Privacy Practices

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.

This Notice of Privacy Practices (the “Notice”) sets forth your rights and JB Counseling & Wellness, PLLC’s (“JBCW”) obligations under the Health Insurance Portability and Account ability Act, 45 C.F.R. Parts 160 and 164 (“HIPAA”); the Texas Medical Records Privacy Act, Tex. Health & Safety Code Ch. 181 (“TMRPA”); and the Identity Theft Enforcement and Protection Act, Tex. Bus. & Com. Code Ch. 521 (“ITEPA”). This Notice is posted in our lobby and on our website. A paper copy is also available upon request during any visit.

All requests that must be made in writing under this Notice may be submitted to the following address:

Julia Bickerstaff, MS, LPC, NCC
JB Counseling & Wellness, PLLC
3101 W. 6th St., Unit 470003
Fort Worth, Texas 76147
juliabickerstaff013@gmail.com

HOW WE MAY USE AND DISCLOSE PROTECTED HEALTH INFORMATION

The following describes the ways we may use and disclose health information that is individually identifiable (“Protected Health Information”). Except for the purposes described below, we will use and disclose Protected Health Information only with your written permission. You may revoke such permission at any time by writing to us at the address provided near the beginning of this Notice. For some of these disclosure purposes, certain categories of records (for example, records regarding sexually-transmitted diseases, mental health, or substance-use disorders) may be subject to heightened protections requiring a separate, explicit consent; court order; or other special requirement to release such information.

For Treatment. We may use and disclose Protected Health Information for your treatment and to provide you with treatment-related health care services. For example, we may disclose Protected Health Information to doctors, nurses, technicians, or other personnel, including people outside our office, who are involved in your medical care and need the information to provide you with medical care.

For Payment. We may use and disclose Protected Health Information so that we or others may bill and receive payment from you, an insurance company, or a third party for the treatment and services you receive. For example, we may give your health plan information about you so that they will pay for your treatment.

For Health Care Operations. We may use and disclose Protected Health Information for health care operations purposes. These uses and disclosures are necessary to make sure that all of our patients receive quality care and to operate and manage our office. For example, we may use and disclose information to remind you of upcoming appointments or to make sure the care you receive is of the highest quality. We also may share information with other entities that have a relationship with you (for example, your health plan) for their health care operation activities.

Individuals Involved in Your Care or Payment for Your Care. Unless you object, we may disclose to a member of your family, a relative, a close friend, or any other person you identify your Protected Health Information that directly relates to that person’s involvement in your health care or to your location or general condition. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment.

Electronic Disclosure of Protected Health Information. Your Protected Health Information may be stored or transmitted electronically for treatment, payment, or health care operations. Any other electronic disclosure of your Protected Health Information, unless otherwise provided for by applicable state or federal laws, requires a separate, specific authorization.

To Avert a Serious and Imminent Threat to Health or Safety. We may use and disclose Protect ed Health Information when necessary to prevent a serious and imminent threat to your health and safety or the health and safety of the public or another person. Disclosures, however, will be made only to someone who may be able to help prevent the threat.

Business Associates. We may disclose Protected Health Information to business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. For example, we may use another company to perform billing services on our behalf. All of our business associates are obligated to protect the privacy of your information.

Public Health Risks. We may disclose Protected Health Information for public health activities. These activities generally include disclosures to prevent or control disease, injury, or disability; report births and deaths; report child abuse or neglect; report reactions to medications or problems with products; notify people of recalls of products they may be using; notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.

Health Oversight Activities. We may disclose Protected Health Information to a health over sight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

Data Breach Notification Purposes. We may use or disclose your Protected Health Information to provide legally required notices of unauthorized access to or disclosure of your Protected Health Information.

Fundraising. We may use or disclose your Protected Health Information for fundraising purposes, including contacting you to raise funds. You have the right to opt out of receiving any such communications, and our provision of services to you will not be affected by your choice to opt out of receiving any fundraising communications from us.

Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose Protected Health Information in response to a court or administrative order. We also may disclose Protect ed Health Information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute.

Law Enforcement. We may release Protected Health Information to federal, state, or local law enforcement officials as required by law.

As Required by Law. We will disclose Protected Health Information when required to do so by any other applicable federal, state, or local law.

YOUR RIGHTS AND PRIVILEGES

You have the following rights and privileges regarding Protected Health Information we have about you:

Right to Inspect and Access Your Health Records. You may see or get an electronic or paper copy of your records. JBCW stores your health records electronically. If you submit a written request for your electronic health records, we will provide those records to you, in electronic form, within fifteen business days, unless the electronic health records are exempt from disclosure. Some exemptions from disclosure include:

a licensed health care professional has determined that access to the records would endanger a person’s life or physical safety;
psychotherapy notes;
records compiled in anticipation of litigation or an administrative proceeding;
the records reference another person (other than a health care provider) and a licensed health care professional has determined that the access is reasonably likely to cause substantial harm to that other person;
the request is being made by your personal representative, and a licensed health care provider has determined that releasing the records to that personal representative is reasonably likely to cause you or another person substantial harm;
records that are prohibited from disclosure by the Privacy Act, 5 U.S.C. § 552a;
records obtained from someone other than a health care provider under a promise of confidentiality when disclosure would be likely to reveal the source of the information; or h. disclosure of the records are otherwise prohibited by law.

