NOTICE OF PRIVACY PRACTICES

Your Information. Your Rights. My Responsibilities.

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.

For purposes of this notice, “protected health information” or “PHI” means health information that identifies you and is protected by applicable privacy laws.

YOUR RIGHTS

When it comes to your health information, you have certain rights.

Get an electronic or paper copy of your health information

You can ask to see or receive an electronic or paper copy of your health information that I maintain about you, subject to applicable law.

You may request a copy or, where permitted, a summary of your health information. I will generally respond within 30 days of receiving your request, as permitted by law. A reasonable, cost-based fee may apply where permitted by law.

Ask me to correct your health information

You can ask me to correct health information about you that you believe is incorrect or incomplete. I may deny your request when permitted by law, but I will provide you with a written explanation.

Request confidential communications

You can ask me to contact you in a specific way or at a specific location—for example, by telephone, email, or mail at a particular address. I will accommodate reasonable requests.

Ask me to limit what I use or share

You can ask me not to use or disclose certain health information for treatment, payment, or health care operations. I am not required to agree to every request.

If you pay for a health care item or service completely out-of-pocket, you may request that I not disclose information about that item or service to your health plan for payment or health care operations, unless disclosure is required by law.

Get a list of certain disclosures

You can request an accounting of certain disclosures of your health information made during the six years preceding your request, subject to the limitations and exceptions provided by law.

Get a copy of this notice

You may request a paper copy of this notice at any time, even if you have agreed to receive it electronically. The current notice will also be available on my website.

Choose someone to act for you

If you have given someone legal authority to act as your personal representative, that person may exercise your rights and make certain choices regarding your health information as permitted by law. I will verify that person's authority before taking action.

File a complaint

If you believe your privacy rights have been violated, you may contact me using the information below. 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 privacy complaint.

YOUR CHOICES

For certain uses and disclosures of your health information, you may have choices about how information is shared.

You may ask me to share information with a family member, close friend, or another person involved in your care or payment for your care. Where permitted by law, I may also disclose limited information to such a person when you are unable to express your preference and I determine that doing so is in your best interest.

You may also request that I communicate with you using a particular method or at a particular location.

I do not use or disclose your PHI for marketing purposes or sell your PHI without your written authorization, except as permitted or required by law.

HOW I MAY USE OR SHARE YOUR HEALTH INFORMATION

Treat you

I may use your health information and share it with other health care professionals when necessary to provide, coordinate, or manage your treatment.

As an LMFT-Associate, I practice under the supervision of a qualified supervisor. I may consult with my supervisor regarding your care as permitted by law. I may also participate in professional consultation when appropriate. I will make reasonable efforts to protect your privacy and limit identifying information shared to what is reasonably necessary.

Run my practice

I may use and disclose your health information as necessary to operate my practice and perform activities permitted by law, including quality improvement, recordkeeping, compliance, professional consultation, and other health care operations.

If I use a third-party service provider that requires access to PHI to perform services for my practice, I will use appropriate privacy and security safeguards as required by law.

Obtain payment

I may use and disclose your health information as necessary to obtain payment for services.

I am a private-pay provider and do not bill health insurance directly. If you request a superbill for possible out-of-network reimbursement, the superbill may contain information such as your name, dates of service, service codes, provider information, charges, and diagnosis code.

Providing a superbill does not guarantee that your insurance company will reimburse you. You are responsible for determining whether your insurance plan provides out-of-network benefits.

HOW ELSE I MAY USE OR SHARE YOUR HEALTH INFORMATION

I may use or disclose your health information when permitted or required by law for purposes such as protecting public health or safety, complying with legal requirements, conducting certain research, or responding to certain government or legal requests. Specific legal requirements and limitations apply to these disclosures.

Required by law

I may use or disclose your health information when required by federal or Texas law. I may also disclose information to the U.S. Department of Health and Human Services when required for purposes of determining compliance with federal privacy law.

Public health and safety

I may use or disclose your health information when permitted or required by law to address certain public health or safety concerns, including when necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.

Abuse, neglect, or exploitation

I may be required by law to report suspected abuse, neglect, or exploitation of a child, elderly person, or person with a disability to the appropriate authority.

