Reproductive Psychiatry and Counseling


This  Notice  of  Privacy  Practices  (the  “  Notice  ”)  tells  you  about  the  ways  we  may  use  and  disclose  your  protected  health  information  (“  medical  information  ”)  and  your  rights  and  our  obligations  regarding  the  use  and  disclosure  of  your  medical  information.  This  Notice  applies  to  Reproductive  Psychiatry  Clinic  of Austin, including its providers and employees (the “  Practice  ”).

We are required by law to:
● Maintain the privacy of your medical information, to the extent required by state and federal law;
● Give  you  this  Notice  explaining  our  legal  duties  and  privacy  practices  with  respect  to  medical  information about you;
● Notify  affected  individuals  following  a  breach  of  unsecured  medical  information  under  federal  law; and
● Follow the terms of the version of this Notice that is currently in effect.

The  following  categories  describe  the  different  reasons  that  we  typically  use  and  disclose  medical information.  These  categories  are  intended  to  be  general  descriptions  only,  and  not  a  list  of  every  instance  in  which  we  may  use  or  disclose  your  medical  information.  Please  understand  that  for  these  categories,  the  law  generally  does  not  require  us  to  get  your  authorization  in  order  for  us  to  use  or  disclose  your  medical information.

A. For Treatment.  We  may  use  and  disclose  medical  information  about  you  to  provide  you  with  health  care  treatment  and  related  services,  including  coordinating  and  managing  your  health  care.  We  may  disclose  medical  information  about  you  to  physicians,  nurses,  other  health  care  providers  and  personnel  who  are  providing  or  involved  in  providing  health  care  to  you  (both  within  and  outside  of  the  Practice).  For  example,  should  your  care  require  referral  to  or  treatment  by  another  physician  of  a  specialty  outside  of  the  Practice,  we  may  provide  that  physician  with  your  medical  information  in  order  to  aid the physician in his or her treatment of you.

B. For Payment.  We may use and disclose medical information  about you so that we or  may bill and collect from you, an insurance company, or a third party for the health care services we  provide.  This may also include the disclosure of medical information to obtain prior authorization for treatment and procedures from your insurance plan.  For example, we may send a claim for payment to  your insurance company, and that claim may have a code on it that describes the services that have been  rendered to you.  If, however, you pay for an item or service in full, out of pocket and request that we not  disclose to your health plan the medical information solely relating to that item or service, as described  more fully in Section IV of this Notice, we will follow that restriction on disclosure unless otherwise  required by law.

C. For Health Care Operations. We  may  use  and  disclose  medical  information  about  you  for  our  health  care  operations.  These  uses  and  disclosures  are  necessary  to  operate  and  manage  our  practice  and  to  promote  quality  care.  For  example,  we  may  need  to  use  or  disclose  your  medical  information  in  order  to  assess  the  quality  of  care  you  receive  or  to  conduct  certain  cost  management,  business  management,  administrative,  or  quality  improvement  activities  or  to  provide  information  to  our  insurance  carriers.

D. Quality Assurance.  We  may  need  to  use  or  disclose  your  medical  information  for  our  internal processes to assess and facilitate the provision of quality care to our patients.

E. Utilization Review. We  may  need  to  use  or  disclose  your  medical  information  to  perform  a  review  of  the  services  we  provide  in  order  to  evaluate  whether  that  the  appropriate  level  of  services  is  received, depending on condition and diagnosis.

F. Credentialing and Peer Review. We  may  need  to  use  or  disclose  your  medical  information  in order for us to review the credentials, qualifications and actions of our health care providers.

G. Treatment Alternatives.  We  may  use  and  disclose  medical  information  to  tell  you  about  or recommend possible treatment options or alternatives that we believe may be of interest to you.

H. Appointment  Reminders  and  Health  Related  Benefits  and  Services.  We  may  use  and  disclose  medical  information,  in  order  to  contact  you  (including,  for  example,  contacting  you  by  phone  and  leaving  a  message  on  an  answering  machine)  to  provide  appointment  reminders  and  other  information.  We  may  use  and  disclose  medical  information  to  tell  you  about  health-related  benefits  or  services  that  we  believe  may  be  of  interest  to  you.  We  may  use  and  disclose  medical  information,  in  order  to contact you by email to provide information.

