Notice of Privacy Practices
Effective August 1, 2025
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Purpose of the Notice of Privacy Practices: Dragonfly Therapeutic Services (DTS) preserves the confidentiality of your protected health information (PHI) as required by federal and Texas law. However, providers of mental health services at DTS must use and disclose client information as necessary to deliver quality care and to the extent necessary to provide treatment, obtain payment, or perform healthcare operations. The law requires DTS to:
• Ensure the privacy of PHI that identifies you
• Provide this notice of DTS’s legal responsibility and privacy practices related to PHI
• Honor the terms of the notice currently in effect. DTS has the right to change the terms of this
notice. If DTS exercises that right, changes will apply to all your information on file with DTS.
Protected Health Information (PHI) and Your Rights: This Notice describes how DTS may use and disclose PHI for treatment, payment, healthcare operations, and other purposes permitted or required by law. Certain sensitive disclosures, including mental health records beyond psychotherapy notes, substance abuse treatment records, and HIV-related information, may require separate written authorization under Texas law
Treatment, Payment, and Healthcare Operations: Your PHI is the basis for planning your care and treatment and serves as a means of communication among healthcare providers involved in your care. For example, one provider may share information with another provider to make a proper diagnosis. DTS also uses your PHI to obtain payment for services we provide to you as required by your insurance company. DTS can also use your PHI to improve our quality of care (e.g., training).
Use and Disclosure of PHI: Your PHI may be used or disclosed, in addition to providing treatment, obtaining payment, and performing healthcare operations, for the following purposes (unless you request restrictions on a specific use or disclosure):
• Appointment reminders
• Providing information regarding treatment alternatives, benefits, or services that may interest you (as
required by law)
• Public health activities
• Notifying the appropriate authorities of suspected child, elder, or dependent abuse or neglect
• Granting information, in the event of an emergency, to any emergency treatment provider who delivers
emergency treatment to you
• Preventing or lessening a serious and imminent threat to the health and safety of a person or the public by
disclosure to person(s) reasonably able to prevent or reduce the threat
• Health oversight activities (e.g., audits and investigations)
• Worker’s compensation or other similar programs established by law, to the extent authorized and
necessary to comply with applicable laws
• Participation in lawsuits, disputes, or other judicial/administrative proceedings to which DTS is a party,
including responding to a court or administrative order. DTS may disclose your information in response to a court or administrative order for a lawsuit to which you are a party. DTS may also disclose information about your child or dependent in response to a subpoena, discovery request, or other lawful processes by someone involved in the dispute, but only after making efforts to tell you about the request or obtain an order protecting the requested information.
• Reporting crimes occurring at DTS offices to law enforcement
• Coroners, medical examiners, or funeral directors
• Research projects approved by an institutional review board
• Carrying out treatment, payment, or healthcare operations functions through a business associate under a written agreement requiring the business associate to protect the information. The minimum necessary standard for disclosure does not apply to treatment purposes, which include, but are not limited to, coordinating and managing health care providers with a third party, consulting between health care providers, and referrals for health care from one provider to another. Therapists and other health care providers need access to complete client records to deliver quality care.
• Releasing information about inmates of a correctional institution to the institution
• National Security, intelligence or counter-intelligence activities operations, or the protection of government officials and dignitaries
• When state or federal law requires disclosure and disclosure complies with and is limited to the relevant requirements of those laws.
• DTS does not sell your PHI.
• If PHI is disclosed electronically, DTS will inform you and obtain specific consent, as required under Texas law
Disclosures Requiring Your Authorization: Except as previously described, DTS will not use or disclose your PHI unless you authorize such use or disclosure in writing. You may revoke permission to use or disclose your PHI, which will be effective upon receipt of written revocation.
Your Rights Concerning Your PHI: You may invoke the following rights regarding your PHI by completing a written request using the form provided for you by DTS.
• Right to request a restriction – You may request that DTS restrict their uses or disclosures of your PHI for providing treatment, obtaining payment, or performing healthcare operations. However, DTS is not obligated to comply with your request.
• Right to object to disclosure to friends or family members – If you indicate a friend, family member, or other person is involved in your care or payment for services, DTS may provide them with your PHI unless you object. Your opportunity to consent may occur retroactively in the case of an emergency.
• Right to confidential communication – DTS agrees to all reasonable requests to contact you in a specific manner (e.g., work or home phone) or send written communications to a different address.
• Right to inspect and copy – You may request an electronic or paper copy of your medical record and other information DTS has about you (other than psychotherapy notes). DTS will provide a copy or a summary of your record within 30 days of your written request. We reserve the right to charge a reasonable fee for this service.
• Right to request amendment – If you believe there is missing or mistaken information in your PHI, you may request that DTS correct the records or include the missing information. However, DTS is not obligated to comply with your request.
• Right to an accounting of disclosures – You may request that DTS provide a list of PHI disclosures to persons or entities in the past 6 years. This list will exclude disclosures made to you, with your authorization, or for providing treatment, obtaining payment, or performing healthcare operations. You are entitled to one request for this accounting at no charge. DTS may charge a reasonable fee for additional requests.
• Right to a copy of this notice – You may request a paper copy of this notice at any time, even if you have already received an electronic copy.
• Right to make a complaint – If you believe your privacy has been violated, you may file a complaint with DTS, the Secretary of the United States Department of Health and Human Services, and/or the Texas Attorney General’s Office. You will not be penalized or retaliated against for making a complaint. Please call our main office number if you wish to register a complaint, ask questions about this notice, request restrictions on uses and disclosures of your PHI, or obtain a form to exercise your right(s).
Texas Office of the Attorney General: https://www.texasattorneygeneral.gov/consumer-protection/health-care/patient-privacy
