Notice of Privacy Practices

Dallas Modern Therapy Effective Date: January 1, 2026 This Notice of Privacy Practices describes how mental health information about you may be used and disclosed and how you can access this information. Please review it carefully.

Our Commitment to Your Privacy

Dallas Modern Therapy is committed to protecting the privacy of your protected health information (PHI). PHI includes information that identifies you and relates to your past, present, or future physical or mental health condition and related health care services. We are required by law to:

Maintain the privacy of your PHI
Provide you with this Notice of Privacy Practices
Notify you if there is a breach of unsecured PHI
Follow the terms of this Notice currently in effect

How We May Use and Disclose Your Information

We may use and disclose your PHI without your written authorization for the following purposes:

Treatment

We may use and share your PHI to provide, coordinate, or manage your mental health care. This may include sharing information with other health care providers involved in your care at your request or with your authorization.

Payment

We may use and disclose your PHI as needed to obtain payment for services provided. This may include submitting information to your insurance company for billing, authorization, or reimbursement purposes.

Health Care Operations

We may use or disclose your PHI to support the daily operations of our practice. These activities may include administrative tasks, quality improvement, training, licensing, compliance reviews, and contacting you regarding appointments or practice-related matters.

Other Common Uses

We may contact you by phone, email, or mail regarding appointments or follow-up care, unless you request otherwise.
We may disclose information to clinicians-in-training or students working under appropriate supervision.
We may call your name in the waiting area when your therapist is ready to see you.

Uses and Disclosures Required or Permitted by Law

We may use or disclose your PHI without your authorization in certain situations, including:

Public health and safety purposes (such as reporting suspected abuse, neglect, or imminent risk of harm)
Health oversight activities
Judicial or administrative proceedings (as required by court order, subpoena, or other legal process)
Law enforcement purposes, as permitted by law
Coroners or medical examiners
To prevent or lessen a serious and imminent threat to your health or the health or safety of others

All other uses and disclosures of your PHI will be made only with your written authorization, unless otherwise required by law. You may revoke an authorization in writing at any time, except to the extent that action has already been taken based on your authorization.

Reproductive Health Information Privacy

Federal law provides additional protections for information related to reproductive health care. Dallas Modern Therapy will not use or disclose PHI related to reproductive health care:

For criminal, civil, or administrative investigations
In response to requests from out-of-state entities seeking information about care that is lawful in this state
For proceedings related to the lawful provision or receipt of reproductive health care

If we receive a request that may involve reproductive health information, we are required to obtain a signed attestation from the requesting party before releasing any information, unless disclosure is otherwise required by law.

Your Rights Regarding Your Health Information

You have the right to:

Access your records: Inspect and obtain a copy of your health record, including an electronic copy.
Request an amendment: Ask us to correct information you believe is incorrect or incomplete.
Request confidential communications: Ask us to contact you in a specific way or at a specific location.
Request restrictions: Ask us to limit how your PHI is used or disclosed. We are not required to agree, but we will consider your request.
Receive an accounting of disclosures: Request a list of certain disclosures of your PHI made for reasons other than treatment, payment, or health care operations.
Receive a copy of this Notice: Obtain a paper or electronic copy of this Notice at any time.

To exercise any of these rights, please submit your request in writing.

Changes to This Notice

We reserve the right to change the terms of this Notice. Any changes will apply to all PHI we maintain. The updated Notice will be available upon request and will be posted in our office and on our website.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with:

Dallas Modern Therapy, or
The U.S. Department of Health and Human Services, Office for Civil Rights

Filing a complaint will not affect your care or result in retaliation.

Contact Information

If you have questions about this Notice or wish to exercise your rights, please contact: Dallas Modern Therapy Privacy Officer / Practice Contact 972-767-8075; info@dallasmoderntherapy.com