Privacy Policy and Consumer rights
PRIVACY POLICY AND CONSUMER RIGHTS
NOTICE OF PRIVACY PRACTICES
Effective Date: December 16, 2025
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THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
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I. MY PLEDGE REGARDING HEALTH INFORMATION
I understand that health information about you and your health care is personal. I am committed to protecting health information about you. I create a record of the care and services you receive from me. I need this record to provide you with quality care and to comply with certain legal requirements.
This notice applies to all of the records of your care generated by this mental health care practice. This notice will tell you about the ways in which I may use and disclose health information about you. I also describe your rights to the health information I keep about you, and certain obligations I have regarding the use and disclosure of your health information.
I am required by law to:
Make sure that protected health information (“PHI”) that identifies you is kept private.
Give you this notice of my legal duties and privacy practices with respect to health information.
Follow the terms of the notice that is currently in effect.
I can change the terms of this Notice, and such changes will apply to all information I have about you. The new Notice will be available upon request, in my office, and on my website.
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II. HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
The following categories describe different ways that I use and disclose health information. Not every use or disclosure in a category will be listed; however, all permitted uses and disclosures will fall within one of the categories below.
Treatment, Payment, or Health Care Operations
Federal privacy regulations allow health care providers who have a direct treatment relationship with the patient/client to use or disclose the patient/client’s PHI without written authorization to carry out treatment, payment, or health care operations.
I may also disclose your PHI for the treatment activities of another licensed health care provider without your written authorization. For example, if I consult with another licensed health care provider about your condition, I may disclose relevant PHI to assist in diagnosis or treatment.
Disclosures for treatment purposes are not limited to the minimum necessary standard, as full access to records is often required to provide quality care. Treatment includes coordination of care, consultations, and referrals.
Lawsuits and Disputes
If you are involved in a lawsuit or legal dispute, I may disclose health information in response to a court or administrative order. I may also disclose health information in response to a subpoena, discovery request, or other lawful process if reasonable efforts have been made to notify you or to obtain a protective order.
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III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION
Psychotherapy Notes
I do keep psychotherapy notes as defined by 45 CFR § 164.501. Any use or disclosure of psychotherapy notes requires your written Authorization unless the use or disclosure is:
a. For my use in treating you
b. For training or supervising mental health practitioners
c. For my defense in legal proceedings initiated by you
d. For investigations by the Secretary of Health and Human Services
e. Required by law
f. Required for health oversight activities
g. Required by a coroner
h. Necessary to prevent a serious threat to health or safety
Marketing Purposes
I will not use or disclose your PHI for marketing purposes.
Sale of PHI
I will not sell your PHI in the regular course of business.
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IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION
Subject to applicable law, I may use or disclose your PHI without your authorization for:
Disclosures required by state or federal law
Public health activities, including reporting abuse or neglect
Health oversight activities
Judicial and administrative proceedings
Law enforcement purposes
Coroners or medical examiners
Research purposes
Specialized government functions
Workers’ compensation purposes
Appointment reminders and information about treatment alternatives or services I offer
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V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT
Disclosures to Family, Friends, or Others
I may disclose your PHI to a family member, friend, or other person involved in your care or payment for your care unless you object. The opportunity to consent may be obtained retroactively in emergency situations.
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VI. YOUR RIGHTS REGARDING YOUR PHI
You have the right to:
Request limits on uses and disclosures of your PHI
Request restrictions for services paid for out-of-pocket in full
Request confidential communications
Inspect and obtain copies of your PHI (excluding psychotherapy notes)
Request an accounting of disclosures
Request corrections or amendments to your PHI
Receive a paper or electronic copy of this Notice
Requests must be submitted in writing. I will respond within the timeframes required by law.
VII. HOW TO REQUEST YOUR HEALTH CARE RECORDS
(Required by Texas Health & Safety Code §181.105)
You have the right to request access to your health care records maintained by this practice.
To request your records, please:
Submit a written request by email to smunoz@lucianamentalhealth.com or by mail to Luciana Mental Health: 3900 Merrett Dr. Fort Worth TX, 76135
Specify the records you are requesting and your preferred delivery method
Provide verification of identity if requested
Requests will be processed in accordance with applicable state and federal law. Reasonable, cost-based fees may apply.
VIII. LICENSING AND REGULATORY AUTHORITY
(Required by Texas Health & Safety Code §181.105)
This practice is regulated by the following licensing authority:
Texas Behavioral Health Executive Council
Website: https://bhec.texas.gov/
Phone: (800) 821-3205
Address: 1801 Congress Ave., Ste. 7.300
Austin, Texas 78701
You may contact this agency regarding concerns about professional conduct or licensure.
IX. HOW TO FILE A CONSUMER COMPLAINT
(Required by Texas Health & Safety Code §181.105)
If you believe your rights regarding access to health care records or privacy protections have been violated, you may file a consumer complaint with:
Office of the Texas Attorney General – Consumer Protection Division
Website: https://www.texasattorneygeneral.gov/consumer-protection/file-consumer-complaint
You may also contact the licensing authority listed above.
This information is provided in compliance with Texas Health & Safety Code §181.105.
ACKNOWLEDGEMENT OF RECEIPT OF PRIVACY NOTICE
Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information.
By signing below, you acknowledge that you have received, read, and understood this Notice of Privacy Practices.
BY SIGNING BELOW, I AGREE THAT I HAVE READ, UNDERSTOOD, AND AGREE TO THE ITEMS CONTAINED IN THIS DOCUMENT.