Privacy Practices

By Design Behavioral Health, PLLC

5900 Balcones Drive, STE 25308

Austin, Texas 78731

(469) 807-8077

This notice describes how mental health information about you may be used and disclosed and how you may obtain access to this information. Please review it carefully.

By Design Behavioral Health, PLLC is a private practice. Individual therapy services are provided by a licensed mental health professional. All information describing your mental health treatment and related health care services (“mental health information”) is personal, and we are committed to protecting the privacy of the personal and mental health information you disclose to us. We are required by law to maintain the confidentiality of information that identifies you and the care you receive. When we disclose information to other persons and companies to perform services for us, we require them to protect your privacy, too. We must also provide certain protections for information related to your medical diagnosis and treatment, including HIV/AIDs, and information about alcohol and other substance abuse. We are required to give you this Notice about our privacy practices, your rights and our legal responsibilities. This notice is effective as of May 2, 2025.

WE MAY USE AND DISCLOSE YOUR MENTAL HEALTH INFORMATION

• For Treatment. For example, we may give information about your psychological condition or assessment to other health care providers, such as your family physician or another psychologist, to facilitate your treatment, referrals or consultations.

• For Payment. For example, a health care provider may contact your insurer to verify what benefits you are eligible for, to obtain prior authorization, and to receive payment from your insurance carrier.

• For Healthcare Operations. For example, we may give information to professional mental health and training organizations to review the quality of care provided, for performance improvement or for the training of health professionals. Other examples could include audits and administrative services, and case management and care coordination.

• For Appointments and Services to remind you of an appointment or tell you about treatment alternatives or health related benefits or services.

• To Individuals Involved in Your Care. For example, your conservator.

• With your written authorization we may use or disclose mental health information for purposes not described in this Notice.

WE MAY USE YOUR MENTAL HEALTH INFORMATION FOR OTHER PURPOSES WITHOUT YOUR WRITTEN AUTHORIZATION

There are certain circumstances when we are allowed to disclose medical information from your records without your permission. In some of these situations we must use our professional judgment before disclosing information. Generally, we must determine if the disclose is in your best interest. Although services for mental health and chemical dependency may be somewhat more protected than other health information, there are still circumstances when we may need to disclose your medical information.

• As Required by Law when required or authorized by other laws, such as the reporting of child abuse, elder abuse, disabled or dependent adult abuse.

• For health oversight activities to governmental, licensing, auditing, and accrediting agencies as authorized or required by law including audits; civil, administrative, or criminal investigations; licensure or disciplinary actions; and monitoring of compliance with law.

• In Judicial Proceedings in response to court/administrative orders, subpoenas, discovery requests, or other legal process. If By Design Behavioral Health, PLLC and/or your provider is subpoenaed to appear in court and provide testimony regarding our knowledge and experience of you and our assessment, we will assert privilege on your behalf. Nevertheless, if the judge insists we testify, we will testify truthfully and honestly to our thoughts and professional opinion.

• To Public Health Authorities to prevent or control communicable disease, injury, or disability, or ensure the safety of drugs and medical devices.

• To Law Enforcement. For example, to assist in an involuntary hospitalization process.

• For Research Purposes subject to a special review process, and the confidentiality requirements of state and federal law.

• To Prevent a Serious Threat to Health or Safety of an individual. We may notify the person, tell someone who could prevent the harm, or tell law enforcement officials.

• Organ Donation: If you are an organ donor, we may provide medical information to organizations that handle organs for organ eye, or tissue transplantation or to organ donation bank.

• Military: If you are a member of the armed forces or a veteran, we may release information about you as required.

• Workers Compensation: We may release medical information about you for Workers Compensation or similar programs.

• Medical Examiner or Coroner: We may disclose medical information to medical examiners or coroners as required to fulfill certain obligations.

• Funeral Directors: We may disclose medical information to funeral directors to allow them to carry out their duties upon your death.

• Specialized Government Functions: We may release medical information for national security and intelligence activities.

• Inmate: We may release medical information about you to a correctional facility or law enforcement official if you are an inmate of a correctional facility or under custody of a law enforcement official.

