Note: Blueprint Mental Health does not prescribe stimulant medications as part of our psychiatric services.
Your Information. Your Privacy. Your Rights. Our Responsibilities.
Effective Date: [September, 2026]
BluePrint Mental Health (“BluePrint,” “we,” “us,” or “our”) respects the privacy of your health information and is committed to protecting it. This Notice of Privacy Practices explains how we may use and disclose your protected health information (PHI), your rights regarding that information, and our responsibilities under applicable federal and Texas law.
Please review this Notice carefully. It applies to protected health information we create, receive, maintain, or transmit in connection with providing healthcare services to you.
This Notice applies to BluePrint Mental Health and the healthcare services provided through our practice, including psychiatric evaluations, diagnosis and treatment planning, medication management, follow-up psychiatric care, supportive psychotherapy and psychoeducation, mental health assessment, and telepsychiatry services.
This Notice concerns your protected health information as used in connection with healthcare services. Information collected through our website, including information that does not constitute PHI under HIPAA, may also be governed by our separate Privacy Policy.
You have certain rights regarding your protected health information. You may exercise these rights by contacting BluePrint Mental Health using the contact information provided at the end of this Notice.
You have the right to request access to and obtain a paper or electronic copy of health information that we maintain about you, subject to applicable law and certain legally recognized exceptions.
We may provide your records or a permitted summary of your health information. We may charge a lawful, reasonable, cost-based fee where permitted.
You have the right to ask us to correct health information about you that you believe is inaccurate or incomplete.
Your request should identify the information you believe is incorrect and explain why a correction is appropriate. We may deny a request in certain circumstances permitted by law. If we deny your request, we will provide you with a written explanation of the reason for the denial and information about your rights.
You have the right to request that we communicate with you about your health information in a specific way or at a specific location.
For example, you may ask us to contact you at a particular telephone number or send information to a different mailing address.
We will consider reasonable requests consistent with applicable law and our ability to provide appropriate care and administration.
You have the right to ask us to restrict how we use or disclose certain protected health information for treatment, payment, or healthcare operations.
We are not required to agree to every restriction request. However, when required by law, we will comply with an appropriate restriction.
Because BluePrint Mental Health operates as a self-pay practice and does not bill health insurance plans directly, you may also have the right to request that information concerning a healthcare service or item for which you have paid in full out-of-pocket not be disclosed to your health plan for payment or healthcare operations, except where disclosure is required by law.
You have the right to request a list of certain disclosures of your protected health information made by us during the applicable period required by law.
The accounting does not include every disclosure. Certain disclosures, including many disclosures for treatment, payment, and healthcare operations, are excluded under HIPAA and other applicable rules.
You have the right to request a paper copy of this Notice at any time. You may also obtain an electronic copy from our website.
If you have a person legally authorized to act on your behalf, such as a legal guardian or other authorized personal representative, that individual may exercise certain privacy rights on your behalf, subject to verification of the person’s authority and applicable law.
You have the right to complain if you believe your privacy rights have been violated.
You may file a complaint with BluePrint Mental Health or with the U.S. Department of Health and Human Services, Office for Civil Rights.
We will not retaliate against you for filing a privacy complaint.
We may use or disclose your protected health information without your written authorization when permitted or required by applicable law. The following are common examples.
We may use and disclose your health information to provide, coordinate, or manage your healthcare.
For example, we may use information from your psychiatric evaluation, medical history, medications, or prior treatment to develop and manage your treatment plan. We may also share relevant information with other healthcare professionals involved in your care when permitted by law.
We may use or disclose your health information as necessary to obtain payment for services we provide.
Because BluePrint Mental Health is a self-pay practice and does not bill insurance companies directly, payment-related uses may primarily involve collecting payment from you, maintaining billing records, processing transactions, or addressing payment-related matters.
Where you independently seek reimbursement from an insurance company, you may request documentation from us for that purpose. We will handle such requests in accordance with applicable law and our policies.
We may use and disclose health information for healthcare operations necessary to operate our practice and support quality and effective care.
Examples may include activities related to:
We may use your contact information to communicate with you about appointments, treatment, follow-up care, prescriptions, billing, services, or other healthcare-related matters.
You may request confidential communication arrangements as described above.
When permitted by law, we may disclose appropriate health information to a family member, close friend, or another person you identify who is involved in your healthcare or in helping with payment for your care.
When you are not able to express a preference, we may make such disclosures when we reasonably determine that doing so is in your best interest or otherwise permitted by law.
We may use or disclose protected health information for public health activities when permitted or required by law.
These activities may include, for example:
We may use or disclose protected health information when required by federal, state, or local law, provided that the disclosure meets the requirements of the applicable law.
