HIPAA Notice of Privacy Practices

Kwik Psych Clinics PLLC (DBA KwikPsych)

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

This Notice applies to Kwik Psych Clinics PLLC, including all of our clinicians, staff, contractors, and locations, and our telehealth services for patients in Texas and California.

Our Responsibilities

We are required by federal law (HIPAA) to:

• Protect the privacy and security of your protected health information (“PHI”).
• Give you this Notice describing our privacy practices and your rights.
• Follow the terms of the Notice that is currently in effect.
• Notify you if a breach occurs that may have compromised the privacy or security of your PHI.
• Comply with any stricter privacy protections required by applicable state or federal laws.

We may change our privacy practices and this Notice at any time, as allowed by law. If we do, the new Notice will apply to all PHI we maintain, including information created before the change. See “Changes to This Notice” below for how we will tell you about updates.

How We May Use and Disclose Your Information

When the law allows it, we may use and share your PHI without your written authorization for the purposes below. When state or other laws are more protective than HIPAA, we follow the stricter rules.

1. Treatment

We can use and share your PHI to provide, coordinate, or manage your mental health and medical care.

Examples (not a complete list):

• Sharing information with your other health or mental health providers (such as your primary care doctor, therapist, psychiatrist, or crisis team) to coordinate care.
• Consulting with other professionals about your diagnosis or treatment plan.
• Contacting you about appointments, test results, treatment options, or care coordination through phone, secure messaging, telehealth platforms, or mail.

2. Payment

We can use and disclose your PHI to obtain payment for services.

Examples:

• Sending information to your health plan to verify benefits, obtain prior authorization, or submit claims.
• Sharing necessary information with billing services or collection agencies as allowed by law.
• Confirming services and dates of service with your insurer.

If you pay out of pocket in full for a service, you may ask us not to share that information with your health plan for payment or health care operations. We will honor that request unless a law requires us to share it.

3. Health Care Operations

We may use and share PHI as needed to run our practice and improve our services.

Examples:

• Quality improvement, case reviews, supervision, and training.
• Credentialing and evaluating the performance of our staff and providers.
• Internal audits, compliance activities, and legal or accounting services.
• Customer service, responding to your concerns, and managing our telehealth systems.

4. People Involved in Your Care or Payment

With your verbal permission (or when the law otherwise allows), we may share limited information with a family member, partner, friend, or other person involved in your care or helping pay for your care.

If you are unable to agree or object (for example, in a medical or mental health emergency), we may share information if, in our professional judgment, it is in your best interest, consistent with HIPAA and applicable state law.

5. As Required or Allowed by Law (Without Your Authorization)

We may use or disclose your PHI without your written authorization in the situations below, but only if the legal requirements are met.

Public health and safety

1. Reporting certain communicable diseases to public health authorities.
2. Reporting suspected abuse, neglect, or domestic violence, as required or allowed by law.
3. Reporting certain adverse events (for example, serious reactions to medications).

Serious threats to health or safety

We may share information to help prevent or lessen a serious and imminent threat to you or others, consistent with applicable law and professional duties.

Health oversight activities

We may disclose PHI to government agencies that oversee the health care system or ensure compliance with health laws, such as licensing boards or the U.S. Department of Health and Human Services.

Legal and law enforcement purposes

We may disclose PHI in response to a court or administrative order, subpoena, or other lawful process, and in limited circumstances to law enforcement (for example, to locate a missing person, comply with certain reporting laws, or respond to a crime on our premises).

Coroners, medical examiners, and funeral directors

We may share PHI with these professionals as needed to carry out their duties.

Workers’ compensation and similar programs

We may share PHI related to work-related injuries or illness as required by workers’ compensation or similar laws.

Special government functions

In limited circumstances, we may disclose PHI for specialized government functions such as military or national security activities, as permitted by law.

Other uses and disclosures required or expressly allowed by HIPAA

HIPAA and other laws identify additional situations where PHI may be used or disclosed without your authorization; if those apply, we will follow the law and limit the information shared to what is necessary.

Uses and Disclosures That Require Your Written Authorization

Some uses and disclosures of your PHI will only happen if you sign a written authorization form. You may revoke (cancel) that authorization at any time in writing, except to the extent we have already relied on it.

We will obtain your written authorization for:

• Psychotherapy notes — If your therapist keeps separate psychotherapy notes (detailed notes kept apart from your regular medical record), we will not use or disclose those notes without your written authorization, except in very limited situations allowed by law (such as to defend against a legal claim).
• Most marketing uses of PHI — We will ask your permission before using your information for marketing communications that are not simply about your own treatment, care coordination, or our services.
• Sale of PHI — We do not sell your PHI. If that ever changes, we would do so only as allowed by law and only with your written authorization.
• Certain sensitive information — Some categories of information (for example, certain substance use disorder treatment records under 42 CFR Part 2, HIV test results, and some reproductive health or minor-consented services) may require your written permission for most disclosures, or may be subject to stricter state or federal rules.

Any other use or disclosure of your PHI not described in this Notice will be made only with your written authorization or as otherwise permitted or required by law.

Your Rights

HIPAA gives you several important rights with respect to your PHI. These are only summaries; we can provide more details upon request.