I. Business  Associates.  There  are  some  services  (such  as  billing  or  legal  services)  that  may  be  provided  to  or  on  behalf  of  our  Practice  through  contracts  with  business  associates.  When  these  services  are  contracted,  we  may  disclose  your  medical  information  to  our  business  associate  so  that  they  can  perform  the  job  we  have  asked  them  to  do.  To  protect  your  medical  information,  however,  we  require  the business associate to appropriately safeguard your information.

J. Individuals  Involved  in  Your  Care  or  Payment  for  Your  Care.  We  may  disclose  medical  information  about  you  to  a  friend  or  family  member  who  is  involved  in  your  health  care,  as  well  as  to  someone  who  helps  pay  for  your  care,  but  we  will  do  so  only  as  allowed  by  state  or  federal  law  (with  an  opportunity  for  you  to  agree  or  object  when  required  under  the  law),  or  in  accordance  with  your  prior  authorization.

K. As  Required  by  Law. We  will  disclose  medical  information  about  you  when  required  to  do so by federal, state, or local law or regulations.

L. To  Avert  an  Imminent  Threat  of  Injury  to  Health  or  Safety.  We  may  use  and  disclose  medical  information  about  you  when  necessary  to  prevent  or  decrease  a  serious  and  imminent  threat  of  injury  to  your  physical,  mental  or  emotional  health  or  safety  or  the  physical  safety  of  another  person.  Such disclosure would only be to medical or law enforcement personnel.

M. Organ  and  Tissue  Donation.  If  you  are  an  organ  donor,  we  may  use  and  disclose  medical  information  to  organizations  that  handle  organ  procurement  or  organ,  eye  or  tissue  transplantation  or to an organ donation bank as necessary to facilitate organ or tissue donation and transplantation.

N. Research. We  may  use  or  disclose  your  medical  information  for  research  purposes  in  certain  situations.  Texas  law  permits  us  to  disclose  your  medical  information  without  your  written  authorization  to  qualified  personnel  for  research,  but  the  personnel  may  not  directly  or  indirectly  identify  a  patient  in  any  report  of  the  research  or  otherwise  disclose  identity  in  any  manner.  Additionally,  a  special  approval  process  will  be  used  for  research  purposes,  when  required  by  state  or  federal  law.  For  example,  we  may  use  or  disclose  your  information  to  an  Institutional  Review  Board  or  other  authorized  privacy  board  to  obtain  a  waiver  of  authorization  under  HIPAA.  Additionally,  we  may  use  or  disclose  your  medical  information  for  research  purposes  if  your  authorization  has  been  obtained  when  required  by  law,  or if the information we provide to researchers is “de-identified.”

O. Military  and  Veterans.  If  you  are  a  member  of  the  armed  forces,  we  may  use  and  disclose medical information about you as required by the appropriate military authorities.

P. Workers’  Compensation. We  may  disclose  medical  information  about  you  for  your  workers'  compensation  or  similar  program.  These  programs  provide  benefits  for  work-related  injuries.  For  example,  if  you  have  injuries  that  resulted  from  your  employment,  workers’  compensation  insurance  or  a  state  workers’  compensation  program  may  be  responsible  for  payment  for  your  care,  in  which  case  we might be required to provide information to the insurer or program.

Q. Public  Health  Risks. We  may  disclose  medical  information  about  you  to  public  health  authorities  for  public  health  activities.  As  a  general  rule,  we  are  required  by  law  to  disclose  certain  types  of  information  to  public  health  authorities,  such  as  the  Texas  Department  of  State  Health  Services.  The  types of information generally include information used:
● To  prevent  or  control  disease,  injury,  or  disability  (including  the  reporting  of  a  particular  disease  or injury).
● To report births and deaths.
● To report suspected child abuse or neglect.
● To report reactions to medications or problems with medical devices and supplies.
● To notify people of recalls of products they may be using.
● To  notify  a  person  who  may  have  been  exposed  to  a  disease  or  may  be  at  risk  for  contracting  or  spreading a
disease or condition.
● To  notify  the  appropriate  government  authority  if  we  believe  a  patient  has  been  the  victim  of  abuse,  neglect,  or  domestic  violence.  We  will  only  make  this  disclosure  if  you  agree  or  when  required or authorized by law.
● To provide information about certain medical devices.
● To assist in public health investigations, surveillance, or interventions.

