Effective Date: May 22, 2026

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.

Our Commitment to Your Privacy

Cinco Ranch Psychiatry is committed to protecting the privacy of your health information. This Notice of Privacy Practices explains how we collect, use, disclose, and safeguard your protected health information (PHI) in compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the HITECH Act, and the Texas Medical Records Privacy Act (Texas Health Safety Code, Chapter 181). We are required by law to maintain the privacy of your PHI, provide you with this notice, and follow the terms of this notice currently in effect.

How We May Use and Disclose Your Health Information

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

Treatment — We may use your PHI to provide, coordinate, or manage your psychiatric care. This includes sharing information with other healthcare providers involved in your treatment, such as your primary care physician, therapist, or specialists, when clinically necessary.

Payment — We may use and disclose your PHI to bill and collect payment for the services we provide. This may include sharing information with your health insurance plan, a billing service, or other third parties involved in payment for your care.

Healthcare Operations — We may use your PHI for activities that support the operation of our practice, including quality improvement, staff training, compliance activities, and business planning.

As Required by Law — We may disclose your PHI when required to do so by federal, state, or local law.

Public Health and Safety — We may disclose your PHI to prevent a serious and imminent threat to your health or safety or the health or safety of others. We may also disclose PHI for public health activities such as reporting communicable diseases.

Judicial and Administrative Proceedings — We may disclose your PHI in response to a court order, subpoena, or other lawful process.

Law Enforcement — We may disclose limited PHI to law enforcement officials under specific circumstances as permitted by law.

Coroners, Medical Examiners, and Funeral Directors — We may disclose PHI to these individuals as necessary for them to carry out their duties.

Workers’ Compensation — We may disclose your PHI as authorized by workers’ compensation laws.

Military and Veterans — If you are a member of the armed forces, we may disclose your PHI as required by military command authorities.

Abuse or Neglect — We may disclose your PHI to appropriate authorities if we reasonably believe you are a victim of abuse, neglect, or domestic violence.

Health Oversight Activities — We may disclose your PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections.

Uses and Disclosures That Require Your Written Authorization

The following uses and disclosures of your PHI will only be made with your written authorization:

• Psychotherapy notes (notes recorded by your psychiatrist during or after a counseling session that are kept separate from your medical record)
• Marketing purposes
• Sale of your PHI
• Most electronic disclosures of your PHI to third parties beyond treatment, payment, and healthcare operations, as required under Texas law
• Any other uses and disclosures not described in this notice

You may revoke your authorization at any time by submitting a written request to our Privacy Officer. Revocation will not affect any actions we took in reliance on your authorization before we received your revocation.

Special Protections for Mental Health Information

As a psychiatric practice, we want you to understand that your mental health records receive additional protections under both federal and Texas law:

• Psychotherapy notes are maintained separately from your medical record and require your specific written authorization before disclosure in almost all circumstances.
• Under Texas law, confidential communications between a patient and a mental health professional are privileged and may not be disclosed without your consent except in limited circumstances (e.g., imminent danger to yourself or others, court-ordered evaluations, or reports of abuse).
• We will not disclose your mental health information to your employer, family members, or other third parties without your written authorization unless required by law or necessary to prevent serious harm.

Your Rights Regarding Your Health Information

You have the following rights regarding your PHI:

Right to Access — You have the right to inspect and obtain a copy of your PHI maintained in your medical record. Under Texas law, we will provide copies within 15 business days of receiving your written request. Reasonable fees may apply for copying and mailing.

Right to Amend — You have the right to request that we amend your PHI if you believe it is incorrect or incomplete. We may deny your request under certain circumstances, but we will provide you with a written explanation if we do.

Right to an Accounting of Disclosures — You have the right to request a list of certain disclosures we have made of your PHI. This list will not include disclosures made for treatment, payment, or healthcare operations, or disclosures you authorized in writing.

Right to Request Restrictions — You have the right to request that we restrict how we use or disclose your PHI for treatment, payment, or healthcare operations. We are not required to agree to your request, except that we must agree to restrict disclosure to a health plan if you pay for a service in full out of pocket and the disclosure is not required by law.

Right to Request Confidential Communications — You have the right to request that we communicate with you about your health information in a specific way or at a specific location. For example, you may request that we contact you only by mail or at a specific phone number.

Right to a Paper Copy of This Notice — You have the right to obtain a paper copy of this notice at any time, even if you previously agreed to receive it electronically.

Right to Be Notified of a Breach — You have the right to be notified if there is a breach of your unsecured PHI.

Our Responsibilities

• We are required by law to maintain the privacy and security of your PHI.
• We will notify you promptly if a breach occurs that may have compromised the privacy or security of your PHI.
• We will not use or disclose your PHI for marketing purposes or sell your PHI without your written authorization.
• We will not use or disclose your psychotherapy notes without your written authorization except in limited circumstances permitted by law.
• All employees and staff members who have access to PHI have completed HIPAA privacy and security training as required by Texas law (Texas Health Safety Code §181.101).

Electronic Communications and Telehealth

• Email, text messages, and website contact forms are not fully secure methods of communication. Please do not send sensitive health information through these channels unless you understand and accept the risks.
• If you participate in telehealth appointments, your information is transmitted through secure, HIPAA-compliant platforms. A separate Telehealth Informed Consent form is provided and must be signed before telehealth services begin.
• Our website may use cookies or similar technologies for functionality purposes. We do not use tracking technologies that transmit your health information to third parties.

Changes to This Notice

We reserve the right to change the terms of this notice at any time. Any changes will apply to all PHI we maintain. The revised notice will be posted on our website at https://cincoranchpsychiatry.com/privacy-policy/ and will be available at our office. You may request a copy of the current notice at any time.

Complaints

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

Nicole Stahl, M.D.

Cinco Ranch Psychiatry

5757 Flewellen Oaks Lane, Suite 304

Fulshear, TX 77441

713.332.4388

You can also file a complaint with:

U.S. Department of Health and Human Services

Office for Civil Rights

1301 Young Street, Suite 1169

Dallas, TX 75202

Phone: (800) 368-1019

Website: www.hhs.gov/ocr/privacy/hipaa/complaints

Texas Attorney General

Consumer Protection Division

P.O. Box 12548

Austin, TX 78711

Phone: (800) 252-8011

Website: www.texasattorneygeneral.gov

You will not be penalized or retaliated against for filing a complaint.

Contact Information

If you have any questions about this notice or our privacy practices, please contact:

Nicole Stahl, M.D.

Cinco Ranch Psychiatry

5757 Flewellen Oaks Lane, Suite 304

Fulshear, TX 77441

713.332.4388