🌿 NOTICE OF PRIVACY POLICY
Last Updated: November 18th, 2025
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW THIS NOTICE CAREFULLY.
Your health record contains personal information about you and your health. This information about you that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services is referred to as Protected Health Information (“PHI”). This Notice of Privacy Practices describes how we may use and disclose your PHI in accordance with applicable law, including the Health Insurance Portability and Accountability Act (“HIPAA”), regulations promulgated under HIPAA including the HIPAA Privacy and Security Rules, and the NASW Code of Ethics. It also describes your rights regarding how you may gain access to and control your PHI.
We are required by law to maintain the privacy of PHI and to provide you with notice of our legal duties and privacy practices with respect to PHI. We are required to abide by the terms of this Notice of Privacy Practices. We reserve the right to change the terms of our Notice of Privacy Practices at any time. Any new Notice of Privacy Practices will be effective for all PHI that we maintain at that time. We will provide you with a copy of the revised Notice of Privacy Practices by posting a copy on our website, sending a copy to you in the mail upon request or providing one to you at your next appointment.
Uses and Disclosures for Treatment, Payment and Health Care Operations
I may use or disclose your Protected Health Information(PHI), for treatment, payment, and health care operations purposes. The following should help clarify these terms:
PHI refers to information in your health record that could identify you. For example, it may include your name, the fact you are receiving treatment here, and other basic information pertaining to your treatment.
Use applies only to activities within my office and practice group, such as sharing, employing, applying, utilizing, and analyzing information that identifies you.
Disclosure applies to activities outside of my office or practice group, such as releasing, transferring, or providing access to information about you to other parties.
Authorization is your written permission to disclose confidential health information. All authorizations to disclose must be made on a specific and required form. Treatment is when I provide, coordinate, or manage your health care and other services related to your health care. For example, with your written authorization I may provide your information to your physician to ensure the physician has the necessary information to diagnose or treat you.
For Treatment: Your PHI may be used and disclosed by those who are involved in your care for the purpose of providing, coordinating, or managing your health care treatment and related services. This includes consultation with clinical supervisors or other treatment team members. We may disclose PHI to any other consultant only with your authorization.
For Payment: I may use and disclose PHI so that I can assist you in gaining reimbursement for the treatment services provided to you. This will only be done with your written authorization. Examples of payment-related activities are: reviewing services provided to you to determine medical necessity or undertaking utilization review activities. Payment for services is due at the time of service. If it becomes necessary to use collection processes due to lack of payment for services, we will only disclose the minimum amount of PHI necessary for purposes of collection.
For Health Care Operations: I may use or disclose, as needed, your PHI in order in support of my business activities including, but not limited to, quality assessment activities, licensing, and conducting or arranging for other business activities. For example, I may share your PHI with third parties that perform various business activities (e.g., billing or typing services) provided we have a written contract with the business that requires it to safeguard the privacy of your PHI. For training or teaching purposes PHI will be disclosed only with your authorization.
Required by Law Under the law, we must disclose your PHI to you upon your request. In addition, we must make disclosures to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining our compliance with the requirements of the Privacy Rule.
Uses and Disclosures Without Authorization
Without Authorization Federal HIPAA regulations protect the privacy of all communications between a client and a mental health professional. In most situations, I can only release information about your treatment to others if you sign a written authorization. This Authorization will remain in effect for a length of time you and I determine. You may revoke the authorization at any time, unless I have taken action in reliance on it. However, there are some disclosures that do not require your Authorization. I may use or disclose PHI without your consent in the following circumstances:
Child Abuse or Neglect: If I have reasonable cause to believe a child may be abused or neglected, I must report this belief to the appropriate authorities.
Elderly/Disabled Person Abuse or Neglect: If I have reason to believe that an individual such as an elderly or disabled person protected by state law has been abused, neglected, or financially exploited, I must report this to the appropriate authorities.
Health Oversight Activities: I may disclose your PHI to a health oversight agency for oversight activities authorized by law, including licensure or disciplinary actions. If a client files a complaint or lawsuit against me, I may disclose relevant information regarding that patient in order to defend myself.