R. Health  Oversight  Activities. We  may  disclose  medical  information  to  a  health  oversight agency  for  activities  authorized  by  law.  These  oversight  activities  include  audits,  civil,  administrative,  or  criminal  investigations  and  proceedings,  inspections,  licensure  and  disciplinary  actions,  and  other  activities  necessary  for  the  government  to  monitor  the  health  care  system,  certain  governmental  benefit  programs,  certain  entities  subject  to  government  regulations  which  relate  to  health  information,  and  compliance with civil rights laws.

S. Legal  Matters.  If  you  are  involved  in  a  lawsuit  or  a  legal  dispute,  we  may  disclose  medical  information  about  you  in  response  to  a  court  or  administrative  order,  subpoena,  discovery  request,  or  other  lawful  process.  In  addition  to  lawsuits,  there  may  be  other  legal  proceedings  for  which  we  may  be  required  or  authorized  to  use  or  disclose  your  medical  information,  such  as  investigations  of  health  care  providers,  competency  hearings  on  individuals,  or  claims  over  the  payment  of  fees  for  medical  services.

T. Law  Enforcement,  National  Security  and  Intelligence  Activities. In  certain  circumstances  ,  we  may  disclose  your  medical  information  if  we  are  asked  to  do  so  by  law  enforcement  officials,  or  if  we  are  required  by  law  to  do  so.  We  may  disclose  your  medical  information  to  law  enforcement  personnel,  if  necessary  to  prevent  or  decrease  a  serious  and  imminent  threat  of  injury  to  your  physical,  mental  or  emotional  health  or  safety  or  the  physical  safety  of  another  person.  We  may  disclose  medical  information  about  you  to  authorized  federal  officials  for  intelligence,  counterintelligence,  and  other national security activities authorized by law.

U. Coroners,  Medical  Examiners  and  Funeral  Home  Directors. We  may  disclose  your  medical  information  to  a  coroner  or  medical  examiner.  This  may  be  necessary,  for  example,  to  identify  a  deceased  person  or  determine  the  cause  of  death.  We  may  also  release  medical  information  about  our  patients to funeral home directors as necessary to carry out their duties.

V. Inmates. If  you  are  an  inmate  of  a  correctional  institution  or  under  custody  of  a  law  enforcement  official,  we  may  disclose  medical  information  about  you  to  the  health  care  personnel  of  a  correctional institution as necessary for the institution to provide you with health care treatment.

W. Marketing  of  Related  Health  Services.   We  may  use  or  disclose  your  medical  information  to  send  you  treatment  or  healthcare  operations  communications  concerning  treatment  alternatives  or  other  health-related  products  or  services.  We  may  provide  such  communications  to  you  in  instances  where  we  receive  financial  remuneration  from  a  third  party  in  exchange  for  making  the  communication  only  with  your  specific  authorization  unless  the  communication:  (i)  is  made  face-to-face  by  the  Practice  to  you,  (ii)  consists  of  a  promotional  gift  of  nominal  value  provided  by  the  Practice,  or  (iii) is  otherwise  permitted  by  law.  If  the  marketing  communication  involves  financial  remuneration  and  an  authorization  is  required,  the  authorization  must  state  that  such  remuneration  is  involved.  Additionally,  if  we  use  or  disclose  information  to  send  a  written  marketing  communication  (as  defined  by  Texas  law)  through  the  mail,  the  communication  must  be  sent  in  an  envelope  showing  only  the  name  and  addresses  of  sender  and  recipient  and  must  (i)  state  the  name  and  toll-free  number  of  the  entity  sending  the  market  communication;  and  (ii)  explain  the  recipient’s  right  to  have  the  recipient’s  name  removed  from  the  sender’s mailing list. Consumer information is not shared with third-party sources for marketing purposes.

X. Fundraising. We  may  use  or  disclose  certain  limited  amounts  of  your  medical  information  to  send  you  fundraising  materials.  You  have  a  right  to  opt  out  of  receiving  such  fundraising  communications.  Any  such  fundraising  materials  sent  to  you  will  have  clear  and  conspicuous  instructions  on how you may opt out of receiving such communications in the future.

