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 applies to Brooktree Counseling & Consulting PLLC, doing business as DFW SAP (“we”, “us”). Effective date: October 1, 2026.
Our duties
We are required by law to keep the privacy of your protected health information (“health information”), to give you this notice of our legal duties and privacy practices, to follow the terms of the notice currently in effect, and to notify you if a breach of your unsecured health information occurs.
How we may use and share your health information
- Treatment and services. To evaluate you, make recommendations and refer you to education or treatment providers.
- Payment. To bill and collect payment from you or your health plan, including checking your benefits.
- Health care operations. To run our practice, for example quality review, training, licensing and compliance.
- Business associates. With companies that help us (for example, secure email, video and billing services). They must sign an agreement to protect your information.
- As required by law, including to the U.S. Department of Transportation or other agencies when a law requires it; for public health and safety; to prevent a serious and imminent threat to someone’s health or safety; to report suspected abuse or neglect; for health oversight activities; in response to a court order or other lawful process; to law enforcement as the law allows; and for workers’ compensation.
DOT Substance Abuse Professional (SAP) evaluations
If you come to us for a DOT SAP evaluation, federal DOT rules (49 CFR Part 40) also apply. As part of that process we send our reports to your employer’s Designated Employer Representative (DER) and report required information in the FMCSA Drug and Alcohol Clearinghouse. We will ask you to sign a written consent for these disclosures before we release them. Other disclosures of your SAP information are made only as Part 40 allows.
Uses that need your written permission
We will not use or share your information for any other purpose, including most sharing of psychotherapy notes, marketing, or sale of your information, unless you give us written permission. You may take back that permission in writing at any time, except for anything we have already done in reliance on it.
Your rights
- Get a copy of your health and billing records, on paper or electronically. We may charge a reasonable, cost-based fee.
- Ask us to correct information you believe is wrong or incomplete. We may say no, but we will tell you why in writing.
- Ask for confidential communications, for example that we contact you at a different phone number or address. We will agree to reasonable requests.
- Ask us to limit what we use or share. We are not required to agree, except that we must agree not to share information with your health plan about a service you paid for in full out of pocket, if you ask.
- Get a list (accounting) of certain disclosures we have made in the past six years.
- Get a paper copy of this notice at any time.
- Choose someone to act for you, such as a legal guardian or someone with medical power of attorney.
Texas law
Texas law also protects your health information. We will not sell your health information, and we will not share it electronically except as Texas and federal law allow.
Changes to this notice
We may change this notice, and the changes will apply to all information we have about you. The current notice will always be on this page and available on request.
Questions or complaints
If you have questions, want to use one of your rights, or believe your privacy rights have been violated, contact our Privacy Officer:
Nichelle Chandler, Privacy Officer
Brooktree Counseling & Consulting PLLC d/b/a DFW SAP
P.O. Box 794861, Dallas, TX 75252
214-901-7079 · [email protected]
You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights: 200 Independence Avenue SW, Washington, DC 20201; 1-877-696-6775; www.hhs.gov/ocr/complaints. We will not retaliate against you for filing a complaint.