NOTICE OF PRIVACY PRACTICES
Mentality PLLC
Effective Date: [INSERT DATE]
YOUR INFORMATION. YOUR RIGHTS. OUR RESPONSIBILITIES.
This Notice of Privacy Practices describes how Mentality PLLC (“Mentality,” “we,” “us,” or “our”) may use and disclose your protected health information (“PHI”), your rights regarding your health information, and our responsibilities concerning the privacy of your information.
Please review this notice carefully.
Mentality provides mental-health services to adolescents and adults, including therapy and services addressing substance use and related concerns.
YOUR RIGHTS
You have certain rights regarding your health information.
You have the right to obtain a copy of your health information.
You may request an electronic or paper copy of your medical record and other health information that Mentality maintains about you, subject to applicable law.
We may charge a reasonable, cost-based fee where permitted by law.
You have the right to request a correction.
You may ask Mentality to correct health information that you believe is incorrect or incomplete.
We may deny a request in certain circumstances permitted by law. If we deny your request, we will provide an explanation and information regarding your rights.
You have the right to request confidential communications.
You may ask us to communicate with you about your healthcare in a particular way or at a particular location.
For example, you may request that we contact you by telephone rather than email or contact you at a particular mailing address.
We will consider reasonable requests.
You have the right to request restrictions.
You may ask us to limit how we use or disclose certain health information.
We are not required to agree to every request.
However, if you pay for a service completely out-of-pocket and request that we not disclose information about that service to your health plan for payment or healthcare operations, we will generally honor that request unless disclosure is required by law.
You have the right to receive an accounting of certain disclosures.
You may request information about certain disclosures of your health information made by Mentality, subject to limitations established by law.
You have the right to receive a copy of this notice.
You may request a paper or electronic copy of this Notice of Privacy Practices at any time.
You have the right to choose a personal representative.
If you have a person legally authorized to act on your behalf, such as a legal guardian or other personal representative, that person may exercise rights on your behalf as permitted by law.
You have the right to file a complaint.
You may complain to Mentality if you believe your privacy rights have been violated.
You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights.
Mentality will not retaliate against you for filing a complaint.
HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION
We may use or disclose your PHI without a separate written authorization when permitted or required by applicable law.
Treatment
We may use and disclose your health information to provide, coordinate, or manage your healthcare.
For example, we may communicate with other healthcare professionals involved in your treatment when permitted by law.
Payment
We may use and disclose health information to obtain payment for services.
If you use health insurance, this may include providing information to your health plan or other entities involved in processing or paying claims.
Healthcare Operations
We may use and disclose health information as necessary to operate our practice, including activities such as scheduling, quality-related activities, billing, credentialing, compliance, and administrative functions.
Insurance and Benefits
When you elect to use insurance, Mentality may disclose information reasonably necessary to verify benefits, obtain authorization when required, submit claims, receive payment, address claim questions, and perform other permitted payment activities.
Insurance coverage is determined by your health plan, not by Mentality.
You may be responsible for deductibles, copayments, coinsurance, non-covered services, denied claims, and other amounts permitted under your insurance plan and our financial policies.
Self-Pay Services
If you elect to pay privately rather than use insurance, Mentality may still use and disclose health information as permitted by law for treatment, payment, and healthcare operations.
If applicable law provides you with a right to request restrictions on disclosures to a health plan after paying for a service completely out-of-pocket, Mentality will honor that request as required by law.
Appointment and Administrative Communications
We may contact you using the contact information you provide for purposes such as:
Appointment scheduling;
Appointment reminders;
Cancellations or rescheduling;
Billing and payment matters;
Patient-portal notifications;
Practice-related communications; and
Other communications related to your care.
You may request reasonable alternative methods of communication.
Patient Portal
Mentality uses Ensora Health / TheraNest for its patient portal and related practice-management functions.
Depending on the services used by Mentality, the platform may support functions such as intake, forms, scheduling, documentation, billing, communications, and access to patient information.
Information submitted or maintained through the patient portal may constitute PHI and is handled in accordance with applicable privacy and security requirements.
Patients should use the secure patient portal when instructed to provide sensitive clinical or intake information rather than sending that information through ordinary email or social media.
Telehealth
Mentality may provide services through telehealth.
When telehealth is used, Mentality may use secure technology and other systems necessary to provide care, communicate with patients, document services, schedule appointments, and perform billing and administrative functions.
Telehealth services remain subject to applicable privacy and confidentiality protections.
Persons Involved in Your Care
When permitted by law, we may disclose limited information to a family member, close personal friend, or other person involved in your care or payment for your care when you agree or when the circumstances permit such disclosure.
Required by Law
We may use or disclose health information when required by federal, state, or local law.
Public Health
We may disclose information for certain public-health activities as permitted or required by law.
Abuse, Neglect, or Domestic Violence
We may disclose information to appropriate governmental authorities when required or permitted by law concerning suspected abuse, neglect, or domestic violence.
