Connect and Restore Therapy, LLC
Stacy Huddleston, LCSW
Effective date: September 10, 2026
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.
I am required by law to protect the privacy of your health information. Your health information includes records of our sessions, your diagnosis and treatment, and your billing information. This notice explains how I may use and share that information, your rights, and my responsibilities. In this notice, “I,” “me,” and “my” refer to Stacy Huddleston, LCSW, and Connect and Restore Therapy, LLC.
Get a copy of your records. You can ask to see or get a copy of your health information, on paper or electronically. Please make your request in writing. I will provide a copy, or a summary if you agree, within 15 business days. I may charge a reasonable, cost-based fee. In limited cases, I may deny access to part of your records if I believe it could seriously harm you or someone else. If that happens, I will explain why in writing, and you may ask to have the decision reviewed by another licensed professional.
Ask me to correct your records. If you believe information in your records is incorrect or incomplete, you can ask me in writing to correct it. I may say no, but I will tell you why in writing within 60 days.
Request confidential communications. You can ask me to contact you in a specific way, such as only on your cell phone, or to send mail to a different address. I will say yes to all reasonable requests.
Ask me to limit what I use or share. You can ask me not to use or share certain health information for treatment, payment, or my practice operations. I am not required to agree if it would affect your care. If you pay for a service out of pocket in full, you can ask me not to share information about that service with your health insurer. I will say yes unless a law requires me to share it.
Get a list of those I have shared information with. You can ask for a list of the times I have shared your health information in the six years before your request, who I shared it with, and why. The list will not include disclosures for treatment, payment, or practice operations, or disclosures you asked me to make. I will provide one list a year for free and may charge a reasonable, cost-based fee for additional lists within 12 months.
Get a copy of this notice. You can ask for a paper copy of this notice at any time, even if you agreed to receive it electronically.
Choose someone to act for you. If you have given someone medical power of attorney, or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. I will confirm that the person has this authority before I act.
File a complaint if you believe your rights have been violated. You can contact me using the information at the end of this notice. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by writing to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. You may also contact the Texas Behavioral Health Executive Council, which licenses social workers in Texas. I will not retaliate against you for filing a complaint.
You can tell me whether to share information with people involved in your care. This includes family members, close friends, or others who help with your care or payment. If you are not able to tell me your preference, such as in an emergency, I may share information if I believe it is in your best interest. I may also share information when needed to lessen a serious and imminent threat to health or safety.
Appointment reminders. I may contact you by phone, text message, or email about appointments. Regular text messages and email are not fully secure. Tell me if you prefer a different way to be contacted.
I will never share your information without your written permission for:
To treat you. I use your health information to provide your care. For example, I may coordinate with your doctor or psychiatrist about your treatment.
To run my practice. I use your health information for scheduling, record keeping, and to maintain the quality of my services. Companies that support my practice, such as SimplePractice, which provides my electronic health record and telehealth platform, must sign agreements to protect your information.
To bill for your services. I may share information with your health insurance plan, such as dates of service and diagnosis, so it will pay for your care.
Texas law gives mental health records extra protection. When Texas law is stricter than federal law, I follow Texas law. These situations are uncommon, and I share only the information needed:
When required by law. For example, if the U.S. Department of Health and Human Services asks to review my compliance with federal privacy law.
To report abuse or neglect. I am required by Texas law to report suspected abuse or neglect of a child, an elderly person, or a person with a disability.
To prevent serious harm. I may share information with 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.
For health oversight. For example, during an investigation or audit by my licensing board or another oversight agency.
For legal proceedings. In response to a court order, or as otherwise permitted by Texas law.
For government functions. For workers’ compensation claims, for special government functions such as military or national security activities, or to a medical examiner, only as the law allows.
Substance use disorder records. If I receive records protected by federal confidentiality rules for substance use disorder treatment (42 CFR Part 2), I will not use or share them in any civil, criminal, administrative, or legislative investigation or proceeding against you unless you give written consent or a court orders it.
Electronic disclosure. Texas law requires me to tell you that your health information may be shared electronically, such as through my electronic health record system or when billing your insurance. Except for treatment, payment, practice operations, or as otherwise allowed by law, I will not share your health information electronically without your written authorization.
All other uses. For any use or sharing not described in this notice, I will ask for your written permission. You may change your mind at any time by telling me in writing, except for information I have already shared based on your permission.
I can change the terms of this notice, and the changes will apply to all information I have about you. The updated notice will be available on request, in my office, and on my website.
If you have questions about this notice or want to exercise any of your rights, please contact my Privacy Officer:
Stacy Huddleston, LCSW, Privacy Officer
Connect and Restore Therapy, LLC
2624 Kensington Dr #103
Tyler, TX 75703
Phone: 903-200-9540
Email: stacy@connectandrestoretherapy.com
