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Notice of
Privacy Practices



Your health record contains personal information about you and your health. This information about you  that may identify you and that relates to your past, present or future physical or mental health or condition  and related health care services is referred to as Protected Health Information (“PHI”). This Notice of  Privacy Practices describes how we may use and disclose your PHI in accordance with applicable law,  including the Health Insurance Portability and Accountability Act (“HIPAA”), regulations promulgated  under HIPAA including the HIPAA Privacy and Security Rules, and the NASW Code of Ethics. It also describes your rights regarding how you may gain access to and control your PHI.  


We are required by law to maintain the privacy of PHI and to provide you with notice of our legal duties  and privacy practices with respect to PHI. We are required to abide by the terms of this Notice of Privacy Practices. We reserve the right to change the terms of our Notice of Privacy Practices at any time. Any new Notice of Privacy Practices will be effective for all PHI that we maintain at that time. We will provide you with a copy of the revised Notice of Privacy Practices by posting a copy on our website, sending a copy to you in the mail upon request or providing one to you at your next appointment.  




For Treatment. Your PHI may be used and disclosed by those who are involved in your care for the  purpose of providing, coordinating, or managing your health care treatment and related services. This includes consultation with clinical supervisors or other treatment team members. We may disclose PHI to any other consultant only with your authorization. 

For Payment. We may use and disclose PHI so that we can receive payment for the treatment services provided to you. This will only be done with your authorization. Examples of payment-related activities are: making a determination of eligibility or coverage for insurance benefits, processing claims with your insurance company, reviewing services provided to you to determine medical necessity, or undertaking utilization review activities. If it becomes necessary to use collection processes due to lack of payment for services, we will only disclose the minimum amount of PHI necessary for purposes of collection.  


For Health Care Operations. We may use or disclose, as needed, your PHI in order to support our business activities including, but not limited to, quality assessment activities, employee review activities, licensing, and conducting or arranging for other business activities. For example, we may share your PHI with third parties that perform various business activities (e.g., billing or typing  services) provided we have a written contract with the business that requires it to safeguard the privacy of your PHI. For training or teaching purposes PHI will be disclosed only with your authorization.  


Required by Law. Under the law, we must disclose your PHI to you upon your request. In addition, we  must make disclosures to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining our compliance with the requirements of the Privacy Rule. 


Without Authorization. Following is a list of the categories of uses and disclosures permitted by HIPAA  without an authorization. Applicable law and ethical standards permit us to disclose information about  you without your authorization only in a limited number of situations.  




As a social worker licensed in this state and as a member of the National Association of Social Workers, it  is our practice to adhere to more stringent privacy requirements for disclosures without an authorization. The following language addresses these categories to the extent consistent with the NASW Code of Ethics  and HIPAA.  


Child Abuse or Neglect. We may disclose your PHI to a state or local agency that is authorized by law to  receive reports of child abuse or neglect.  


Judicial and Administrative Proceedings. We may disclose your PHI pursuant to a subpoena (with your  written consent), court order, administrative order or similar process. 


Deceased Patients. We may disclose PHI regarding deceased patients as mandated by state law, or to a  family member or friend that was involved in your care or payment for care prior to death, based on your  prior consent. A release of information regarding deceased patients may be limited to an executor or  administrator of a deceased person’s estate or the person identified as next-of-kin. PHI of persons that  have been deceased for more than fifty (50) years is not protected under HIPAA.  


Medical Emergencies. We may use or disclose your PHI in a medical emergency situation to medical  personnel only in order to prevent serious harm. Our staff will try to provide you a copy of this notice as  soon as reasonably practicable after the resolution of the emergency.  


Family Involvement in Care. We may disclose information to close family members or friends directly  involved in your treatment based on your consent or as necessary to prevent serious harm. 


Health Oversight. If required, we may disclose PHI to a health oversight agency for activities authorized  by law, such as audits, investigations, and inspections. Oversight agencies seeking this information  include government agencies and organizations that provide financial assistance to the program (such as  third-party payors based on your prior consent) and peer review organizations performing utilization and  quality control.  


Law Enforcement. We may disclose PHI to a law enforcement official as required by law, in compliance  with a subpoena (with your written consent), court order, administrative order or similar document, for  the purpose of identifying a suspect, material witness or missing person, in connection with the victim of  a crime, in connection with a deceased person, in connection with the reporting of a crime in an  emergency, or in connection with a crime on the premises. 


Specialized Government Functions. We may review requests from U.S. military command authorities  if you have served as a member of the armed forces, authorized officials for national security and  intelligence reasons and to the Department of State for medical suitability determinations, and disclose  your PHI based on your written consent, mandatory disclosure laws and the need to prevent serious harm.  

Public Health. If required, we may use or disclose your PHI for mandatory public health activities to a  public health authority authorized by law to collect or receive such information for the purpose of  preventing or controlling disease, injury, or disability, or if directed by a public health authority, to a  government agency that is collaborating with that public health authority.  


Public Safety. We may disclose your PHI if necessary to prevent or lessen a serious and imminent threat  to the health or safety of a person or the public. If information is disclosed to prevent or lessen a serious  threat it will be disclosed to a person or persons reasonably able to prevent or lessen the threat, including  the target of the threat. 




Research. PHI may only be disclosed after a special approval process or with your authorization.  


Fundraising. We may send you fundraising communications at one time or another. You have the right  to opt out of such fundraising communications with each solicitation you receive. 


