Kid Time Counseling PLLC
Effective Date: September 1, 2025

This Notice describes how medical and mental health information about you and your child may be used and disclosed, and how you can get access to this information. Please review it carefully.

We understand that health information about you and your family is personal. We are committed to protecting it. Each time you or your child visit our office, a record is created. This record includes information about symptoms, diagnoses, treatment, and billing. We use this information to provide quality care and to comply with certain legal requirements.

This Notice applies to all records of your care created or maintained by [Practice Name].

“Protected Health Information” (PHI) is any information that identifies you or your child and relates to your health, treatment, or payment for care. Examples include:

• Identifying information (name, birthdate, address)
• Counseling notes, treatment plans, diagnoses
• Billing and insurance information

We may use or share PHI without your written permission in the following ways:

To provide and coordinate care, including sharing information with other healthcare professionals involved in your or your child’s treatment.

To bill and collect payment for services from you, your insurance company, or another responsible party.

To run our practice, improve services, train staff, and ensure quality of care.

We may use or disclose PHI without authorization in certain situations, including:

• Child abuse or neglect: Reporting suspected abuse or neglect to authorities.
• Threats of harm: If there is a serious risk of harm to your child or others.
• Legal proceedings: In response to a valid court order or subpoena.
• Public health and safety: To prevent or lessen a serious threat to health or safety.
• Health oversight activities: For audits, licensing, or investigations.

In all other cases, we will ask for your written authorization before using or disclosing your or your child’s PHI. You may revoke this authorization in writing at any time, except when action has already been taken.

You and/or your child (as permitted by Texas law) have the following rights:

• Right to Inspect and Copy: You may request access to your or your child’s records.
• Right to Amend: You may request corrections if information is inaccurate.
• Right to Request Restrictions: You may ask us not to share certain information (though we are not always required to agree).
• Right to Confidential Communications: You may request that we contact you in specific ways (e.g., by mail, at a certain phone number).
• Right to an Accounting of Disclosures: You may request a list of certain disclosures we have made.
• Right to a Paper Copy of This Notice: You may request a paper copy at any time, even if you have received this Notice electronically.

All requests must be made in writing to our Privacy Officer.

In most cases, parents or guardians have the right to access their child’s counseling records. However, under Texas law, minors 16 years and older may have certain rights to consent to and keep parts of their mental health treatment confidential. We will follow Texas law in these situations and explain your rights as needed.

We are required by law to:

• Maintain the privacy of your PHI
• Provide you with this Notice of our legal duties and privacy practices
• Notify you if a breach of your PHI occur
• Abide by the terms of this Notice

We reserve the right to change this Notice. If we do, the new Notice will apply to all PHI we maintain and will be available at our office and on our website.

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

• Our Privacy Officer: Sharon Montcalm, M.Ed, LPC-Supervisor
• The U.S. Department of Health & Human Services, Office for Civil Rights

You will not be penalized for filing a complaint.

If you have questions about this Notice or your privacy rights, please contact:

Privacy Officer: Sharon Montcalm, M.Ed, LPC-Supervisor
Kid Time Counseling PLLC
(940)268-3900
sharon@kidtimeoounseling.ocm