HIPAA Notice of Privacy Practices

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.

Restore & Thrive Counseling, PLLC (the “Practice”) is committed to protecting your privacy. The Practice is required by federal law to maintain the privacy of Protected Health Information (“PHI”), which is information that identifies or could be used to identify you. The Practice is required to provide you with this Notice of Privacy Practices (this “Notice”), which explains the Practice’s legal duties and privacy practices and your rights regarding the PHI we collect and maintain.

Your Rights

Your rights regarding PHI are explained below. To exercise these rights, please submit a written request to the Practice at the address noted below.

To inspect and copy PHI

  • You can ask for an electronic or paper copy of your PHI. The Practice may charge a reasonable, cost-based fee.

  • The Practice may deny your request in limited circumstances. You may have a right to have that decision reviewed.

To amend PHI

  • You can ask us to correct PHI you believe is incorrect or incomplete. We may ask you to submit your request in writing and provide a reason.

  • We may deny your request. If we do, we’ll explain why in writing and you may submit a statement of disagreement.

To request confidential communications

  • You can ask us to contact you in a specific way (for example, a personal rather than a work email) or at a specific location. We will accommodate all reasonable requests.

To request limits on what we use or share

  • You can ask us not to use or share certain PHI for treatment, payment, or operations. We are not required to agree if it would affect your care.

  • If you pay out-of-pocket in full for a service, you can ask us not to share that information with your health insurer.

  • You can ask us not to share your PHI with specific family members or friends.

To receive a list of certain disclosures

  • You can request an accounting of certain disclosures of your PHI. One accounting per 12-month period is provided at no charge; additional requests may incur a reasonable fee.

To receive a paper copy of this Notice

  • You may request a paper copy at any time, even if you agreed to receive it electronically.

To choose someone to act on your behalf

  • If someone has your medical power of attorney or is your legal guardian, they may exercise these rights for you.

To file a complaint

  • You may file a complaint with the Practice using the contact information below.

  • You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights: 200 Independence Avenue, S.W., Washington, D.C. 20201, phone 1-877-696-6775, or online at www.hhs.gov/ocr/privacy/hipaa/complaints/.

  • The Practice will not retaliate against you for filing a complaint.

Our Uses and Disclosures

1. Routine uses and disclosures (no authorization required)

To provide treatment. We may share PHI with other professionals involved in your care, such as a physician you’ve asked us to coordinate with.

To run our operations. We may use PHI to manage the Practice, improve care, and communicate with you — for example, sending appointment reminders through our secure client portal or Spruce Health.

To bill for services. As a self-pay practice, this is typically limited to providing you with superbills or receipts for your own records or for submission to your insurer for possible reimbursement.

2. Disclosures that may be made without your authorization or opportunity to object

  • Public health and safety: to prevent the spread of disease, report adverse events, or as required by the Secretary of Health and Human Services to investigate compliance.

  • Health oversight: audits, investigations, or inspections by government agencies.

  • Serious threat to health or safety: to prevent a serious and imminent threat to you or others.

  • Abuse, neglect, or domestic violence: as required by Texas law.

  • Legal requirements: to comply with a court order, subpoena, or other legal process; if required by law; or for workers’ compensation claims.

  • Coroners, funeral directors, or organ donation organizations, as legally authorized.

  • Research approved by an institutional review board.

3. Disclosures you may object to

Unless you object, we may share PHI with family, friends, or others directly involved in your care, or if it’s in your best interest and you’re unable to state a preference.

4. Disclosures requiring your written authorization

We must have your written authorization before using or disclosing PHI for marketing, sale of PHI, or release of psychotherapy notes. You may revoke this authorization in writing at any time.

Our Responsibilities

  • We are required by law to maintain the privacy and security of your PHI.

  • We will abide by the terms of this Notice currently in effect. Where Texas law is more protective of your privacy than federal law, we follow the more protective standard.

  • We reserve the right to change this Notice. Updated versions will be posted at www.restoreandthrivecounseling.com and made available upon request.

  • We will notify you if a breach compromises your unsecured PHI.

Effective Date: September 1, 2026

Privacy Officer Contact
Restore & Thrive Counseling, PLLC
5757 Flewellen Oaks Lane, Suite 304
Fulshear, TX 77441
(346) 707-8569
Attn: Privacy Officer, Heather McCutcheon, LPC

This Notice is provided as general guidance based on standard HIPAA Notice of Privacy Practices requirements and is not a substitute for legal advice. Please have an attorney or your malpractice carrier’s risk management resource review before publishing.