Dream Revival Psychiatry, PLLC
Effective Date: September 15, 2025

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.

Our Legal Duty

Dream Revival Psychiatry, PLLC is required by law to:

  • Maintain the privacy of your protected health information (PHI)
  • Provide this Notice of our legal duties and privacy practices
  • Abide by the terms of this Notice currently in effect

Uses and Disclosures of Your PHI

1. Treatment
To provide, coordinate, or manage your healthcare.

2. Payment
To obtain reimbursement for services provided.

3. Healthcare Operations
For quality assessment, staff training, licensing, compliance, and administrative functions.

Other Permitted Uses

We may disclose PHI:

  • As required by law
  • For public health reporting
  • For health oversight activities
  • For judicial or administrative proceedings
  • To avert a serious threat to health or safety
  • For workers’ compensation claims
  • To comply with law enforcement requests when legally required

Uses Requiring Authorization

We will obtain your written authorization for:

  • Psychotherapy notes (except limited permitted uses)
  • Marketing communications
  • Sale of PHI (we do not sell PHI)
  • Any other uses not described in this Notice

You may revoke authorization in writing at any time.

Your Rights

  • Access: Request copies of your medical records
  • Amend: Request corrections to your records
  • Restrict: Request limits on certain disclosures (we may not be required to agree)
  • Confidential Communications: Request communications by alternative means or locations
  • Accounting of Disclosures: Receive a list of certain disclosures of your PHI
  • Paper Copy: Receive a paper copy of this Notice upon request

State-Specific Protections

Where state law provides greater protection than HIPAA, we comply with the more stringent standard. This includes additional protections under:

  • Texas Medical Records Privacy Act
  • Colorado Privacy Act
  • Minnesota Health Records Act
  • Arizona and New Mexico privacy statutes

Breach Notification

We will notify you if a breach of unsecured PHI occurs as required by federal and state law.

Changes to This Notice

We reserve the right to change this Notice. The revised Notice will be posted on our website and available upon request.

Complaints

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

Dream Revival Psychiatry, PLLC
1400 N Coit Rd, Ste 202
McKinney, TX 75071

Phone: (469) 949-4941
Email: frontdesk@dreamrevivalpsychiatry.com

You may also file a complaint with the U.S. Department of Health & Human Services, Office for Civil Rights. You will not be retaliated against for filing a complaint.