Right to Request Amendments to Your Records. If you believe information in your health records is incomplete or incorrect, you can request that we amend your records to correct that information. Requests for amendment must be made in writing to JBCW. Right to an Accounting of Disclosures. You have the right to request a list of disclosures of Protected Health Information in the six years prior to your request. Some disclosures, including those made for purposes of treatment, payment, health care operations, or fulfilling a patient’s written authorization, are not required to be included in an accounting of disclosures. A request for an accounting of disclosures must be made in writing to JBCW.

Right to Request Restrictions on Disclosures. You have the right to request certain restrictions or limitations on the Protected Health Information that we use or disclose for treatment, payment, or health care operations. You have the right to request a restriction on our providing Protected Health Information to other health care providers or facilities that previously provided you with care. You may request a limit on the Protected Health Information that we disclose to someone involved in your care or the payment for your care, like a family member or friend. A request for a restriction on disclosure must be made in writing to JBCW. We are not required to agree to all requests; but, if we agree to a request, we will comply with the request, even if it is not legally required, unless the information must be disclosed to provide you with emergency treatment or nondisclosure would violate applicable law. We are required, however, to agree to requests to restrict disclosure of Protected Health Information to a health plan if the disclosure is not otherwise required by law and the disclosure is for payment or health care operations purposes and the Protected Health Information pertains solely to an item or service that has been paid in full.

Right to Request Confidential Communications. You may request that we communicate with you about health care matters in a certain way or at a certain location. For example, you may re quest that we only contact you by mail or at work. To request a particular communication manner or location, you must make a written request to JBCW. We will accommodate all reasonable requests. Right to Remove Yourself from Any Mailing List We Administer. You may request that we remove you from any mailing lists that we administer. If you so request, you will be removed within 45 days of the request.

Right to Receive a Paper Copy of this Notice. If you would like a paper copy of this Notice of Privacy Practices, our office will provide one to you.

OUR DUTIES

We have the following duties with respect to your Protected Health Information:

Maintenance of Your Protected Health Information. We are required by law to maintain the privacy of your Protected Health Information as described in this Notice and to provide you with this Notice of our legal duties and privacy practices and to follow the terms of the Notice currently in effect.

No Reidentification Without Consent. We will not piece together anonymized data to re-identify any person without the prior written consent of that person.

No Use of Protected Health Information for Marketing Without Consent. We will not use your Protected Health Information for any sort of marketing communications without your written or oral consent, unless such use is made in a face-to-face communication with you or is necessary for the administration of a patient assistance program or a drug savings or discount program.

No Sale of Protected Health Information Except for Certain Uses. We will not sell your Protected Health Information, except that we may receive remuneration in certain circumstances for sending your Protected Health Information to another covered entity for purposes of treatment or health care operations or as otherwise permitted by state or federal law.

Notice of Certain Security Breaches. We will notify you of any breach of system security that results in unauthorized persons having unauthorized access to or using sensitive personal information in an unauthorized manner. This notice shall be provided without unreasonable delay not later than 60 days after the date in which any such breach is discovered, except that the notice may be delayed further if law enforcement determines that notification will impede a criminal investigation. If the breach affected at least 250 persons, we will notify the Texas Attorney General without unreasonable delay not later than 30 days after the date in which the breach is discovered.

POTENTIAL FOR REDISCLOSURE

Protected Health Information that is disclosed to third parties who are not themselves subject to healthcare privacy laws may be redisclosed by them. Healthcare privacy laws may not provide protection in such circumstances.

CHANGES TO THIS NOTICE

This Notice is effective as of September 27, 2025. We may change this Notice at any time and ap ply the provisions of the new notice to Protected Health Information that we already have as well as to any new information we receive in the future. We will post any revised notice in our lobby, on our website, and will give it to you upon request. The notice will contain the effective date in the top-right-hand corner (September 27, 2025).

QUESTIONS, COMPLAINTS, OR REQUESTS

We strive to provide excellent service to each of our clients. If you have questions about your care, complaints, believe we can do better, or need assistance, please reach out to us at the following mailing address, email address, or phone number:

Julia Bickerstaff

JB Counseling & Wellness, PLLC

3101 W. 6th St., Unit 470003

Fort Worth, Texas 76147

julia@jbcounselingwellness.com

(817) 580-4727

You may also file a complaint with the Texas Attorney General’s Consumer Protection Division by going to https://www.texasattorneygeneral.com and searching for “TMHRA complaints” or by calling 1-800-621-0508. Additionally, you may file a complaint with the Secretary of Health and Human Services. We will not retaliate against you for filing a complaint.