of attorney, or a court has appointed a guardian, that person may exercise these rights on your behalf. We will ask for documentation.

Be notified of a breach

If your unsecured information is ever breached, we will notify you.

Electronic sharing of your information

Your health information is kept in an electronic record and may be shared electronically — with your pharmacy, your health plan, laboratories, and other clinicians involved in your care. This notice serves as your notification that your information is subject to electronic disclosure.

Our responsibilities

• We are required by law to protect the privacy of your health information.
• We must follow the terms of this notice while it is in effect.
• We must notify you if a breach affects your information.
• We will not use or share your information other than as described here without your written permission.

Changes to this notice

We may change this notice, and the changes will apply to information we already hold as well as to information we receive afterward. The current version is always available at the office, through your patient portal, and on our website.

Questions and complaints

If you have a question about this notice, or you believe your privacy rights have been violated, contact the Privacy Officer:

Privacy Officer, Lakeridge Psychiatry PLLC, 669 Airport Freeway, Suite 401, Hurst, TX 76053, 972-332-5922 · info@lakeridgepsychiatry.com

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you for filing a complaint with us or with them, and doing so will not affect your care.