Y. Electronic  Disclosures  of  Medical  Information.   Under  Texas  law,  we  are  required  to  provide  notice  to  you  if  your  medical  information  is  subject  to  electronic  disclosure.  This  Notice  serves  as  general  notice  that  we  may  disclose  your  medical  information  electronically  for  treatment,  payment,  or  health care operations or as otherwise authorized or required by state or federal law.


A. Authorizations. There are times we may need  or want to use or disclose your medical information for reasons other than those listed above, but to do so we will need your prior authorization.  Other than expressly provided herein, any other uses or disclosures of your medical information will  require your specific written authorization.

B. Psychotherapy  Notes,  Marketing  and  Sale  of  Medical  Information.  Most  uses  and  disclosures  of  “psychotherapy  notes,”  uses  and  disclosures  of  medical  information  for  marketing  purposes,  and  disclosures  that  constitute  a  “sale  of  medical  information”  under  HIPAA  require  your  authorization.

C. Right  to  Revoke  Authorization. If  you  provide  us  with  written  authorization  to  use  or  disclose  your  medical  information  for  such  other  purposes,  you  may  revoke  that  authorization  in  writing  at  any  time.  If  you  revoke  your  authorization,  we  will  no  longer  use  or  disclose  your  medical  information  for  the  reasons  covered  by  your  written  authorization.  You  understand  that  we  are  unable  to  take  back  any  uses  or  disclosures  we  have  already  made  in  reliance  upon  your  authorization,  and  that  we  are  required to retain our records of the care that we provided to you.


Federal  and  state  laws  provide  you  with  certain  rights  regarding  the  medical  information  we  have  about you.  The following is a summary of those rights.

A. Right  to  Inspect  and  Copy.  Under  most  circumstances,  you  have  the  right  to  inspect  and/or  copy  your  medical  information  that  we  have  in  our  possession,  which  generally  includes  your  medical  and  billing  records.  To  inspect  or  copy  your  medical  information,  you  must  submit  your  request  to do so in writing to the Practice’s HIPAA Officer at the address listed in Section VI below.

If  you  request  a  copy  of  your  information,  we  may  charge  a  fee  for  the  costs  of  copying,  mailing,  or  certain  supplies  associated  with  your  request.  The  fee  we  may  charge  will  be  the  amount  allowed  by  state law.

If  your  requested  medical  information  is  maintained  in  an  electronic  format  (e.g.,  as  part  of  an  electronic  medical  record,  electronic  billing  record,  or  other  group  of  records  maintained  by  the  Practice  that  is  used  to  make  decisions  about  you)  and  you  request  an  electronic  copy  of  this  information,  then  we  will  provide  you  with  the  requested  medical  information  in  the  electronic  form  and  format  requested,  if  it  is  readily  producible  in  that  form  and  format.  If  it  is  not  readily  producible  in  the  requested  electronic  form  and  format,  we  will  provide  access  in  a  readable  electronic  form  and  format  as  agreed  to  by  the  Practice and you.

In  certain  very  limited  circumstances  allowed  by  law,  we  may  deny  your  request  to  review  or  copy  your  medical  information.  We  will  give  you  any  such  denial  in  writing.  If  you  are  denied  access  to  medical  information,  you  may  request  that  the  denial  be  reviewed.  Another  licensed  health  care  professional  chosen  by  the  Practice  will  review  your  request  and  the  denial.  The  person  conducting  the  review will not be the person who denied your request.  We will abide by the outcome of the review.

B. Right  to  Amend. If  you  feel  the  medical  information  we  have  about  you  is  incorrect  or  incomplete,  you  may  ask  us  to  amend  the  information.  You  have  the  right  to  request  an  amendment  for  as  long  as  the  information  is  kept  by  the  Practice.  To  request  an  amendment,  your  request  must  be  in  writing  and  submitted  to  the  HIPAA  Officer  at  the  address  listed  in  Section  VI  below.  In  your  request,  you  must  provide  a  reason  as  to  why  you  want  this  amendment.  If  we  accept  your  request,  we  will  notify  you  of  that in writing.