We may disclose health information to appropriate government agencies for activities authorized by law, such as audits, investigations, inspections, licensing matters, or other oversight activities.
We may disclose protected health information in response to a court order, administrative order, subpoena, discovery request, or other lawful process when the applicable legal requirements are satisfied.
We may disclose health information to law enforcement officials when permitted or required by applicable law, including in limited circumstances involving legal processes, identification purposes, reporting certain crimes, or other circumstances specifically authorized by law.
We may disclose health information to a coroner, medical examiner, or funeral director when permitted or required by law for purposes related to determining cause of death or carrying out legally authorized responsibilities.
We may use or disclose health information for research when permitted by applicable law and when the required privacy protections are in place.
We may disclose health information for workers’ compensation or similar programs when permitted or required by law.
We may use or disclose protected health information when necessary to help prevent or lessen a serious and imminent threat to the health or safety of a person or the public, when permitted by law.
We may disclose protected health information for certain specialized government functions when authorized by applicable law, including limited military, national security, protective services, and other governmental functions.
Certain uses and disclosures of your protected health information require your written authorization.
Unless otherwise permitted by law, we will obtain your written authorization before:
Using or disclosing your protected health information for marketing purposes when HIPAA requires authorization.
Selling your protected health information when HIPAA requires your authorization.
Using or disclosing most separately maintained psychotherapy notes when an authorization is required by law.
An authorization is separate from your general consent for treatment. You may revoke an authorization in writing at any time to the extent permitted by law, except to the extent we have already relied on the authorization.
Because BluePrint Mental Health provides psychiatric and mental health services, our records may contain sensitive information relating to diagnosis, evaluation, treatment, medications, and mental or emotional health.
We will use and disclose this information in accordance with HIPAA, applicable federal requirements, and applicable Texas law.
Texas law provides confidentiality protections for certain communications between a patient and a professional and for certain mental-health records. Disclosures are permitted only under applicable legal exceptions and other authorized circumstances.
To the extent BluePrint Mental Health creates or maintains substance use disorder patient records that are subject to 42 CFR Part 2, those records may receive additional federal privacy protections.
Where applicable, we will handle Part 2 records in accordance with the requirements governing such records, including applicable requirements concerning consent and disclosures for certain investigations and legal proceedings.
Where permitted by law, you may tell us whether you want us to:
If you are unable to communicate your preference, we may disclose information when permitted by law and when we reasonably determine that doing so is in your best interest or necessary to address a serious health or safety concern.
BluePrint Mental Health is required by law to:
We will not use or disclose your protected health information other than as described in this Notice or as otherwise permitted or required by law unless you provide written authorization.
BluePrint Mental Health provides telepsychiatry services and may communicate with patients electronically when appropriate.
Electronic communications may involve privacy or security risks depending on the method used. You may request confidential communication arrangements as described in this Notice.
Patients should avoid sending sensitive medical or mental-health information through unsecured website forms, ordinary email, or other channels that are not specifically designated by BluePrint for secure clinical communication.
For telepsychiatry services, additional privacy, security, and operational requirements may apply based on the technology used and applicable law.
This Notice addresses protected health information handled in connection with healthcare services.
Our website may separately collect technical or contact information through cookies, analytics tools, forms, scheduling systems, or other technologies. Information about those website practices is addressed in our Privacy Policy.
Patients should not use general website contact forms to submit information about a psychiatric emergency or highly sensitive clinical information unless the practice specifically instructs them to do so through an appropriate secure process.
We reserve the right to change this Notice at any time.
Any revised Notice will apply to protected health information we maintain, subject to applicable law. When required, the updated Notice will be made available on our website and in our office.
The effective date shown at the beginning of this Notice identifies the version currently in effect.
If you have questions about this Notice, would like to exercise one of your privacy rights, or believe your privacy rights have been violated, please contact:
BluePrint Mental Health
Phone: (832) 510-0690
Email: care@myblueprintmentalhealth.com
Address: 23410 Kingsland Blvd, Suite 200, Katy, Texas 77494
You may also submit a privacy complaint directly to the U.S. Department of Health and Human Services, Office for Civil Rights.
Filing a complaint will not affect your ability to receive care from BluePrint Mental Health, and BluePrint will not retaliate against you for exercising your privacy rights or filing a complaint.
You may be asked to acknowledge that you received this Notice of Privacy Practices.
Your acknowledgment confirms receipt of the Notice. It does not constitute authorization for uses or disclosures of your protected health information beyond those permitted by law.
BluePrint Mental Health
23410 Kingsland Blvd, Suite 200
Katy, Texas 77494
(832) 510-0690
care@myblueprintmentalhealth.com