Judicial and Administrative Proceedings: If you are involved in a court proceeding and a request is made for information by any party about your treatment and the records thereof, such information is privileged under state law, and is not to be released without a court order. Information about all other psychological services (e.g., psychological evaluation) is also privileged and cannot be released without your authorization or a court order. The privilege does not apply when you are being evaluated for a third party or where the evaluation is court ordered. You must be informed in advance if this is the case.
Serious Threat to Health or Safety : If you communicate to me a specific threat of imminent harm against another individual or if I believe that there is clear, imminent risk of injury being inflicted against another individual, I may make disclosures that I believe are necessary to protect that individual from harm. If I believe that you present an imminent, serious risk of injury or death to yourself, I may make disclosures I consider necessary to protect you from harm.
Suicidal Ideation I may disclose your PHI to the police if you threaten to kill yourself and are unable or unwilling commit to a safety plan with your counselor. If your counselor deems it necessary to seek hospitalization on your behalf, they will make every effort to discuss this with you before taking any action.
Deceased Patients: I may disclose PHI regarding deceased patients as mandated by state law, or to a family member or friend that was involved in your care or payment for care prior to death, based on your prior consent. A release of information regarding deceased patients may be limited to an executor or administrator of a deceased person’s estate or the person identified as next-of-kin. PHI of persons that have been deceased for more than fifty (50) years is not protected under HIPAA.
Medical Emergencies: I may use or disclose your PHI in a medical emergency situation to medical personnel only in order to prevent serious harm. I will try to provide you a copy of this notice as soon as reasonably practicable after the resolution of the emergency.
Family Involvement in Care: I may disclose information to close family members or friends directly involved in your treatment based on your consent or as necessary to prevent serious harm.
Law Enforcement: I may disclose PHI to a law enforcement official as required by law, in compliance with a subpoena (with your written consent), court order, administrative order or similar document, for the purpose of identifying a suspect, material witness or missing person, in connection with the victim of a crime, in connection with a deceased person, in connection with the reporting of a crime in an emergency, or in connection with a crime on the premises.
Specialized Government Functions: I may review requests from U.S. military command authorities if you have served as a member of the armed forces, authorized officials for national security and intelligence reasons and to the Department of State for medical suitability determinations, and disclose your PHI based on your written consent, mandatory disclosure laws and the need to prevent serious harm.
Public Safety **:**I may disclose your PHI if necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. If information is disclosed to prevent or lessen a serious threat it will be disclosed to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat.
Verbal Permission: I may also use or disclose your information to family members that are directly involved in your treatment with your verbal permission.
Worker’s Compensation: I may disclose PHI regarding you as authorized by and to the extent necessary to comply with laws relating to worker’s compensation or other similar programs, established by law, that provide benefits for work-related injuries or illness without regard to fault.
Special Authorizations
Certain categories of information have extra protections by law, and thus require special written authorizations for disclosures.
Psychotherapy Notes: I will obtain a special authorization before releasing your Psychotherapy Notes. “Psychotherapy Notes” are notes I have made about our conversation during a private, group, joint, or family counseling session, which I have kept separate from the rest of your record. These notes are given a greater degree of protection than PHI.
HIV Information Special legal protections apply to HIV/AIDS related information. I will obtain a special written authorization from you before releasing information related to HIV/AIDS.
Alcohol and Drug Use Information Special legal protections apply to information related to alcohol and drug use and treatment. I will obtain a special written authorization from you before releasing information related to alcohol and/or drug use/treatment. You may revoke all such authorizations (of PHI, Psychotherapy Notes, HIV information, and/or Alcohol and Drug Use Information) at any time, provided each revocation is in writing, signed by you, and signed by a witness. You may not revoke an authorization to the extent that (1) I have relied on that authorization; or (2) if the authorization was obtained as a condition of obtaining insurance coverage, law provides the insurer the right to contest the claim under the policy.
Client’s Rights
You have the following rights regarding PHI I maintain about you. To exercise any of these rights, please submit your request in writing to Casey Davids at 4131 Spicewood Springs #F2 Austin, TX 78759.
Right to Request Restrictions: You have the right to request a restriction or limitation on the use or disclosure of your PHI for treatment, payment, or health care operations. I am not required to agree to your request unless the request is to restrict disclosure of PHI to a health plan for purposes of carrying out payment or health care operations, and the PHI pertains to a health care item or service that you paid for out of pocket. In that case, I am required to honor your request for a restriction.
