Notice of Privacy Practices

This notice is provided before your first session when you complete your paperwork and is available upon request at any time. 

​

Health Insurance Portability Accountability Act (HIPAA)

Client Rights & Therapist Duties

 

Dr. Harriet Singelyn, Licensed Psychologist, Texas License No. 39356 

Dr. Harriet Singelyn Psychotherapy, PLLC

Effective Date March 23rd, 2026 

 

This document contains important information about federal law, the Health Insurance Portability and Accountability Act (HIPAA), that provides privacy protections and patient rights with regard to the use and disclosure of your Protected Health Information (PHI) used for the purpose of treatment, payment, and health care operations. 

 

HIPAA requires that I provide you with a Notice of Privacy Practices (the Notice) for use and disclosure of PHI for treatment, payment and health care operations.  The Notice explains HIPAA and its application to your PHI in greater detail.  

 

Please note that Texas law — including the Texas Medical Records Privacy Act (TMRPA), Texas Health and Safety Code Chapter 181 (HB 300), Texas Health and Safety Code Chapter 611, and Texas Senate Bill 1188 (effective September 1, 2025) — may provide broader protections for your health information than federal HIPAA law. Where Texas law provides greater protection, Texas law applies.

 

The law requires that I obtain your signature acknowledging that I have provided you with this.  If you have any questions, it is your right and obligation to ask so I can have a further discussion prior to signing this document.  When you sign this document, it will also represent an agreement between us.  You may revoke this Agreement in writing at any time.  That revocation will be binding unless I have taken action in reliance on it.  

 

Your signature on this document, whether provided in person or electronically, constitutes a valid and binding acknowledgment under the federal Electronic Signatures in Global and National Commerce Act (E-SIGN Act) and applicable Texas law.

 

MENTAL HEALTH RECORDS — SPECIAL TEXAS PROTECTIONS

 

Your mental health records are protected by both federal HIPAA law and Texas Health and Safety Code Chapter 611, which provides additional protections specific to mental health information. Chapter 611 imposes stricter confidentiality requirements on mental health records than those required under general medical records law. In the event of any conflict between HIPAA and Chapter 611, the more protective standard applies.

 

LIMITS ON CONFIDENTIALITY

 

The law protects the privacy of all communication between a patient and a therapist.  In most situations, I can only release information about your treatment to others if you sign a written authorization form that meets certain legal requirements imposed by HIPAA.  There are some situations where I am permitted or required to disclose information without either your consent or authorization. If such a situation arises, I will limit my disclosure to what is necessary.  

 

Federal law protects records that identify a person as having applied for or received services related to substance use disorder under, including alcohol or drug use treatment (“SUD”) a special federal law (42 C.F.R. Part 2) that provides extra privacy safeguards. These special protections apply only if the records were created by a federally assisted (including accepting Medicare or Medicaid) substance use disorder treatment program, or I receive protected SUD treatment records from such a program. SUD records cannot be used or disclosed without your written permission (“authorization”) unless federal and state law allows it.

 

Not all mentions of alcohol or drug use in your record are covered by this special law.

 

If your records are protected under the special SUD law:

• I will not share them without your written permission except in limited situations allowed by law.

• Your written permission may allow future sharing for treatment, payment, and healthcare operations as described below.

• Anyone who receives these protected records is generally not allowed to share them again without proper authorization.

 

Reasons I may have to release your information without authorization:

 

1. If you are involved in a court proceeding and a request is made for information concerning your diagnosis and treatment, such information is protected by the psychotherapist-patient privilege law.  I cannot provide any information without your (or your legal representative's) written authorization, or a court order, or if I receive a subpoena of which you have been properly notified and you have failed to inform me that you oppose the subpoena.  If you are involved in or contemplating litigation, you should consult with an attorney to determine whether a court would be likely to order me to disclose information.

2. If a government agency is requesting the information for health oversight activities, within its appropriate legal authority, I may be required to provide it for them.

3. If a patient files a complaint or lawsuit against me, I may disclose relevant information regarding that patient in order to defend myself.

4. If a patient files a worker's compensation claim, and I am providing necessary treatment related to that claim, I must, upon appropriate request, submit treatment reports to the appropriate parties, including the patient's employer, the insurance carrier or an authorized qualified rehabilitation provider.

5. I may disclose the minimum necessary health information to my business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services.  My business associates sign agreements to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.

 

There are some situations in which I am legally obligated to take actions which I believe are necessary to attempt to protect others from harm, and I may have to reveal some information about a patient's treatment:

 

1. If I know, or have reason to suspect, that a child under 18 has been abused, abandoned, or neglected by a parent, legal custodian, caregiver, or any other person responsible for the child's welfare, the law requires that I file a report with the appropriate state Abuse Hotline. Because I provide telepsychology services under the PSYPACT Interstate Compact, my mandatory reporting obligation is governed by the laws of the state in which you are physically located at the time of our session — not the state in which I am licensed. I will identify and contact the appropriate reporting authority for your state of residence or physical location. Once such a report is filed, I may be required to provide additional information.

2. If I know or have reasonable cause to suspect that a vulnerable adult has been abused, neglected, or exploited, the law requires that I file a report with the appropriate state Abuse Hotline. As with child abuse reporting, under PSYPACT, the applicable law and reporting authority will be determined by the state in which you are physically located at the time services are provided. Once such a report is filed, I may be required to provide additional information.