1. Right to a Copy of This Notice

You can ask for a paper copy of this Notice at any time, even if you agreed to receive it electronically. We will provide a paper copy promptly.

2. Right to See and Get a Copy of Your Records

You can ask to see or obtain a copy of your PHI in paper or electronic form.

• We will provide a copy or summary of your information, generally within 30 calendar days of your request, as required by HIPAA. If we need additional time, we may extend once for up to 30 additional calendar days, but we will notify you in writing within the initial 30-day period.
• We may charge a reasonable, cost-based fee as allowed by law.

In rare cases, we may deny your request (for example, if we believe access would seriously endanger you or someone else). If we deny your request, we will tell you why in writing and let you know if you can request a review of that decision.

3. Right to Request a Correction (Amendment)

If you believe your information is incorrect or incomplete, you can ask us in writing to correct it.

• We may say “no” if we did not create the information, if it is already accurate and complete, or for other reasons allowed by law.
• If we deny your request, we will explain why in writing and let you add a written statement of disagreement to your record.

4. Right to Request Restrictions

You can ask us not to use or share certain information for treatment, payment, or health care operations.

• We do not have to agree to your request, and may say “no” if it would affect your care or we are legally required to use or share the information.
• However, if you pay in full out-of-pocket for a specific service and ask us not to share that information with your health plan for payment or operations, we generally must agree unless a law requires disclosure.

5. Right to Request Confidential Communications

You can ask us to contact you in a specific way (for example, only on your mobile phone, only through our patient portal, or at a different mailing address).

• We will honor all reasonable requests and may ask you how you would like us to communicate securely for telehealth and electronic communications.

6. Right to a List of Certain Disclosures (Accounting of Disclosures)

You can ask for a list (“accounting”) of certain disclosures of your PHI made in the last six years before your request, excluding disclosures for treatment, payment, and health care operations and some other routine disclosures.

• We will provide one list per 12-month period at no cost; we may charge a reasonable fee for additional lists.

7. Right to Choose Someone to Act for You

If you have given someone medical power of attorney, or someone is your legally authorized representative or guardian, that person can exercise your rights and make choices about your PHI, to the extent allowed by law. We will confirm their authority before we take any action.

8. Rights Related to Minors (Ages 14–17)

Because we see patients ages 14 and older, special rules sometimes apply:

• In general, a parent or legal guardian is the “personal representative” and may access a minor’s record.
• However, Texas and California law may allow minors to consent to certain services on their own (for example, some mental health, or substance use related services) and to limit what can be shared with parents/guardians. When these laws apply, we follow them.
• We will explain how this works if it affects your care.

9. Right to Breach Notification

You have the right to be notified if we (or one of our business associates) discover a breach of your unsecured PHI, as defined by HIPAA.

10. Right to File a Complaint

If you believe your privacy rights have been violated, you can:

Complain to KwikPsych:

• Contact: Privacy Officer
• Title: Medical Director
• Phone: 737-367-1230
• Email: info@kwikpsych.com
• Mailing Address: 12335 Hymeadow Dr, Ste 450, Austin, TX, 78750-1952

You may also file a complaint directly with the U.S. Department of Health and Human Services, Office for Civil Rights (OCR), through the OCR Complaint Portal or by following OCR’s complaint instructions.

• Online: OCR Complaint Portal
• Email: ocrprivacy@hhs.gov
• Phone: (800) 368-1019 (TDD: (800) 537-7697)

We will not treat you differently or reduce your quality of care because you file a complaint.

Your Choices

In some situations, you have additional choice in how we use and share your information. If you have a clear preference, tell us, and we will follow your instructions to the extent allowed by law.

You may tell us yes or no about:

• Sharing information with your family, partner, or close friends involved in your care.
• Sharing information in an emergency or disaster-type situation.
• Leaving messages with limited information (for example, that we called, or appointment reminders) at specific numbers or with specific people.

We do not:

• Use your PHI for fundraising.
• Sell your PHI.
• Use psychotherapy notes for purposes other than your treatment, our training/supervision, or as otherwise allowed by law.

If we ever want to use your information for reasons that require your written authorization, we will ask you first.

Additional Protections for Certain Types of Information

Some kinds of information receive extra protection under federal or state law, such as:

• Certain substance use disorder treatment records (for example, records from a federal “Part 2 program”).
• Some services minors can consent to on their own.

When these laws apply, we follow them and may need your written consent before sharing that information, except when the law specifically allows disclosure.

Telehealth and Electronic Communications

Because KwikPsych is also a telehealth practice:

• We use secure platforms for video visits and electronic messaging consistent with HIPAA and other applicable laws.
• We will discuss with you which communication methods (portal messaging, phone, email, text) are available and how to use them safely.
• Email and text may not be fully secure. We will ask for your preferences and your consent before using less secure methods for PHI when required by law or best practices.

Changes to This Notice

We may change this Notice and our privacy practices at any time, as allowed by law. When we make material changes, we will update the “Effective Date” at the top of this Notice.

The updated Notice will be posted on our website at kwikpsych.com and will be available in our offices or by request (paper or electronic copy).