Client Rights, Privacy
& Required Disclosures

Becoming to Belong Counseling & Coaching
633 East Fernhurst Dr., Suite 703 · Katy, Texas 77450
Phone: (832) 563-0170 · Email: mindy@b2bcounseling.com
Effective Date: May 14, 2025

I. Our Pledge Regarding Health Information

We understand that health information about you and your health care is personal. We are committed to protecting health information about you. We create a record of the care and services you receive from each therapy session. We 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.

We are required by law to:

• Make sure that protected health information ("PHI") that identifies you is kept private.
• Give you this notice of our legal duties and privacy practices with respect to health information.
• Follow the terms of the notice that is currently in effect.
• We can change the terms of this Notice, and such changes will apply to all information we have about you. The new Notice will be available upon request, in our office, and on our website.

II. How We May Use and Disclose Health Information About You

For Treatment, Payment, or Health Care Operations: Federal privacy rules allow health care providers who have a direct treatment relationship with the patient/client to use or disclose the patient/client's personal health information without the patient's written authorization, to carry out the health care provider's own treatment, payment or health care operations.

Lawsuits and Disputes: If you are involved in a lawsuit, we may disclose health information in response to a court or administrative order. We may also disclose health information in response to a subpoena, discovery request, or other lawful process, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

III. Certain Uses and Disclosures Require Your Authorization

• Psychotherapy Notes. We do keep "psychotherapy notes" as that term is defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your Authorization unless the use or disclosure is required by law or for specific permitted purposes.
• Marketing Purposes. We will not use or disclose your PHI for marketing purposes.
• Sale of PHI. We will not sell your PHI in the regular course of our business.

IV. Certain Uses and Disclosures Do Not Require Your Authorization

Subject to certain limitations in the law, we can use and disclose your PHI without your Authorization for the following reasons:

• When disclosure is required by state or federal law.
• For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone's health or safety.
• For health oversight activities, including audits and investigations.
• For judicial and administrative proceedings, including responding to a court or administrative order.
• For law enforcement purposes, including reporting crimes occurring on our premises.
• To coroners or medical examiners, when such individuals are performing duties authorized by law.
• For research purposes, including studying and comparing mental health treatments.
• Specialized government functions, including military missions, intelligence operations, or correctional institutions.
• For workers' compensation purposes.
• Appointment reminders and health related benefits or services.

V. Your Rights With Respect to Your PHI

• The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask us not to use or disclose certain PHI for treatment, payment, or health care operations purposes.
• The Right to Choose How We Send PHI to You. You have the right to ask us to contact you in a specific way or to send mail to a different address.
• The Right to See and Get Copies of Your PHI. Other than psychotherapy notes, you have the right to get an electronic or paper copy of your medical record within 30 days of receiving your written request.
• The Right to Get a List of the Disclosures We Have Made. You have the right to request a list of instances in which we have disclosed your PHI for purposes other than treatment, payment, or health care operations.
• The Right to Correct or Update Your PHI. If you believe there is a mistake in your PHI or that important information is missing, you have the right to request a correction.
• The Right to Get a Paper or Electronic Copy of this Notice. You have the right to get a paper copy of this Notice, and you have the right to get a copy by e-mail.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us at (832) 563-0170 or mindy@b2bcounseling.com. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. You will not be retaliated against for filing a complaint.