Verbal Permission. We may also use or disclose your information to family members that are directly  involved in your treatment with your verbal permission.  


With Authorization. Uses and disclosures not specifically permitted by applicable law will be made  only with your written authorization, which may be revoked at any time, except to the extent that we have  already made a use or disclosure based upon your authorization. The following uses and disclosures will  be made only with your written authorization: (i) most uses and disclosures of psychotherapy notes which  are separated from the rest of your medical record; (ii) most uses and disclosures of PHI for marketing  purposes, including subsidized treatment communications; (iii) disclosures that constitute a sale of PHI;  and (iv) other uses and disclosures not described in this Notice of Privacy Practices.  




You have the following rights regarding PHI we maintain about you. To exercise any of these rights,  please submit your request in writing to our Privacy Officer at ________________________:  


• Right of Access to Inspect and Copy. You have the right, which may be restricted only in  exceptional circumstances, to inspect and copy PHI that is maintained in a “designated record  set”. A designated record set contains mental health/medical and billing records and any other  records that are used to make decisions about your care. Your right to inspect and copy PHI will  be restricted only in those situations where there is compelling evidence that access would cause  serious harm to you or if the information is contained in separately maintained psychotherapy  notes. We may charge a reasonable, cost-based fee for copies. If your records are maintained  electronically, you may also request an electronic copy of your PHI. You may also request that a  copy of your PHI be provided to another person.  


• Right to Amend. If you feel that the PHI we have about you is incorrect or incomplete, you may  ask us to amend the information although we are not required to agree to the amendment. If we  deny your request for amendment, you have the right to file a statement of disagreement with us.  We may prepare a rebuttal to your statement and will provide you with a copy. Please contact the  Privacy Officer if you have any questions.


• Right to an Accounting of Disclosures. You have the right to request an accounting of certain of  the disclosures that we make of your PHI. We may charge you a reasonable fee if you request  more than one accounting in any 12-month period.  


• Right to Request Restrictions. You have the right to request a restriction or limitation on the use  or disclosure of your PHI for treatment, payment, or health care operations. We are not required  to agree to your request unless the request is to restrict disclosure of PHI to a health plan for  purposes of carrying out payment or health care operations, and the PHI pertains to a health care  item or service that you paid for out of pocket. In that case, we are required to honor your request  for a restriction.

• Right to Request Confidential Communication. You have the right to request that we  communicate with you about health matters in a certain way or at a certain location. We will  accommodate reasonable requests. We may require information regarding how payment will be  handled or specification of an alternative address or other method of contact as a condition for  accommodating your request. We will not ask you for an explanation of why you are making the  request.  


• Breach Notification. If there is a breach of unsecured PHI concerning you, we may be required to  notify you of this breach, including what happened and what you can do to protect yourself. 


• Right to a Copy of this Notice. You have the right to a copy of this notice. 


If you believe we have violated your privacy rights, you have the right to file a complaint in writing with the Secretary of Health and Human Services at  200 Independence Avenue, S.W. Washington, D.C. 20201 or by calling (202) 619-0257. We will not  retaliate against you for filing a complaint.  


Ms. Powers is a licensed clinical social worker-supervisor. The Texas Behavioral Health Executive Council investigates and prosecutes professional misconduct committed by marriage and family therapists, professional counselors, psychologists, psychological associates, social workers, and licensed specialists in school psychology. Although not every complaint against or dispute with a licensee involves professional misconduct, the Executive Council will provide you with information about how to file a complaint.
Texas Behavioral Health Executive Council
George H.W. Bush State Office Building
1801 Congress Ave., Ste. 7.300
Austin, Texas 78701
Main Line (512) 305-7700

Investigations/Complaints 24-hour, toll-free system (800) 821-3205


As outlined in the Advisement Form related to your court-ordered adoption/child custody evaluation, the process of such an evaluation is not confidential, and the information acquired during the course of that evaluation, which can include your Protected Health Information (PHI), can be produced to the Court and to the attorneys of record or to clients who represent themselves upon completion of that evaluation.

As a mental health professional, I am required to maintain the privacy of your PHI and to provide you with notice of my legal duties and privacy practices related to your PHI. I am required to abide by the terms of this Notice of Privacy Practices at all times, and while I reserve the right to change the terms of my Notice of Privacy Practices at any time, any new Notice of Privacy Practices will be effective for all PHI that I maintain at that time. Should I change this policy at any time during the course of your evaluation, you will be provided with a copy of the revised Notice of Privacy Practices and asked to sign that new document. Should your evaluation be completed before such a revision occurs, you will not be provided such a copy since my services with your family at that time will no longer be in process. You can access my current Notice of Privacy Practices at any time on my website.



We prioritize transparency in our services, and aim to offer as much as a comprehensive disclosure as possible. While we don't perceive any inherent conflicts of interest in the following professional connections, however, if you and your attorney perceive any issues we want you to have all that information up front.  


I am part of the AFCC, Texas AFCC, and NASW


I also affiliate and take part in independent contracting work for Between Two Homes and Bradley Craig, LMSW


Bradley S. Craig, LMSW-IPR, CFLE 

Mr. Craig is the one of the members of Between Two Homes, LLC where he meets virtually clients or in person at various locations. 



My office is subleased from attorney, Jackie Van Zant; however, I have my own office and suite number.

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