3. If I believe that there is a clear and immediate probability of physical harm to the patient, to other individuals, or to society, I may be required to disclose information to take protective action, including communicating the information to the potential victim, and/or appropriate family member, and/or the police, or to seek hospitalization of the patient. The laws governing my duty to protect or warn vary by state. Under PSYPACT, I will comply with the duty-to-protect laws of the state where you are physically located at the time of the relevant disclosure or threat.

 

CLIENT RIGHTS AND THERAPIST DUTIES

 

Use and Disclosure of Protected Health Information:

 

Federal and State laws allow disclosure of your therapy and other mental health records (excluding SUD treatment) without authorization:

 

• For Treatment – I use and disclose your health information internally in the course of your treatment.  If I wish to provide information outside of our practice for your treatment by another health care provider, I will have you sign an authorization for release of information.  Furthermore, an authorization is required for most uses and disclosures of psychotherapy notes.

• For Payment – I may use and disclose your health information to obtain payment for services provided to you as delineated in the Therapy Agreement. 

• For Operations – I may use and disclose your health information as part of our internal operations.  For example, this could mean a review of records to assure quality.  I may also use your information to tell you about services, educational activities, and programs that I feel might be of interest to you.

 

By signing the authorization, you agree that we may disclose SUD care and treatment records, whether performed in this office or rendered by another provider, and allow all future uses and disclosures for the treatment, payment and operations as described above.

 

Patient's Rights:

• Right to Treatment – You have the right to ethical treatment without discrimination regarding race, ethnicity, gender identity, sexual orientation, religion, disability status, age, or any other protected category.

• Right to Confidentiality – You have the right to have your health care information protected. If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. I will agree to such unless a law requires us to share that information.

• Right to Request Restrictions – You have the right to request restrictions on certain uses and disclosures of protected health information about you. However, I am not required to agree to a restriction you request.

• Right to Receive Confidential Communications by Alternative Means and at Alternative Locations – You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations.

• Right to Inspect and Copy – You have the right to inspect or obtain a copy (or both) of PHI. Records must be requested in writing and a release of information must be completed. If you request electronic copies of your health records, I will provide them within 15 days of receiving your written request, in compliance with Texas law (TMRPA). For paper copies, please make your request well in advance and allow up to 30 days to receive the copies, in accordance with federal HIPAA law. A copying fee may apply in accordance with the fee schedule permitted under Texas Health and Safety Code Section 241.154. If I refuse your request for access to your records, you have a right of review, which I will discuss with you upon request.

• Right to Amend – If you believe the information in your records is incorrect and/or missing important information, you can ask us to make certain changes, also known as amending, to your health information. You have to make this request in writing. You must tell us the reasons you want to make these changes, and I will decide if it is appropriate. If I refuse to do so, I will tell you why within 60 days.

• Right to Breach Notification – In the event of a breach of your unsecured protected health information, you have the right to be notified in accordance with the HIPAA Breach Notification Rule and applicable Texas law. I will notify you promptly if a breach occurs that may have compromised the privacy or security of your information.

• Right to a Copy of This Notice – You have the right to receive a paper or electronic copy of this Notice at any time upon request. If you received this paperwork electronically, you have a copy in your email. If you completed this paperwork at your first session, a copy will be provided to you per your request or at any time.

• Right to an Accounting – You generally have the right to receive an accounting of disclosures of PHI regarding you. On your request, I will discuss with you the details of the accounting process.

• Right to Choose Someone to Act for You – If someone is your legal guardian, that person can exercise your rights and make choices about your health information. I will make sure the person has this authority and can act for you before I take any action.

• Right to Choose – You have the right to decide not to receive services with me. If you wish, I will provide you with names of other qualified professionals.

• Right to Terminate – You have the right to terminate therapeutic services with me at any time without any legal or financial obligations other than those already accrued. I ask that you discuss your decision with me in session before terminating or at least contact me by phone letting me know you are terminating services.

• Right to Release Information with Written Consent – With your written consent, any part of your record can be released to any person or agency you designate. Together, we will discuss whether or not I think releasing the information in question to that person or agency might be harmful to you.

 

Therapist’s Duties:

 

• I am required by law to maintain the privacy of PHI and to provide you with a notice of my legal duties and privacy practices with respect to PHI. I reserve the right to change the privacy policies and practices described in this notice. Unless I notify you of such changes, however, I am required to abide by the terms currently in effect. If I revise my policies and procedures, I will provide you with a revised notice during our session or via the client portal.

• Your protected health information is stored on HIPAA-compliant platforms that comply with applicable Texas data storage requirements under Texas law, including Texas Senate Bill 1188 (effective September 1, 2025).

• I will inform you if any artificial intelligence tools are used in the provision of your care or the management of your health information, in accordance with Texas Senate Bill 1188 and applicable Texas law.

 

COMPLAINTS 

 

If you are concerned that I have violated your privacy rights, or you disagree with a decision I made about access to your records, you may contact any of the following:

 

• Dr. Harriet Singelyn directly via email at contact@harrietsingelynpsychotherapy.com

• Texas State Board of Examiners of Psychologists (TSBEP)

  • For complaints regarding licensed psychologists in Texas

  • Website: www.tsbep.texas.gov

  • Phone: 512-305-7700

• Office of the Texas Attorney General

  • For complaints under Texas Health and Safety Code Chapter 181 (HB 300)

  • Website: www.texasattorneygeneral.gov

• U.S. Department of Health and Human Services

  • For federal HIPAA complaints

  • Website: www.hhs.gov/ocr

  • Phone: 1-800-368-1019

 

Filing a complaint with any of these agencies will not affect your care in any way.