We  may  deny  your  request  for  an  amendment  if  it  is  not  in  writing  or  does  not  include  a  reason  to  support  the  request.  In  addition,  we  may  deny  your  request  if  you  ask  us  to  amend  information  that  (i)  was  not  created  by  us  (unless  you  provide  a  reasonable  basis  for  asserting  that  the  person  or  organization  that  created  the  information  is  no  longer  available  to  act  on  the  requested  amendment),  (ii)  is  not  part  of  the  information  kept  by  the  Practice,  (iii)  is  not  part  of  the  information  which  you  would  be  permitted  to  inspect  and  copy,  or  (iv)  is  accurate  and  complete.  If  we  deny  your  request,  we  will  notify  you  of  that  denial in writing.

C. Right  to  an  Accounting  of  Disclosures. You  have  the  right  to  request  an  "accounting  of  disclosures"  of  your  medical  information.  This  is  a  list  of  the  disclosures  we  have  made  for  up  to  six  years  prior  to  the  date  of  your  request  of  your  medical  information,  but  does  not  include  disclosures  for  Treatment,  Payment,  or  Health  Care  Operations  (as  described  in  Sections  II  A,  B,  and  C  of  this  Notice)  or  disclosures  made  pursuant  to  your  specific  authorization  (as  described  in  Section  III  of  this  Notice),  or  certain other disclosures.

If  we  make  disclosures  through  an  electronic  health  records  (EHR)  system,  you  may  have  an  additional  right  to  an  accounting  of  disclosures  for  Treatment,  Payment,  and  Health  Care  Operations.   Please  contact  the  Practice’s  HIPAA  Officer  at  the  address  set  forth  in  Section  VI  below  for  more  information  regarding  whether  we  have  implemented  an  EHR  and  the  effective  date,  if  any,  of  any additional  right  to  an  accounting  of  disclosures  made  through  an  EHR  for  the  purposes  of  Treatment,  Payment, or Health Care Operations.    

To  request  a  list  of  accounting,  you  must  submit  your  request  in  writing  to  the  Practice’s  HIPAA  Officer at the address set forth in Section VI below.

Your  request  must  state  a  time  period,  which  may  not  be  longer  than  six  years  (or  longer  than  three  years  for  Treatment,  Payment,  and  Health  Care  Operations  disclosures  made  through  an  EHR,  if  applicable)  and  may  not  include  dates  before  April  14,  2003.  Your  request  should  indicate  in  what  form  you  want  the  list  (for  example,  on  paper  or  electronically).  The  first  list  you  request  within  a  twelve-month  period  will  be  free.  For  additional  lists,  we  may  charge  you  a  reasonable  fee  for  the  costs  of  providing  the  list.  We  will  notify  you  of  the  cost  involved  and  you  may  choose  to  withdraw  or  modify  your request at that time before any costs are incurred.

D. Right  to  Request  Restrictions.  You  have  the  right  to  request  a  restriction  or  limitation  on  the  medical  information  we  use  or  disclose  about  you  for  treatment,  payment,  or  health  care  operations.  You  also  have  the  right  to  request  a  restriction  or  limitation  on  the  medical  information  we  disclose  about  you  to  someone  who  is  involved  in  your  care  or  the  payment  for  your  care,  like  a  family  member or friend.

Except  as  specifically  described  below  in  this  Notice,  we  are  not  required  to  agree  to  your  request  for  a  restriction  or  limitation.  If  we  do  agree,  we  will  comply  with  your  request  unless  the  information  is  needed  to  provide  emergency  treatment.  In  addition,  there  are  certain  situations  where  we  won’t  be  able  to  agree  to  your  request,  such  as  when  we  are  required  by  law  to  use  or  disclose  your  medical  information.  To  request  restrictions,  you  must  make  your  request  in  writing  to  the  Practice’s  HIPAA  Officer  at  the  address  listed  in  Section  VI  of  this  Notice  below.  In  your  request,  you  must  specifically  tell  us  what  information  you  want  to  limit,  whether  you  want  us  to  limit  our  use,  disclosure,  or  both,  and  to  whom you want the limits to apply.