Research

I may use or disclose health information for research when permitted by applicable law and when the required privacy protections and approval processes are satisfied.

Workers' compensation

I may disclose health information as necessary to comply with applicable workers' compensation laws.

Law enforcement and government requests

I may disclose health information to law enforcement or government authorities when permitted or required by applicable law. These disclosures are subject to the requirements and limitations of federal and Texas law.

Lawsuits and legal proceedings

I may disclose health information in response to a court or administrative order or other lawful process when permitted or required by applicable law.

Medical examiners and similar purposes

I may disclose health information to a medical examiner, coroner, or other authorized person when permitted or required by law.

SUBSTANCE USE DISORDER RECORDS

To the extent that I create or maintain substance use disorder patient records that are subject to 42 CFR Part 2, those records may have additional federal privacy protections.

Part 2 generally restricts the use or disclosure of covered substance use disorder records in civil, criminal, administrative, or legislative proceedings against a patient unless the applicable requirements for consent or a court order and subpoena are satisfied.

USES THAT REQUIRE YOUR WRITTEN AUTHORIZATION

Certain uses and disclosures require your written authorization.

These generally include:

• Most uses and disclosures of psychotherapy notes maintained separately from the rest of your health record

• Uses or disclosures for marketing purposes

• Disclosures that constitute a sale of PHI

• Other uses or disclosures not described in this notice that are not otherwise permitted or required by law

If you provide written authorization, you may generally revoke it in writing at any time, except to the extent action has already been taken in reliance on the authorization.

TEXAS MENTAL HEALTH PRIVACY

Texas law provides additional confidentiality protections for mental-health communications and records.

Texas Health and Safety Code Chapter 611 generally provides that communications between a patient and a professional, as well as records concerning a patient's identity, diagnosis, evaluation, or treatment, are confidential and may be disclosed only as authorized by applicable law.

I will comply with applicable Texas confidentiality requirements in addition to federal privacy requirements.

For more information about the specific circumstances in which confidentiality may be limited, please see the confidentiality section of your informed consent/working relationship agreement.

TELEHEALTH AND ELECTRONIC COMMUNICATIONS

Telehealth services are primarily conducted through Sessions Health, a HIPAA-compliant platform that uses encryption to protect information in transit and at rest. Sessions Health and the practice are covered by a Business Associate Agreement (BAA).

Other secure technology platforms may be used when clinically appropriate and when appropriate privacy and security safeguards are in place.

I use reasonable administrative, technical, and physical safeguards to protect your health information. I do not record audio or video therapy sessions without your written authorization.

Electronic communications, including email and text messaging, may carry privacy or security risks. Information about the risks and your communication preferences is provided in my informed consent and electronic communication policies.

SUPERBILLS AND OUT-OF-NETWORK REIMBURSEMENT

If requested, I may provide you with a superbill for possible submission to your health insurance company for out-of-network reimbursement.

A superbill may include:

• Your name

• Dates of service

• Service codes

• Provider information

• Charges and amounts paid

• Diagnosis code

Submitting a superbill to your insurance company may result in your health information being disclosed to that company. I do not submit claims to insurance companies on your behalf unless separately agreed upon.

Providing a superbill does not guarantee insurance reimbursement.

MY RESPONSIBILITIES

I am required by law to:

• Maintain the privacy and security of your PHI.

• Provide you with this notice describing my legal duties and privacy practices.

• Follow the privacy practices described in the notice currently in effect.

• Notify you as required by law if a breach occurs that may have compromised the privacy or security of your PHI.

• Make the current notice available to you upon request.

I may change the terms of this notice. Any revised notice will apply to PHI I maintain and will be made available upon request and on my website.

QUESTIONS OR PRIVACY COMPLAINTS

Privacy Contact:
Annie Dahm, M.Ed., LMFT-Associate
Annie Dahm Therapy, PLLC
Email: wetalk@anniedahmtherapy.com
Phone: (254) 489-8369

If you have questions about this notice or my privacy practices, please contact me using the information above.

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.

EFFECTIVE DATE

August 18, 2026