Notice of Privacy Practices

Effective Date: September 1, 2026

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Six Pines Counseling is required by law to protect the privacy and security of your protected health information. This notice explains your privacy rights, how we may use and share your information, and our responsibilities for protecting it.

Your Privacy Rights

Access Your Health Records

You may request an electronic or paper copy of your health record and other health information maintained about you.

We will generally provide a copy or summary within 30 days of receiving your request. We may charge a reasonable, cost-based fee as permitted by law.

Your right of access generally does not include psychotherapy notes maintained separately from the rest of your clinical record or information prepared in reasonable anticipation of a legal proceeding.

In limited circumstances, we may deny all or part of your request. When applicable, you may request that the denial be reviewed by another licensed healthcare professional who was not involved in the original decision.

Request a Correction

You may ask us to correct health information that you believe is incorrect or incomplete.

We may deny your request, but we will provide a written explanation, generally within 60 days. If your request is denied, you may submit a written statement of disagreement to be included in your record.

Request Confidential Communications

You may ask us to contact you in a specific way or at a particular phone number, email address, or mailing address.

We will accommodate reasonable requests. Please understand that standard email and text messages may present privacy risks unless secure communication methods are used.

Request Limits on Uses or Disclosures

You may ask us not to use or share certain health information for treatment, payment, or healthcare operations. We are generally not required to agree to your request, particularly when the information is necessary to provide appropriate care.

If you pay for a service entirely out of pocket, you may ask us not to share information about that service with your health plan for payment or healthcare operations. We will honor that request unless disclosure is required by law.

Receive a List of Disclosures

You may request a list, also called an accounting, of certain disclosures of your health information made during the six years before your request.

The accounting will not include disclosures made for treatment, payment, or healthcare operations; disclosures made directly to you; disclosures you authorized; and certain other disclosures excluded by law.

We will provide one accounting each year at no cost. We may charge a reasonable, cost-based fee for additional requests made within the same 12-month period.

Receive a Copy of This Notice

You may request a paper copy of this notice at any time, even if you previously agreed to receive it electronically. A current copy is also available on our website.

Choose Someone to Act for You

If you have given someone healthcare power of attorney, have a legal guardian, or have another legally authorized personal representative, that person may exercise your rights and make choices about your health information.

We will verify that the individual has the appropriate legal authority before taking action.

File a Privacy Complaint

You may file a complaint if you believe your privacy rights have been violated.

You may contact Six Pines Counseling using the information at the end of this notice. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by:

U.S. Department of Health and Human Services
200 Independence Avenue SW
Washington, DC 20201

Six Pines Counseling will not retaliate against you for filing a complaint.

Your Choices About Sharing Information

Family, Friends, and Others Involved in Your Care

You may tell us whether we may share relevant information with a family member, friend, caregiver, or another person involved in your care or payment for your care.

If you are unable to communicate your preference, we may share information when we believe it is in your best interest and the disclosure is permitted by law. We may also share information when necessary to reduce a serious and imminent threat to health or safety.

Disaster Relief

We may share limited information with a disaster-relief organization to help notify family members or others responsible for your care about your location, condition, or safety.

Marketing

We will not use your protected health information for marketing purposes without your written authorization when authorization is required by law.

Sale of Information

Six Pines Counseling does not sell protected health information. We would obtain your written authorization before any sale of protected health information when required by law.

Fundraising

Six Pines Counseling does not currently use protected health information for fundraising. If this practice changes, you will have the right to tell us not to contact you again for fundraising purposes.

How We May Use and Share Your Information

Treatment

We may use your health information and share it with other professionals who are involved in your care.

For example, with your permission or as otherwise allowed by law, your therapist may communicate with another healthcare provider to coordinate your treatment.

Practice Operations

We may use and share health information to operate the practice, improve services, supervise clinicians, conduct quality reviews, train staff, and contact you when necessary.

For example, clinical documentation may be reviewed to evaluate the quality of services or meet professional supervision requirements. Information used during professional consultation or supervision will be limited to what is reasonably necessary, and appropriate confidentiality safeguards will be used.

Payment

We may use and share health information to bill and receive payment from health plans or other entities.