As  stated  above,  in  most  instances  we  do  not  have  to  agree  to  your  request  for  restrictions  on  disclosures  that  are  otherwise  allowed.  However,  if  you  pay  or  another  person  (other  than  a  health  plan)  pays  on  your  behalf  for  an  item  or  service  in  full,  out  of  pocket,  and  you  request  that  we  not  disclose  the  medical  information  relating  solely  to  that  item  or  service  to  a  health  plan  for  the  purposes  of  payment  or  health  care  operations,  then  we  will  be  obligated  to  abide  by  that  request  for  restriction  unless  the  disclosure  is  otherwise  required  by  law.  You  should  be  aware  that  such  restrictions  may  have  unintended  consequences,  particularly  if  other  providers  need  to  know  that  information  (such  as  a  pharmacy  filling  a  prescription).  It  will  be  your  obligation  to  notify  any  such  other  providers  of  this  restriction.  Additionally,  such  a  restriction  may  impact  your  health  plan’s  decision  to  pay  for  related  care  that  you  may not want to pay for out of pocket (and which would not be subject to the restriction).

E. Right  to  Request  Confidential  Communications.   You  have  the  right  to  request  that  we  communicate  with  you  about  medical  matters  in  a  certain  way  or  at  a  certain  location.  For  example,  you  can  ask  that  we  only  contact  you  at  home,  not  at  work  or,  conversely,  only  at  work  and  not  at  home.  To  request  such  confidential  communications,  you  must  make  your  request  in  writing  to  the  Practice’s  HIPAA Officer at the address listed in Section VI below.

We  will  not  ask  the  reason  for  your  request,  and  we  will  use  our  best  efforts  to  accommodate  all  reasonable  requests,  but  there  are  some  requests  with  which  we  will  not  be  able  comply.  Your  request  must specify how and where you wish to be contacted.

F. Right  to  a  Paper  Copy  of  This  Notice.  You  have  the  right  to  a  paper  copy  of  this  Notice.  You  may  ask  us  to  give  you  a  copy  of  this  Notice  at  any  time.  To  obtain  a  copy  of  this  Notice,  you  must  make  your  request  in  writing  to  the  Practice’s  HIPAA  Officer  at  the  address  set  forth  in  Section  VI below.

G. Right  to  Breach  Notification. In  certain  instances,  we  may  be  obligated  to  notify  you  (and  potentially  other  parties)  if  we  become  aware  that  your  medical  information  has  been  improperly  disclosed  or  otherwise  subject  to  a  “breach”  as  defined  in  and/or  required  by  HIPAA  and  applicable  state  law.


We  reserve  the  right  to  change  this  Notice  at  any  time,  along  with  our  privacy  policies  and  practices.  We  reserve  the  right  to  make  the  revised  or  changed  Notice  effective  for  medical  information  we  already  have  about  you  as  well,  as  any  information  we  receive  in  the  future.  We  will  post  a  copy  of  the  current  notice,  along  with  an  announcement  that  changes  have  been  made,  as  applicable,  in  our  office.  When  changes  have  been  made  to  the  Notice,  you  may  obtain  a  revised  copy  by  sending  a  letter  to  the  Practice’s  HIPAA  Officer  at  the  address  listed  in  Section  VI  below  or  by  asking  the  office  receptionist  for  a current copy of the Notice.


If  you  believe  that  your  privacy  rights  as  described  in  this  Notice  have  been  violated,  you  may  file  a complaint with the Practice at the following address or phone number:

Reproductive Psychiatry And Counseling
4022 Menchaca Road
Austin, Texas 78704

To  file  a  complaint,  you  may  either  call  or  send  a  written  letter.  The  Practice  will  not  retaliate  against  any  individual  who  files  a  complaint.  You  may  also  file  a  complaint  with  the  Secretary  of  the  Department of Health and Human Services.

In  addition,  if  you  have  any  questions  about  this  Notice,  please  contact  the  Practice’s  HIPAA  Officer at the address or phone number listed above.

By  signing  below,  you  acknowledge  that  you  have  received  this  Notice  of  Privacy  Practices  prior  to  any  service  being  provided  to  you  by  the  Practice,  and  you  consent  to  the  use  and  disclosure  of  your  medical information as set forth herein except as expressly stated below.

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