HIPAA PRIVACY PRACTICES

HIPAA NOTICE OF PRIVACY PRACTICES

Effective as of April 10, 2026

Jeffrey C. Siegel, Ph.D. (“we,” “our,” “us”) respects your privacy. 

This Notice describes how Your Protected Health Information (PHI)  may be used and disclosed and how you can access this information.

Uses and Disclosures of Your Protected Health Information (PHI)

We may use and disclose your health information for the following purposes:

1. Treatment

We may use your health information to provide you with psychological services, including evaluations and therapeutic interventions.

2. Payment

We may use and share your health information to bill and collect payment for the services provided.

3. Health Care Operations

We may use your information to improve our services and manage the office’s day-to-day operations.

4. Legal and Court-Ordered Activities

As a forensic psychologist, your information may be disclosed as required by court order, including reporting findings to the attorneys and the court.

5. Mandatory Reporting

If we suspect abuse, neglect, or exploitation of a child, elder, or disabled person, we are required by law to report this information to the appropriate authorities.

6. Other Uses and Disclosures

We may disclose your health information as required by law or for the following reasons:

• To public health authorities
• For health oversight activities
• To comply with workers’ compensation laws
• For law enforcement purposes (if required by subpoena, warrant, or other legal mandate)

Your Rights

1. Get a Copy of Your Records 

You can request to see or obtain a copy of your health records. We may charge a reasonable fee for copying and mailing. 

2. Request Amendments

If you believe information in your records is incorrect or incomplete, you may request an amendment.

3. Request Restrictions

You can ask us not to use or share certain health information for treatment, payment, or operations. 

We will consider your request, but we are not required to agree if it would impact your care.

4. Request Confidential Communications

You can ask us to contact you in a specific way (e.g., calling your mobile number) or send mail to a different address.

5. Get a List of Disclosures

You can ask for a list of the times we shared your health information, who we shared it with, and why, going back six years.

6. Choose Someone to Act for You

If you have a medical power of attorney or legal guardian, they can exercise your rights on your behalf.

How to Exercise Your Rights

To exercise any of these rights, contact our Office:

Office Contact Information
Jeffrey C. Siegel, Ph.D., ABPP
17330 Preston Rd., Suite 110B
Dallas, Texas 75252
Phone: 972-960-1472
Fax: 972-960-1476

Complaints

If you believe your privacy rights have been violated, you can file a complaint with:

1. Our office (contact information above).
2. The U.S. Department of Health and Human Services Office for Civil Rights (OCR)  at hhs.gov/ocr or by calling 1-800-368-1019.

You will not be retaliated against for filing a complaint.

Changes to This Notice and Professional Duties

We reserve the right to change this Notice, and the revised version will apply to all health information we maintain. 

Any updates will be posted in our office and on our website.