Notice of Privacy Practices

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.

Effective Date: June 2026

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, the Texas Medical Records Privacy Act (Texas Health & Safety Code Chapter 181), 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 prominently posting the updated version on our practice website or by providing an electronic copy directly to you upon request at your next digital appointment.

NOTICE OF ELECTRONIC DISCLOSURE OF PHI

In accordance with Texas Health & Safety Code § 181.154, notice is hereby given that your Protected Health Information (PHI) may be created, received, stored, or transmitted electronically. This electronic health information is subject to the same stringent privacy and security protections outlined in this Notice.

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU

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 external consultant or provider 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. Examples of payment-related activities include: making a determination of eligibility or coverage for insurance benefits, processing claims with your health 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 Business Associate Agreement 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 (Permitted Uses and Disclosures)

Following is a list of the categories of uses and disclosures permitted by HIPAA without an authorization. As a social worker licensed in the State of Texas 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 authorization. The following language addresses these categories to the extent consistent with Texas law, 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 (such as the Texas Department of Family and Protective Services).

• Judicial and Administrative Proceedings: We may disclose your PHI pursuant to a court order, administrative order, or similar legal process. Disclosures in response to a subpoena generally require your written consent or a qualified protective order.

• Deceased Patients: We may disclose PHI regarding deceased patients as mandated by state law, or to a family member or friend who 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 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 court order, administrative order, or similar document, or for the purpose of identifying a suspect, material witness, or missing person.

• 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 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.

• 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. Information will only 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 use or disclose your information to family members that are directly involved in your treatment with your verbal permission.

With Written 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 in writing (except to the extent that we have already acted in reliance on it).

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

1. Most uses and disclosures of psychotherapy notes which are separated from the rest of your medical record.

2. Most uses and disclosures of PHI for marketing purposes, including subsidized treatment communications.

3. Disclosures that constitute a sale of PHI.

4. Other uses and disclosures not explicitly described in this Notice of Privacy Practices.

YOUR RIGHTS REGARDING YOUR PHI

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

Diane Yang, LCSW, at innerzen@innerzenpllc.com.

• Right of Access to Inspect and Copy: You have the right to inspect and copy PHI that is maintained in a “designated record set” (your mental health/medical and billing records). Your right to inspect and copy PHI may be restricted only in exceptional situations where there is compelling clinical 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 request an electronic copy. In accordance with Texas Health & Safety Code § 181.102, we will fulfill your written request to inspect or copy your records within fifteen (15) business days of receipt.

• 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.

• Right to an Accounting of Disclosures: You have the right to request an accounting of certain 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 solely to a health care item or service for which you have paid out-of-pocket in full. In that case, we are required to honor your request.

• 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 the specification of an alternative address/method of contact as a condition for accommodation.

• Breach Notification: If there is a breach of unsecured PHI concerning you, we are required to notify you of this breach, including what happened and what steps you can take to protect yourself.

• Right to a Copy of this Notice: You have the right to a paper or electronic copy of this notice.

COMPLAINTS

If you believe your privacy rights have been violated, you have the right to file a complaint in writing with our Privacy Officer:

Diane Yang, LCSW (Privacy Officer)

InnerZen PLLC

Mailing Address: 1919 Taylor Street, STE F, #1335, Houston, TX 77007

Email: innerzen@innerzenpllc.com

You may also file a complaint with state and federal regulatory bodies:

Texas Behavioral Health Executive Council (BHEC)

Texas State Board of Social Worker Examiners

333 Guadalupe St, Tower 3, Room 900

Austin, TX 78701

Phone: (800) 821-3205

Secretary of the U.S. Department of Health and Human Services

200 Independence Avenue, S.W.

Washington, D.C. 20201

Phone: (202) 619-0257

We will not retaliate against you for filing a complaint.