Notice of Privacy Practices

Moonrise Mental Health
(DBA of Orange Cats Club PLLC)
5900 Balcones Drive STE 100, Austin, TX 78731

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

I. Our Pledge Regarding Health Information

We understand that health information about you and your healthcare is personal. We are committed to protecting your health information. We create a record of the care and services you receive to provide you with quality care and to comply with certain legal requirements. This notice applies to all the records of your care generated by our 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; and
• Inform you that we may change the terms of this notice, and that 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

We may use or disclose your PHI for treatment, payment, and health care operations without your written authorization. For example:

• To coordinate care with other healthcare providers.
• To submit claims to your health insurance plan.
• For internal administrative purposes.

Disclosures for treatment purposes are not subject to the minimum necessary standard, as full access to your information is needed to provide effective care.

Telehealth Services

We offer services via telehealth. Your PHI shared via telehealth will be protected with reasonable safeguards. Please be aware that electronic communications involve certain inherent security risks, despite our best efforts to protect them.

Lawsuits and Disputes

We may disclose health information in response to a court or administrative order, or under other legal processes with appropriate protections.

III. Certain Uses and Disclosures Require Your Authorization

Psychotherapy Notes: Use or disclosure of psychotherapy notes requires your specific authorization unless for:

• Treatment;
• Training or supervision purposes;
• Legal defense;
• Regulatory compliance;
• Legal requirements;
• Coroner duties;
• Serious threats to health or safety.

Marketing Purposes: We will not use or disclose your PHI for marketing.

Sale of PHI: We will not sell your PHI.

IV. Certain Uses and Disclosures Do Not Require Your Authorization

We are permitted to use and disclose your PHI without your authorization for:

• When required by law.
• For public health activities.
• For health oversight activities.
• For judicial and administrative proceedings.
• For law enforcement purposes.
• To coroners or medical examiners.
• For research purposes.
• For specialized government functions.
• For workers' compensation purposes.
• For appointment reminders and information about health-related benefits and services.

V. Certain Uses and Disclosures Require You to Have the Opportunity to Object

We may provide your PHI to a family member, friend, or other person involved in your care or the payment for your health care unless you object.

VI. Your Rights Regarding Your PHI

You have the following rights:

• Request Restrictions: You may ask us not to use or disclose certain PHI for treatment, payment, or health care operations. We are not required to agree.
• Request Restrictions for Out-of-Pocket Payments: If you paid out-of-pocket in full for a healthcare service, you may request that the PHI related to that service not be disclosed to a health plan.
• Confidential Communications: You may request communications via specific methods or locations.
• Inspect and Copy: You have the right to inspect and obtain a copy of your medical records, excluding psychotherapy notes.
• Amend PHI: You may request corrections to your PHI.
• Accounting of Disclosures: You can request a list of disclosures made of your PHI.
• Paper or Electronic Copy of This Notice: You have the right to receive this notice electronically or in paper form.

VII. Complaints

If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer or with the Secretary of the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.

To file a complaint with us, contact:

Shelbee Hensley
Moonrise Mental Health
(DBA of Orange Cats Club PLLC)
5900 Balcones Drive STE 100
Austin, TX 78731
Phone: 1.972.638.9647

To file a complaint with HHS, follow instructions at: https://www.hhs.gov/hipaa/filing-a-complaint/index.html

VIII. Website Contact Forms and Non-Secure Communication

Please note that our website contact form and general email are not secure or HIPAA-compliant methods of communication. Do not submit any personal health information (PHI) through the contact form or unencrypted email. For secure communication, please use our HIPAA-compliant client portal or speak with us directly.

IX. Website Privacy Practices

In addition to our obligations under HIPAA, we may use standard website technologies such as cookies and third-party analytics tools (e.g., Google Analytics) to understand how visitors interact with our website. These tools collect non-personal information such as browser type, IP address, and pages visited. This information helps us improve the site and user experience.

These analytics tools do not collect or access your personal health information (PHI), and their use is distinct from our clinical or HIPAA-covered services. By using our website, you consent to the collection and use of such information as described.

Effective Date of This Notice: April 28, 2025

Acknowledgment 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 (PHI). By checking the box or signing below, you are acknowledging that you have received a copy of this HIPAA Notice of Privacy Practices.

Patient Name: ___________________________
Date: ___________________________
Signature: ___________________________
If signed by a personal representative, state authority: ___________________________