For example, we may provide your health plan with information about your diagnosis, dates of service, treatment, or medical necessity so it can process a claim.

Business Associates

We may share information with third-party service providers that perform services on our behalf, such as electronic health-record systems, client portals, billing services, telehealth platforms, insurance platforms, and secure technology providers.

When required, these providers enter into agreements requiring them to appropriately safeguard protected health information.

Other Permitted or Required Disclosures

When Required by Law

We will share information when federal or Texas law requires it, including reporting suspected abuse, neglect, or exploitation; responding to valid legal requirements; or complying with authorized health-oversight activities.

Preventing a Serious Threat to Health or Safety

We may use or disclose health information when necessary to prevent or reduce a serious and imminent threat to your health or safety or the health or safety of another person. Disclosures will be made only to someone reasonably able to help address the threat.

Public Health and Safety Activities

We may share information for certain public health activities, including:

  • Preventing or controlling disease;

  • Reporting suspected abuse, neglect, or exploitation;

  • Reporting adverse reactions to medications or products;

  • Preventing or reducing a serious threat to health or safety; and

  • Complying with other public health reporting requirements.

Health Oversight Activities

We may disclose information to authorized agencies for audits, investigations, inspections, licensure matters, disciplinary proceedings, and other activities necessary for oversight of the healthcare system.

Judicial and Administrative Proceedings

We may disclose health information in response to a valid court order, subpoena, discovery request, or other lawful process when the requirements of applicable law have been met.

Law Enforcement

We may disclose information to law enforcement officials when permitted or required by law, such as in response to certain warrants, court orders, reporting requirements, emergencies, or safety concerns.

Workers’ Compensation

We may disclose information as authorized by and to the extent necessary to comply with workers’ compensation laws or similar programs.

Coroners, Medical Examiners, and Funeral Directors

We may share information with a coroner, medical examiner, or funeral director when permitted or required by law.

Research

We may use or share information for approved health research when applicable legal safeguards have been satisfied. Six Pines Counseling does not currently conduct research using client records without authorization.

Specialized Government Functions

When legally authorized, we may disclose information for certain government functions, including military activities, national security, protective services, correctional institutions, or benefits programs.

Uses Requiring Written Authorization

Uses and disclosures not described in this notice will generally be made only with your written authorization.

Written authorization is generally required for:

  • Most uses or disclosures of separately maintained psychotherapy notes;

  • Marketing communications when authorization is required;

  • The sale of protected health information; and

  • Other uses or disclosures not otherwise permitted by law.

You may revoke an authorization in writing at any time. Revocation will not affect information already used or disclosed in reliance on your authorization before it was revoked.

Substance Use Disorder Records

Certain substance use disorder treatment records may receive additional protection under 42 U.S.C. § 290dd-2 and 42 C.F.R. Part 2.

Records protected by Part 2, or testimony describing the contents of those records, generally may not be used or disclosed in civil, criminal, administrative, or legislative proceedings against an individual unless the individual provides specific written consent or a court issues an appropriate order after the individual receives notice and an opportunity to be heard.

A court order authorizing disclosure or use of Part 2 records does not compel disclosure. Separate legal requirements may apply.

Our Privacy Responsibilities

Six Pines Counseling is required to:

  • Maintain the privacy and security of your protected health information;

  • Follow the duties and privacy practices described in the notice currently in effect;

  • Provide you with a copy of this notice;

  • Notify you promptly if a breach occurs that may have compromised the privacy or security of your information; and

  • Refrain from using or sharing your information except as described in this notice unless you provide written authorization or the law otherwise permits or requires the use or disclosure.

We will not ask you to waive your right to file a complaint as a condition of receiving treatment.

Changes to This Notice

We may change the terms of this notice and apply the revised terms to all health information maintained by Six Pines Counseling, including information created or received before the change.

When the notice changes, the updated version will be posted on our website and made available upon request. The effective date will appear at the beginning of the notice.

Questions or Complaints

For questions, privacy requests, or complaints, contact:

Privacy Officer: Gabrielle Bunch
Practice: Six Pines Counseling
Mailing address: P.O. Box 97, Tomball, TX 77377
Phone: (214) 918-2271
Email: info@sixpinescounseling.com
Website: www.sixpinescounseling.com