Notice of Privacy Practices

Effective Date: January 1, 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.
This Notice applies to HarmonyVille Behavioral Health (HarmonyVille PLLC) and its locations, providers, and workforce. It covers our behavioral health services for children, adolescents, and adults at our Mansfield and McKinney, Texas offices, including any telehealth services we provide.

Our Pledge

We understand that information about you and your health is personal. We are required by law to maintain the privacy and security of your protected health information (PHI), to give you this Notice of our legal  duties and privacy practices, to follow the terms of the Notice currently in effect, and to notify you if a  breach affects your unsecured PHI.

How We May Use and Disclose Your Health Information

The following describes the ways we are permitted to use and disclose PHI without your written  authorization. Not every use is listed, but each falls into one of these categories. 

For Treatment 

We use and share PHI to provide, coordinate, and manage your care, including with doctors, nurses,  therapists, pharmacists, laboratories, specialists, hospitals, and other providers involved in your care. 

For Payment 

We use and share PHI to bill and collect for services, verify insurance coverage, obtain prior authorizations,  and respond to payer audits and claim questions. 

For Health Care Operations 

We use and share PHI to run our practice, including quality assessment and improvement, training,  licensing and credentialing, compliance, legal services, business planning, and customer service. 

Other Permitted Uses and Disclosures 

• Appointment reminders and treatment information, by phone, text, email, or mail, using the contact information you give us. 
• Business associates, vendors that perform services for us under written agreements requiring them  to protect your PHI. 
• Family, friends, and others involved in your care or payment, when you agree or do not object, or  when we reasonably believe it is in your best interest if you are unable to agree. 

• Required by law, including court orders, subpoenas, and lawful requests from government agencies. • Public health and safety, such as reporting diseases, immunizations, injuries, product problems, and  preventing serious threats to health or safety. 
• Abuse, neglect, or domestic violence, as required or permitted by law. 
• Health oversight activities, such as audits, inspections, and licensure. 
• Judicial and administrative proceedings, and law enforcement, as permitted by law. • Coroners, medical examiners, funeral directors, and organ and tissue donation. • Research, when approved through a process that protects privacy, or when information is de identified. 
• Workers’ compensation, military and veterans’ activities, national security, and correctional  institutions, as permitted by law.

Uses and Disclosures That Require Your Written Authorization

We will obtain your written authorization before the following, and you may revoke an authorization at any time in writing (this will not affect disclosures already made): 

• Most uses and disclosures of psychotherapy notes (a clinician’s separate notes of counseling  sessions), with limited exceptions allowed by law. 
• Uses and disclosures of PHI for marketing, and any sale of PHI.
• Photographs, video, testimonials, and similar materials that identify you or your child for any  purpose other than treatment. We share these only under a signed consent and authorization. • Any other use or disclosure not described in this Notice.

Special Protections 

Mental and behavioral health information. Information about mental health care receives additional  protection under certain federal and state laws. We share it only as those laws allow. 

Substance use disorder records. If we receive or create records from a federally assisted substance use  disorder program covered by 42 C.F.R. Part 2, those records have additional protections. Generally, we may use and disclose them for treatment, payment, and health care operations based on your single written  consent, and they may not be used against you in civil, criminal, administrative, or legislative proceedings  without your consent or a qualifying court order. You will be told separately if this applies to your care. 

State law. Texas law may be more protective of your privacy than HIPAA, and we follow the stricter rule. In  Texas, your PHI may be subject to electronic disclosure, for example through electronic health records,  secure messaging, and health information exchanges, and we do not sell PHI. Mental health records are  also subject to confidentiality protections under Texas law, and we release them only as state and federal  law permit or require.

Minors, Parents, and Guardians

A parent or legal guardian is generally the “personal representative” of a minor child and may exercise the  child’s privacy rights and receive the child’s PHI. There are exceptions. In certain situations, state law allows 

a minor to consent to specific types of care on their own, and in those cases information about that care  may be controlled by the minor and may not be shared with a parent or guardian except as the law allows.  We may also limit a parent’s or guardian’s access if we reasonably believe it could endanger the child or  another person. When a patient turns 18, the patient, not the parent, holds the privacy rights over their  record, and the parent will need the patient’s written permission to receive information. 

Your Rights Regarding Your Health Information

• Access and copies. You may inspect and obtain a paper or electronic copy of your medical and billing  records, and ask that a copy be sent to another person you designate. We will respond within 30 days and may charge a reasonable, cost-based fee. In limited cases we may deny access, and you may ask  for that decision to be reviewed. 
• Amendment. You may ask us to correct information you believe is wrong or incomplete. We may  deny the request in certain cases, and you may submit a statement of disagreement. • Accounting of disclosures. You may request a list of certain disclosures we made of your PHI in the  six years before your request. 
• Request restrictions. You may ask us to limit how we use or share your PHI. We are not required to  agree, except that we must agree to your request not to disclose PHI to a health plan for payment or  operations when the care has been paid for in full out of pocket and the disclosure is not required by  law. 
• Confidential communications. You may ask that we contact you in a particular way or at a particular  place, such as a different phone number or address. We will accommodate reasonable requests. • Paper copy of this Notice. You may ask for a paper copy at any time, even if you agreed to receive it  electronically. 
• Choose someone to act for you. If you have given someone medical power of attorney, or someone  is your legal guardian, that person may exercise your rights. We will verify their authority first. To exercise any of these rights, submit a written request to our Privacy Officer using the contact  information below.

Our Responsibilities

Privacy Officer: Mr. Ali Shah, Executive Manager

HarmonyVille Behavioral Health

Email: info@harmonyvillepsych.com

Mail: HarmonyVille Behavioral Health, Attn: Privacy Officer, 1759 Broad Park Circle South, Suite 101, Mansfield, TX 76063

Office locations and phone numbers:

• Mansfield: 1759 Broad Park Cir S., Suite 101, Mansfield, TX 76063; Phone (682) 868-1004; Fax (682) 345-7662; officemf@harmonyvillepsych.com

• McKinney: 1400 N. Coit Road, Suites 1803 & 1804, McKinney, TX 75071; Phone (682) 708-2797; Fax (682) 382-6060; officemck@harmonyvillepsych.com

General inquiries: info@harmonyvillepsych.com.

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, at www.hhs.gov/ocr/privacy/hipaa/complaints, by phone at 1-877-696-6775, or by mail at 200 Independence Avenue S.W., Washington, D.C. 20201. We will not retaliate against you for filing a complaint.