Notice of Privacy Practices

Effective Date: October 4, 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 of your health information. This notice explains how we may use or share that information, your rights, and our responsibilities.

How We May Use and Share Your Information

Treatment. We may use your information and share it with healthcare professionals involved in your care. For example, your therapist may consult with another provider to coordinate treatment when permitted by law.

Payment. We may use and share information to bill for services and receive payment. For example, we may give your health plan information about your diagnosis and services so it can process a claim.

Practice operations. We may use and share information to run the practice, supervise clinicians, and review the quality of care. For example, a clinical supervisor may review documentation as part of supervision.

People involved in your care. We may share relevant information with a family member, friend, or another person involved in your care or payment for your care when you agree, have an opportunity to object and do not, or the law otherwise permits it. If you cannot tell us your preference, we may share information when permitted by law and when we believe doing so is in your best interest.

Service providers. We may share information with companies that perform services for Six Pines Counseling, such as our electronic health record, client portal, telehealth, and billing providers. When required, we have agreements with these providers to safeguard your information.

Other Disclosures Permitted or Required by Law

We may use or share your information in the circumstances below when the requirements of applicable law are met:

  • Required reporting and public health: To comply with the law, including reporting suspected abuse, neglect, or exploitation and making other required public health reports.

  • Serious threats to health or safety: To prevent or reduce a serious and imminent threat to you or another person.

  • Health oversight: For authorized audits, investigations, inspections, licensing, or disciplinary proceedings.

  • Legal proceedings: In response to a court order, subpoena, or other lawful process when the requirements for disclosure have been met.

  • Law enforcement: For purposes permitted or required by law, such as certain warrants, reporting requirements, or emergencies.

  • Workers’ compensation: As authorized by workers’ compensation laws or similar programs.

  • Coroners, medical examiners, and funeral directors: When permitted or required by law.

  • Research: When the applicable legal requirements for research have been met.

  • Certain government functions: When legally authorized for functions such as military activities, national security, or correctional institutions.

  • Disaster relief: To help notify people responsible for your care about your location, condition, or safety when permitted by law.

Uses That Require Your Written Authorization

We generally need your written authorization to use or share your information for purposes not described in this notice. Written authorization is also generally required for most uses or disclosures of psychotherapy notes maintained separately from your clinical record, marketing uses that require authorization, and the sale of protected health information. Six Pines Counseling does not sell protected health information.

You may revoke an authorization in writing at any time. Revocation will not affect information already used or shared in reliance on your authorization.

Your Privacy Rights

You may:

  • Get a copy of your record. You may request an electronic or paper copy of health information we maintain about you. We will generally respond within 30 days and may charge a reasonable, cost-based fee. Some information, including separately maintained psychotherapy notes, may be excluded from the right of access.

  • Ask us to correct your record. If you believe information is incorrect or incomplete, you may request a correction. If we deny your request, we will explain why in writing.

  • Request confidential communication. You may ask us to contact you in a specific way or at a specific location. We will accommodate reasonable requests.

  • Ask us to limit certain uses or disclosures. We are generally not required to agree. However, if you pay in full out of pocket for a service and ask us not to share information about that service with your health plan for payment or healthcare operations, we will honor the request unless disclosure is required by law.

  • Request an accounting of disclosures. You may ask for a list of certain disclosures made during the previous six years. The list will not include every disclosure, such as most disclosures for treatment, payment, or healthcare operations. One accounting is available at no cost each year.

  • Get a paper copy of this notice at any time, even if you received it electronically.

  • Have an authorized person act for you. A parent, guardian, healthcare agent, or other legally authorized representative may exercise applicable rights on your behalf, subject to applicable law. We will verify that person’s authority.

  • File a complaint with Six Pines Counseling or the U.S. Department of Health and Human Services Office for Civil Rights if you believe your privacy rights have been violated. We will not retaliate against you for filing a complaint.

To file a complaint with the Office for Civil Rights, visit hhs.gov/ocr/privacy/hipaa/complaints or call 1-877-696-6775.

Our Responsibilities

We are required by law to protect your health information, provide this notice of our privacy practices, follow the notice currently in effect, and notify you following a breach of unsecured health information.

We may change this notice and apply the revised terms to all health information we maintain, including information received before the change. We will make an updated notice available and show its effective date.

Questions, Requests, or Complaints

Privacy Officer: Gabrielle Bunch
Practice: Six Pines Counseling
Mailing address: P.O. Box 97, Tomball, TX 77377
Email: info@sixpinescounseling.com
Phone: (346) 601-1606