Health and Safety
We may use or disclose information when necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public, as permitted by law.
Judicial and Administrative Proceedings
We may disclose information in response to a court order, subpoena, or other lawful process when the disclosure is permitted or required by applicable law.
Law Enforcement
We may disclose information to law enforcement when permitted or required by law.
Workers' Compensation
We may disclose information as authorized by laws relating to workers' compensation and similar programs.
Medical Examiners and Funeral Directors
We may disclose information to coroners, medical examiners, or funeral directors as permitted by law.
Other Uses and Disclosures
Other uses and disclosures not described in this notice will generally require your written authorization when required by law.
You may revoke an authorization in writing at any time, except to the extent Mentality has already relied upon the authorization.
PSYCHOTHERAPY NOTES
Psychotherapy notes maintained separately from the rest of your medical record receive special protection under HIPAA.
Except as permitted or required by law, Mentality will obtain your written authorization before using or disclosing psychotherapy notes.
SUBSTANCE USE DISORDER INFORMATION
Mentality provides services that may involve assessment, counseling, or treatment relating to substance use.
Certain substance-use-disorder records may be subject to additional federal confidentiality protections under 42 U.S.C. § 290dd-2 and 42 CFR Part 2.
Where Part 2 applies, Mentality will comply with the additional requirements governing the use and disclosure of those records.
Part 2 generally provides heightened protection for records maintained by federally assisted programs providing substance-use-disorder diagnosis, treatment, or referral for treatment. Certain uses and disclosures require patient consent or other legal authority.
To the extent Mentality maintains records subject to Part 2, those records will not be used or disclosed for a civil, criminal, administrative, or legislative investigation or proceeding against you except as permitted by applicable Part 2 requirements, including applicable consent or court-order requirements.
Part 2 protections may also apply to records received from another Part 2 program.
MINORS AND ADOLESCENT PATIENTS
Mentality provides services to adolescents and adults.
The privacy and confidentiality of an adolescent's health information may depend on the adolescent's age, the type of service involved, who legally consented to treatment, applicable Texas law, and other circumstances.
Parents, guardians, and other personal representatives may have rights to access or receive information in certain circumstances, while adolescents may have confidentiality rights in other circumstances.
Mentality will apply applicable federal and state laws when determining what information may be disclosed to a parent, guardian, personal representative, or other person.
Patients and parents/guardians may receive additional information about confidentiality and communication expectations as part of the intake and consent process.
TELEHEALTH AND ELECTRONIC COMMUNICATIONS
Mentality may communicate with patients through telephone, secure patient-portal messaging, and other approved electronic methods.
Electronic communications may involve some risk despite reasonable safeguards.
Patients should avoid sending highly sensitive information through ordinary email, text messaging, or social-media platforms unless specifically instructed by Mentality.
SOCIAL MEDIA
Mentality may maintain social-media accounts for educational, informational, or business purposes.
Mentality will not identify an individual as a patient or disclose confidential patient information through social media without authorization, except as permitted or required by law.
Social-media platforms are not considered secure clinical communication channels.
Please do not send confidential health information through social-media direct messages.
MARKETING
Mentality will obtain authorization when required by HIPAA before using or disclosing PHI for marketing purposes.
Mentality does not sell your protected health information.
FUNDRAISING
Mentality does not currently conduct fundraising activities using patient information.
If this practice changes, Mentality will comply with applicable law regarding fundraising communications and opt-out rights.
BREACH NOTIFICATION
Mentality is required to notify affected individuals and others when required by law following a breach of unsecured protected health information.
Additional breach-notification requirements may apply to information protected under 42 CFR Part 2.
OUR RESPONSIBILITIES
Mentality is required by law to:
Maintain the privacy and security of your protected health information;
Provide you with this notice describing our legal duties and privacy practices;
Follow the terms of the notice currently in effect;
Notify you as required by law following a breach of unsecured protected health information; and
Comply with applicable federal and state privacy requirements.
Mentality will not use or disclose your health information other than as described in this notice or as otherwise permitted or required by law without your written authorization when authorization is required.
CHANGES TO THIS NOTICE
Mentality reserves the right to change this Notice of Privacy Practices.
If we make a material change, the revised notice will be made available as required by law and posted on our Website.
The revised notice will apply to information we maintain as permitted by applicable law.
QUESTIONS OR PRIVACY COMPLAINTS
If you have questions about this notice or believe your privacy rights have been violated, please contact:
Mentality PLLC
Privacy Contact: [NAME/TITLE]
Email: [PRIVACY EMAIL]
Phone: [PHONE NUMBER]
Address: [MAILING ADDRESS]
You may also contact:
U.S. Department of Health and Human Services
Office for Civil Rights
You may obtain information about filing a complaint through the HHS Office for Civil Rights website or by contacting the appropriate regional office.
Mentality will not retaliate against you for filing a privacy complaint.
Effective Date: [INSERT DATE]
Mentality PLLC