Clear Mind Therapy PLLC - Notice of Privacy Policies
Nathaly Moreno, MA, LMFT, CST
Contact: hello@clearmindtherapy.health, 832-301-8218
Website: www.clearmindtherapy.health
Texas State License: 203516, NPI: 1619512233
Last updated: May 15th, 2025
This notice describes how psychological and medical information about you may be used and disclosed and how you can get access to this information. Please read it carefully. This document is provided in accordance with federal and state law, including the Health Insurance Portability and Accountability Act (HIPAA) and relevant Texas privacy statutes.
I. Uses and Disclosures for Treatment, Payment, and Health Care Operations
Clear Mind Therapy, PLLC may use or disclose your Protected Health Information (PHI) for treatment, payment, and health care operations with your consent. These terms include:
- Treatment: Coordinating or managing your mental health care and other related services. For example, we may consult with your primary care physician, psychiatrist, or other providers involved in your care.
- Payment: Billing your insurance, verifying coverage, or collecting fees for services rendered.
- Health Care Operations: Administrative, quality assurance, legal, and auditing functions necessary to run the practice, such as evaluating treatment outcomes, training, or credentialing staff.
"Use" refers to internal activities within Clear Mind Therapy, PLLC. "Disclosure" refers to releasing information to parties outside the practice.
II. Uses and Disclosures Requiring Your Written Authorization
Uses or disclosures of your PHI not covered by treatment, payment, or operations require your written authorization. These include, but are not limited to:
- Sharing your PHI with a third party for reasons not related to care or payment.
- Disclosures of psychotherapy notes—which are kept separate from your main medical record and include detailed documentation of therapy sessions—require a specific authorization.
You may revoke an authorization in writing at any time, except to the extent that action has already been taken based on the original authorization.
III. Uses and Disclosures Without Your Authorization or Consent
Clear Mind Therapy, PLLC may disclose your PHI without your consent or authorization in the following situations, as permitted or required by law:
- Child, Elder, or Dependent Adult Abuse or Neglect: Mandatory reporting to appropriate authorities if abuse, neglect, or exploitation is suspected.
- Serious Threat to Health or Safety: If you present a serious risk of harm to yourself or others, necessary information may be disclosed to prevent such harm.
- Judicial or Administrative Proceedings: In response to a subpoena or court order, or when required by law. Psychotherapy notes will only be released with explicit authorization or legal compulsion.
- Health Oversight Activities: If a regulatory board investigates a complaint against a provider, PHI relevant to the complaint may be disclosed.
- Worker’s Compensation: PHI may be disclosed to comply with laws relating to workers' compensation claims.
- As Required by Law: This includes disclosures to comply with public health reporting, law enforcement inquiries, or other legal obligations.
IV. Your Rights Regarding Your Protected Health Information
You have the following rights concerning your PHI:
- Right to Access and Copy Records: You may request to inspect or obtain copies of your PHI. Certain requests may be denied if they are determined to be likely to cause harm.
- Right to Amend: You may request corrections to your records. If denied, you may submit a statement of disagreement, which will be maintained with your record.
- Right to an Accounting of Disclosures: You may request a list of disclosures of your PHI for purposes other than treatment, payment, and health care operations.
- Right to Request Restrictions: You may request limitations on how your PHI is used or disclosed. While we are not required to agree, we will consider all reasonable requests.
- Right to Confidential Communications: You may request that communications be sent to alternate locations (e.g., work or P.O. Box) or by alternate means (e.g., phone call instead of email).
- Right to a Paper Copy: You may request a paper copy of this notice, even if you have agreed to receive it electronically.
- Right to Breach Notification: You will be notified of any breach of unsecured PHI as required by law.
V. Duties of Clear Mind Therapy, PLLC
- We are required by law to maintain the privacy of your PHI and to provide you with this notice of our privacy practices.
- We reserve the right to revise this notice. Any changes will apply to all PHI we maintain. You will be provided with an updated notice if you are an active client or upon request.
- We are committed to safeguarding your health information and will adhere to the practices described in this notice unless otherwise required by law.
VI. Complaints
If you believe your privacy rights have been violated, you may file a complaint with Clear Mind Therapy, PLLC or with the Secretary of the U.S. Department of Health and Human Services. You will not be retaliated against for filing a complaint.
To file a complaint or inquire about this notice, contact:
Clear Mind Therapy, PLLC
Contact: clearmindtherapypllc@gmail.com, 832-301-8218
Website: www.clearmindtherapy.health
Or:
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 1-877-696-6775
www.hhs.gov