Right to Request Confidential Communication: You have the right to request that I communicate with you about health matters in a certain way or at a certain location. I will accommodate reasonable requests. I may require information regarding how payment will be handled or specification of an alternative address or other method of contact as a condition for accommodating your request. I will not ask you for an explanation of why you are making the request.
Right of Access to Inspect and Copy: You have the right, which may be restricted only in exceptional circumstances, to inspect and copy PHI that is maintained in a “designated record set”. A designated record set contains mental health/medical and billing records and any other records that are used to make decisions about your care. Your right to inspect and copy PHI will be restricted only in those situations where there is compelling evidence that access would cause serious harm to you or if the information is contained in separately maintained psychoCounseling notes. I may charge a reasonable, cost-based fee for copies. If your records are maintained electronically, you may also request an electronic copy of your PHI. You may also request that a copy of your PHI be provided to another person.
Right to an Accounting You generally have the right to receive an accounting of all disclosures of PHI. I can discuss with you the details of the accounting process.
Right to Amend: If you feel that the PHI I have about you is incorrect or incomplete, you may ask me to amend the information although I am not required to agree to the amendment. If I deny your request for amendment, you have the right to file a statement of disagreement. I may prepare a rebuttal to your statement and will provide you with a copy.
Right to a Paper Copy: You have the right to obtain a paper copy of the Notice of Privacy Practices from me upon request.
Right to Know my Qualifications: You are entitled to ask me what my training is, where I received it, my professional competencies, experience, education, biases or attitudes, and any other relevant information that may be important to you in the provision of services. You have the right to expect that I have met the minimum qualifications of training and experience required by state law and to examine public records maintained by the Texas State Board of Examiners of Professional Counselors which are the licensure boards that regulate my practice.
Right to Refuse Services: You have the right to consent to or refuse recommended services. As stated in the limitations to confidentiality, if in my clinical judgment I conclude that failure to act immediately could jeopardize your health (such as critical suicidal ideation), emergency service providers may need to be contacted. I will make reasonable efforts to involve a close relative or friend prior to enlisting emergency services.
Right to Voice Grievances: You have the right to voice grievances and request changes in your counseling plan without restraint, interference, coercion, discrimination or reprisal. I encourage you to share any concerns you may have with me directly, including if you believe your privacy rights have been violated. You also have the right to file a complaint about my services to the Texas State Board of Examiners of Professional Counselors at (512) 776-2150, which is the state licensure board that regulates my practice.
Referral Rights: You have the right not to be referred or terminated without explanation and notice. You have the right to active assistance from me in referring you to other appropriate services.
Minors’ Right to Privacy All non-emancipated minor clients under the age of 18 must have the consent of their parents or guardians following an initial intake session to receive further treatment services. State law provides that minors have the right to request that their records be withheld from their parents or guardians. When a minor client requests that records be withheld and/or, in my professional judgment, I determine that sharing the minor’s counseling information with parents or legal guardians is detrimental to the physical or mental health of a minor, I may refuse to release it to parents and legal guardians in order to prevent harm.
Licensed Professional Counselor’s Responsibilities
• I have the responsibility to provide the best care possible appropriate to your situation, as determined by prevailing therapeutic standards.
• I am required by law to maintain the privacy of PHI and to provide you with a notice of my legal duties and privacy practices with respect to PHI.
• I reserve the right to change the privacy policies and practices described in this notice. Unless I notify you of such changes, however, I am required to abide by the terms currently in effect.
• If I revise my policies and procedures, I am responsible for notifying you of relevant changes.
Licensed Professional Counselor’s Rights
• The right to client information as needed to provide effective care.
• The right to be reimbursed, as agreed, for services provided.
• The right to provide services in an atmosphere free of verbal, physical, or sexual harassment.
• The right and ethical obligation to refer out for services needed which are outside the scope of my Expertise.
Effective Date, Restrictions, and Changes to Privacy Policy
This notice will go into effect on January 22nd, 2017 and remain so unless new notice provisions effective for all protected health information are enacted accordingly.