• To Supporting Vendors:  In the course of operating our mental health clinic we contract with various external vendors such as an accountant, information technology (IT), claims clearinghouse, and an electronic health record (EHR) vendor. In all these cases we have a HIPAA business associate contract in place with our vendors. This means they understand the federal HIPAA guidelines for confidentiality and agree to abide by those regulations set forth and maintain the same level of confidentiality that healthcare professionals are bound to in the event they should encounter patient information. Careful steps are taken with our accountant and IT vendor to ensure they rarely encounter any client information. Our claims clearinghouse and Electronic Health Record (EHR) is used to submit medical claims electronically and maintain patient records. In both cases, security and encryption is used to protect client information. Their systems are also electronically automated and vendor support rep’s are only accessed if a data input error occurred. Support staff of the claims clearinghouse and EHR vendor have restricted access and are not able to access patient narrative notes. Our EHR vendor, like most EHR vendors, does have authority to use de-identified patient information. They do this in compliance with HIPAA guidelines to ensure any data extracted for research purposes can in no way be identified to a client.

YOU HAVE THE FOLLOWING RIGHTS

• To Receive a Copy of this Notice when you obtain care.

• To Request Restrictions. You have the right to request a restriction or limitation on the mental health information we disclose about you for treatment, payment, or health care operations. You must put your request in writing. We are not required to agree with your request. If we do agree with the request, we will comply with your request except to the extent that disclosure has already occurred or if you are in need of emergency treatment and the information is needed to provide the emergency treatment.

• To Inspect and Request a Copy of your Mental Health Record, except in limited circumstances. A fee will be charged to copy your record. You must put your request for a copy of your records in writing. If you are denied access to your mental health record for certain reasons, we will tell you why and what your rights are to challenge that denial.

• To Request an Amendment and/or Addendum to your Mental Health Record. If you believe that information is incorrect or incomplete, you may ask us to amend the information or add an addendum (addition to the record) of no longer than 250 words for each inaccuracy. Your request for amendment and/or addendum must be in writing and give a reason for the request. We may deny your request for an amendment if the information was not created by us, is not a part of the information which you would be permitted to inspect and copy, or if the information is already accurate and complete. Even if we accept your request, we do not delete any information already in your records.

• To Receive an Accounting of Certain Disclosures we have made of your mental health information. You must put your request for an accounting in writing.

• To Request That We Contact You By Alternate Means (e.g., fax versus mail) or at alternate locations. Your request must be in writing, and we must honor reasonable requests.

By Design Behavioral Health, PLLC does not discriminate based on race, color, national origin, creed, religion, sexual orientation, public assistance status, marital status, age, disability, or sex, including sex stereotypes and gender identity. Please reference to your state’s Patient Bill of Rights and Client Rights and Protections (Texas, Oklahoma, or Minnesota). These rights can be found online at bydesignbh.com.

When engaging with By Design Behavioral Health, PLLC on social media, please be aware of potential risks related to the disclosure of confidential information. The nature of social media platforms may present challenges to confidentiality. We cannot guarantee the confidentiality of information shared through these channels. For matters requiring discretion, consider using more secure communication methods.

You have a right to receive a Good Faith Estimate, which is an estimate of the cost of services, upon request. This estimate will provide you with an understanding of the potential financial commitment involved in receiving our services. Please note, if you would like By Design Behavioral Health, PLLC to have a copy of your healthcare directive, you are responsible for providing this information. This is not a requirement, but can be helpful in providing the best treatment in case of emergencies.

CHANGES TO THIS NOTICE

By Design Behavioral Health, PLLC reserves the right to change or revise this Notice. If a revision is made to our policies and procedures, a revised copy will be posted on our website at bydesignbh.com and a copy will be provided to you upon request.

CONTACT INFORMATION

If you have any questions about this Notice, please contact our office at By Design Behavioral Health, PLLC, 5900 Balcones Drive, Suite 25308, Austin, Texas, 78731, or by telephone at 469-807-8077. If you believe your privacy rights have been violated, you may contact the following:

Texas:

Texas Behavioral Health Executive Council George H.W. Bush State Office Building 1801 Congress Ave., Ste. 7.300 Austin, Texas 78701 Main Line (512) 305-7700 Investigations/Complaints 24-hour, toll-free system (800) 821-3205

Contact info: https://bhec.texas.gov/contact-us/

Oklahoma:

State Board of Behavioral Health Licensure (BBHL) 3815 N Santa Fe, Ste. 110 Oklahoma City, OK 73118

Phone: (405) 522-3696 Email: Info.BehavioralHealth@bbhl.ok.gov

Minnesota:

Minnesota Board of Behavioral Health & Therapy

335 Randolph Avenue, Suite 290

St. Paul, MN 55102

Phone: (651)201-2756 Fax: (651)797-1374

Email: bbht.board@state.mn.usYou may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services at 200 Independence Ave. SW, Washington, D.C. 20201. You will not be penalized for filing a complaint.