NOTICE OF PRIVACY PRACTICES
Effective Date: January 1st, 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.
MTV IR, PLLC (“Practice,” “we,” “us”) is required by federal and Texas law to maintain the privacy of your Protected Health Information (“PHI”) and provide you with this Notice of our legal duties and privacy practices. We will follow the terms of this Notice while it is in effect.
HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION
Treatment: To provide, coordinate, or manage your healthcare (e.g., physicians, hospitals, labs, pharmacies).
Payment: To bill and collect payment from you, your insurance company, or a third party.
Healthcare Operations: For quality improvement, credentialing, training, licensing, audits, and general business activities.
Individuals Involved in Your Care: We may disclose information to family or others involved in your care unless you object.
Appointment Reminders & Care Communications: We may contact you regarding appointments, treatment alternatives, or health-related benefits.
As Required or Permitted by Law: Including public health activities, abuse reporting, health oversight, judicial proceedings, law enforcement, organ donation, research (when approved), serious threats to health or safety, workers’ compensation, and specialized government functions.
Business Associates: We may share PHI with contracted service providers who are required by law to safeguard your information.
USES REQUIRING YOUR WRITTEN AUTHORIZATION
We will obtain your written authorization for most uses of psychotherapy notes, marketing communications (when required by law), sale of PHI, and any other use not described in this Notice. You may revoke authorization in writing at any time.
YOUR RIGHTS
Access and obtain copies of your medical records (fees may apply).
Request an amendment to your record.
Request restrictions on certain disclosures (we must honor restrictions to your health plan if you pay in full out-of-pocket).
Request confidential communications by alternative means or location.
Receive an accounting of disclosures (limitations apply).
Receive a paper copy of this Notice at any time.
Receive written notice of a breach of unsecured PHI.
OUR DUTIES
We are required by law (including HIPAA and the Texas Medical Records Privacy Act) to maintain the privacy and security of your PHI, notify you of a breach, and follow the terms of this Notice. We reserve the right to change this Notice and make revisions effective for all PHI we maintain.
If you believe your privacy rights have been violated, you may file a complaint with the Privacy Officer without fear of retaliation. You may also file a complaint with the U.S. Department of Health & Human Services, Office for Civil Rights at www.hhs.gov/ocr.
Privacy Officer: Jasson M. Stansell
MTV IR, PLLC – 9101 N Central Expressway, Suite 550 Dallas, TX 75231
Phone: 469-458-9800 x 104
