The views and descriptions herein of My Rooted Soul Counseling website constitute the opinions and thoughts of the writer and are considered to be educative in nature and form. No form of this website is viewed as therapeutic treatment, psychological therapy, legal advice, absolutes, or continuing education units. As such the user should understand its use to be at one’s own risk. Should adverse events, writing consideration, use of views, creation of an event or enforcement of such views on the self or public cause pain, problems or changes that are unwelcome the writer is not liable for said circumstances unless participating in a mutual legally binding treatment consent contract provided during initial scheduling and first appointments to all clients.

NOTICE OF PRIVACY PRACTICES

ANDREW SIEFERS COUNSELING, PLLC

dba MY ROOTED SOUL COUNSELING

Cell: (972) 977-5885

WEBSITE: www.myrootedsoul.com

OFFICE ADDRESS:

1400 North Coit Road, Suite 1203, McKinney, TX 75071

 

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

PLEASE REVIEW IT CAREFULLY.

I understand that information about you and your counseling is personal, and I am committed to protecting it. I keep a record of the care you receive from me. This notice explains how I may use and share that information, your rights regarding it, and my legal duties. Your health information is called protected health information (PHI). Because I practice in Texas, I follow both the federal HIPAA Privacy Rule and Texas mental health records law, and where Texas law is stricter, I follow Texas law.

My Duties

I am required by law to:

  • Keep your PHI private and secure.

  • Give you this notice of my legal duties and privacy practices.

  • Follow the terms of the notice currently in effect.

  • Notify you promptly if a breach occurs that may have compromised the privacy or security of your information.

  • Not use or share your information other than as described in this notice unless you authorize it in writing.

How I May Use and Share Your Information Without Your Authorization

Treatment. I use your information to provide your care. I share it with other treating providers, such as your physician or psychiatrist, only with your written authorization. I may consult with other professionals about your care without using your name or identifying information.

Payment. If you use insurance, I share the information your insurer requires to process claims, such as dates of service and diagnosis. If an account must be sent to collections, I share only the minimum information necessary.

Practice operations. I use your information to run my practice, such as sending appointment reminders. Companies that help me operate, such as my electronic health record and billing system, may handle your information only under a written agreement requiring them to protect it.

When the law requires or permits it. I may share information without your authorization only in these situations:

  • Danger to self or others. To medical or law enforcement personnel if I determine there is a probability of imminent physical injury to you or others, or of immediate mental or emotional injury to you.

  • Abuse or neglect. To report suspected abuse, neglect, or exploitation of a child, an elderly person, or a person with a disability, as Texas law requires.

  • Exploitation by a provider. To report sexual exploitation of a client by a mental health provider, as Texas law requires.

  • Government agencies. When required or authorized by law, including investigations by my licensing board or by the U.S. Department of Health and Human Services.

  • Court orders and legal proceedings. In judicial or administrative proceedings only as Texas law permits, such as in response to a court order. A subpoena alone is not enough; I will seek your authorization or a court order first.

  • Audits and research. To qualified personnel for audits, program evaluation, or research, who may not identify you in any report.

  • Legal action involving me. To defend myself in a complaint or legal action you bring against me, or to collect fees owed, sharing only what is necessary.

Uses and Disclosures That Require Your Authorization

Except as described above, I will share your information only with your written authorization. This includes sharing with family members, other providers, employers, churches, or anyone else you designate.

  • Process notes. In addition to your main record, I may keep separate process notes (called psychotherapy notes under HIPAA). When I release your records to you, I usually include them. They will be released to anyone else only with your specific written authorization or a court order, or as the law otherwise permits, such as for my own use in supervision and training, in defending myself in legal action you bring, or in an investigation by the U.S. Department of Health and Human Services.

  • Marketing. I will not use or share your information for marketing.

  • Sale of information. I will not sell your information.

Revoking authorization. You may revoke any authorization in writing at any time. Revoking it does not undo disclosures already made while it was in effect.

Special Protections

Texas mental health records law. Texas Health and Safety Code Chapter 611 gives your mental health records stronger protection than federal law in several areas. Where Texas law is stricter, I follow it.

Substance use disorder records. If I receive records about you from a substance use disorder treatment program protected by federal law (42 CFR Part 2), those records will not be used or disclosed in any civil, criminal, administrative, or legislative proceeding against you without your written consent or a court order that meets federal requirements.

Your Rights

To use any of these rights, submit your request in writing through the client portal or to andrew@myrootedsoul.com.

  • See and get a copy of your record. You may request your record, and I will provide it within 15 business days of your written request, electronically unless you agree to another format. Fees are cost-based and listed in your Client Services Agreement. Under Texas law, I may withhold a portion of your record only if releasing it would harm your physical, mental, or emotional health; if I do, I will explain why in writing and you may ask for the decision to be reviewed.

  • Ask me to correct your record. If you believe information is wrong or incomplete, you may ask me to amend it. I may say no, but I will explain why in writing within 60 days.

  • Get a list of disclosures. You may request a list of times I shared your information for purposes other than treatment, payment, or practice operations, or as you authorized, covering up to six years. The first list in any 12-month period is free.

  • Ask me to limit what I share. You may ask me not to use or share certain information. I am not required to agree, except that if you pay for a service in full out of pocket and ask me not to share it with your health plan, I will honor that request.

  • Choose how I contact you. You may ask me to reach you in a specific way or at a specific address, and I will agree to reasonable requests.

  • Get a copy of this notice. You may request a paper or electronic copy at any time.

  • Choose someone to act for you. If you have given someone medical power of attorney or have a legal guardian, that person can exercise your rights.

Questions, Records Requests, and Complaints

Requesting your records. You may request a copy of your mental health records by contacting me through the client portal or at andrew@myrootedsoul.com, as described under Your Rights.

If you believe your privacy rights have been violated or have a concern about your care, you may file a complaint with any of the following. I will not retaliate against you for filing a complaint.

  • My practice: Andrew Siefers Counseling, PLLC, dba My Rooted Soul Counseling, 1400 North Coit Road, Suite 1203, McKinney, Texas 75071 · (972) 977-5885 · andrew@myrootedsoul.com

  • Texas Behavioral Health Executive Council (my licensing authority): George H.W. Bush State Office Building, 1801 Congress Avenue, Suite 7.300, Austin, Texas 78701 · (512) 305-7709 or 1-800-821-3205 · bhec.texas.gov · enforcement@bhec.texas.gov

  • Texas Attorney General, Consumer Protection Division: texasattorneygeneral.gov/consumer-protection

  • U.S. Department of Health and Human Services, Office for Civil Rights: 200 Independence Avenue SW, Washington, D.C. 20201 · 1-800-368-1019 · www.hhs.gov/ocr/complaints

Changes to This Notice

I reserve the right to change this notice and my privacy practices. Changes apply to all information I maintain, including information created or received before the change. The current notice is always available on my website, in my office, and on request.

Effective October 17, 2026. Originally effective February 24, 2018.