NOTICE OF PRIVACY PRACTICES

Effective Date: August 25, 2021

Ashley D. Harris, LPC
Texas License No. 88778
Immigration Evaluation Center
118 Vintage Park Blvd, Ste W700
Houston, TX 77070
Phone: 1-844-766-8638
Secure Fax: 325-244-5881
Secure Email: info@immigrationevaluationcenter.com

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. PLEASE REVIEW IT CAREFULLY.

YOUR RIGHTS

You have the right to inspect or receive a copy of your record and other health information we maintain about you. Requests must be submitted in writing. We generally provide records within the time required by law and may charge a reasonable, cost-based fee as permitted.

You have the right to request a correction or amendment to your record if you believe information is incorrect or incomplete. If we deny your request, we will provide a written explanation and let you know how you may submit a statement of disagreement.

You have the right to request confidential communications. You may ask us to contact you in a specific way or at a specific location, and we will honor reasonable requests.

You have the right to request restrictions on certain uses or disclosures of your protected health information. We are not required to agree to every request, but we will consider each request carefully.

You have the right to request an accounting of certain disclosures of your protected health information made during the six years prior to your request, except for disclosures not required to be included by law.

You have the right to receive a paper copy of this Notice at any time, even if you agreed to receive it electronically.

You have the right to choose someone to act for you. If a person has legal authority to act on your behalf, that person may exercise your rights and make choices about your health information, subject to applicable law.

You have the right to file a complaint if you believe your privacy rights have been violated. We will not retaliate against you for filing a complaint.

YOUR CHOICES

You may tell us your preferences regarding sharing information with family members, attorneys, interpreters, translators, or others involved in your care, case, or payment. When permitted by law, we will follow your written instructions.

We will not use or disclose your information for marketing purposes, will not sell your information, and will not share most psychotherapy notes unless you give us written authorization, except where disclosure is permitted or required by law.

HOW WE MAY USE AND DISCLOSE YOUR INFORMATION

For Treatment
We may use and disclose your protected health information to provide services, coordinate care, consult with other professionals, and manage your treatment-related needs.

For Payment
We may use and disclose your protected health information to bill and collect payment, process transactions, issue invoices or receipts, provide superbills when requested, and manage payment-related matters.

For Health Care Operations
We may use and disclose your protected health information to run our practice, improve services, maintain records, conduct quality review, train staff, comply with legal and regulatory requirements, and contact you regarding services or administrative matters.

OTHER USES AND DISCLOSURES PERMITTED OR REQUIRED BY LAW

We may use or disclose your information when required or permitted by law, including for public health activities, health oversight activities, certain law enforcement requests, court orders, lawful subpoenas, administrative proceedings, workers’ compensation matters, reporting suspected abuse or neglect, preventing or reducing a serious threat to health or safety, and other uses authorized by federal or Texas law.

Texas law provides additional confidentiality protections for mental health records. Mental health records and communications are confidential except as permitted or required by law.

REPRODUCTIVE HEALTH PRIVACY

We do not use or disclose protected health information for the purpose of investigating or imposing liability on any person for seeking, obtaining, providing, or facilitating lawful reproductive health care, where prohibited by law. When required, we will obtain the appropriate attestation before making certain disclosures related to reproductive health information.

SECURE TEXT, EMAIL, AND FAX

We use secure, BAA-backed, HIPAA-conscious text, email, and fax systems for scheduling, billing, forms, records exchange, and limited care coordination. These channels are not monitored 24/7 and should not be used for emergencies or urgent mental health needs. If you choose to communicate electronically, we will use reasonable safeguards to protect your information.

OUR RESPONSIBILITIES

We are required by law to maintain the privacy and security of your protected health information.

We are required to provide you with this Notice of Privacy Practices.

We are required to follow the duties and privacy practices described in this notice.

We will notify you promptly if a breach occurs that may have compromised the privacy or security of your information.

We will not use or disclose your information other than as described in this notice unless you authorize us to do so in writing. You may revoke an authorization in writing at any time, except to the extent we have already acted in reliance on it.

CHANGES TO THIS NOTICE

We reserve the right to change this Notice of Privacy Practices at any time. Any changes will apply to all protected health information we maintain. The current version of this notice will always be available on our website and upon request.

RECORDS REQUESTS

To request records, please submit a signed written request by secure email, secure fax, or mail. Include the client’s full name, date of birth, the records requested, where the records should be sent, and the requester’s signature.

PRIVACY CONTACT

If you have questions about this notice, want to exercise your rights, or want to file a privacy complaint with this practice, contact:

Ashley D. Harris, LPC
Texas License No. 88778
The Ash Tree, LLC dba Immigration Evaluation Center
118 Vintage Park Blvd, Ste W700
Houston, TX 77070
Phone: 1-844-766-8638
Secure Fax: 325-244-5881
Secure Email: info@immigrationevaluationcenter.com

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. You will not be retaliated against for filing a complaint.