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.
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Elevate Mental Health Clinic, PLLC (“Elevate,” “we,” “our,” or “us”) is required by law to maintain the privacy of your Protected Health Information (“PHI”), provide you with this Notice of our legal duties and privacy practices with respect to PHI, notify you following a breach of unsecured PHI, and abide by the terms of the Notice currently in effect.
“Protected Health Information” or “PHI” is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health condition and related healthcare services.
We use and disclose PHI to provide, coordinate, or manage your psychiatric care and any related services. For example, we may share information with another physician, pharmacy, laboratory, or specialist to whom we refer you, or with a hospital where you receive emergency care.
We may use and disclose PHI to obtain payment for the healthcare services we provide. For example, we may submit claims to your insurance company that contain information identifying you, your diagnosis, and the treatment provided.
We may use and disclose PHI to support our business activities, including quality improvement, training, credentialing, accreditation, business management, customer service, and administrative tasks. For example, we may use PHI to evaluate the quality of care provided by our clinicians.
We may use and disclose PHI to contact you about appointment reminders, follow-up after visits, alternative or additional treatments, services, or other health-related benefits that may interest you. These contacts may include phone calls, text messages (SMS), or emails.
We will use and disclose your PHI when required by federal, state, or local law to do so.
We may use or disclose PHI without your authorization for purposes including:
Other uses and disclosures of PHI not described in this Notice will be made only with your written authorization, including but not limited to:
You may revoke any authorization at any time in writing, except to the extent we have already taken action in reliance on it.
You have the right to inspect and obtain a copy of PHI in your designated record set, with limited exceptions. We may charge a reasonable, cost-based fee for copies. Submit your request in writing to our office.
You have the right to request that we amend PHI we maintain about you if you believe it is inaccurate or incomplete. We may deny your request in certain circumstances; if we do, we will provide a written explanation and you may file a written statement of disagreement.
You have the right to request an accounting of certain disclosures of your PHI made by us during the six years prior to your request, excluding disclosures for treatment, payment, healthcare operations, and certain other categories.
You have the right to request a restriction on certain uses and disclosures of your PHI for treatment, payment, and healthcare operations, and on disclosures to family members or others involved in your care. We are not required to agree to your request, except that we must agree to a request to restrict disclosure to a health plan if the disclosure is for payment or operations and the PHI pertains solely to a healthcare item or service you paid for in full out of pocket.
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location (for example, by mail to a P.O. Box rather than your home, or by phone at work rather than home). We will accommodate reasonable requests.
You have the right to a paper copy of this Notice at any time, even if you have agreed to receive it electronically. Request one at the front desk or by contacting us.
You have the right to be notified following a breach of unsecured PHI affecting your information.
If your treatment includes services for substance use disorders, additional federal protections under 42 CFR Part 2 may apply. These records cannot be disclosed without your specific written consent except in limited circumstances (medical emergencies, qualified service organization agreements, scientific research, audit/evaluation, or court order).
Texas Health and Safety Code Chapter 611 provides additional protections for mental health records and psychotherapy notes. These records generally cannot be released without your written consent, except as authorized by law.
We are required by law to:
We reserve the right to change this Notice and to make the revised Notice effective for PHI we already have about you, as well as any information we receive in the future. The current Notice will be posted in our office and on our website. You may request a copy at any time.
If you believe your privacy rights have been violated, you may file a written complaint with us or with the Secretary of the U.S. Department of Health and Human Services:
Privacy Officer: Bonny Petty, PA-C
Elevate Mental Health Clinic, PLLC
3613 Williams Dr, Ste 1004
Georgetown, TX 78628
Phone: (512) 817-0011
Email: info@elevatementalhealthclinic.com
Elevate Mental Health Clinic, PLLC
3613 Williams Dr, Ste 1004
Georgetown, TX 78628
Phone: (512) 817-0011 (Georgetown) | (512) 729-1800 (main)
Email: info@elevatementalhealthclinic.com
Effective date: June 26, 2026. Last updated: June 26, 2026.
This document was drafted using standard healthcare-industry templates and should be reviewed by a licensed healthcare attorney before being relied upon as final legal counsel. Elevate Mental Health Clinic, PLLC reserves the right to update this document at any time; the version posted on this website is the controlling version.