Notice of Privacy Practices
Effective Date: August 15, 2026
Tishna Rollo Psychotherapy PLLC
1500 W. 38th St.
Austin, TX 78731
(512) 710-9781
hello@tishnarollo.com
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
My Responsibilities
I am required by law to maintain the privacy and security of your protected health information (“PHI”), provide you with this Notice of Privacy Practices, and follow the privacy practices described in the Notice currently in effect. I will notify you if a breach occurs that may have compromised the privacy or security of your information when notification is required by law. I may change the terms of this Notice in the future. Changes may apply to health information I already have about you as well as information I receive after the change. The current Notice will be available upon request and on my website.
Your Rights
Get a copy of your health record
You may ask to see or receive an electronic or paper copy of your health record and other health information I maintain about you. I will generally provide a copy or summary within 30 days of receiving your request. I may charge a reasonable, cost-based fee where permitted by law. Psychotherapy notes, as specifically defined under HIPAA, receive additional protection and generally are not included in the information you have a right to access under HIPAA.
Ask me to correct your health record
You may ask me to correct health information about you that you believe is incorrect or incomplete. I may deny your request in certain circumstances. If I do, I will tell you why in writing, generally within 60 days.
Request confidential communications
You may ask me to contact you in a particular way, such as by phone or email, or to send communications to a different address. I will agree to reasonable requests.
Ask me to limit what I use or disclose
You may ask me not to use or disclose certain health information for treatment, payment, or health care operations. I am not always required to agree to your request. If I do agree to a restriction, I will generally follow it except when disclosure is necessary for emergency treatment or otherwise required by law. If you pay for a health care service in full out of pocket, you may ask me not to disclose information about that service to your health plan for purposes of payment or health care operations. I will honor that request unless disclosure is required by law.
Receive an accounting of certain disclosures
You may request a list of certain disclosures I have made of your health information during the six years before your request. The accounting does not include every type of disclosure, including many disclosures made for treatment, payment, or health care operations or disclosures you specifically authorized. I will provide one accounting within a 12-month period at no charge. I may charge a reasonable, cost-based fee for additional requests within the same 12-month period.
Receive a copy of this Notice
You may request a paper or electronic copy of this Notice at any time.
Choose someone to act for you
If another person has legal authority to act on your behalf, such as a legal guardian or a person with an appropriate power of attorney, that person may exercise your privacy rights as permitted by law. I will verify that person's authority before taking action.
File a complaint
If you believe your privacy rights have been violated, you may contact me using the information at the end of this Notice. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. You will not be retaliated against for filing a complaint.
Your Choices
For certain health information, you may tell me how you would like your information to be shared. For example, you may tell me whether I may share relevant information with a family member, close friend, or another person involved in your care or payment for your care. If you are unable to express your preference, I may share information when permitted by law and when I believe doing so is in your best interest. I may also disclose information when permitted by law to prevent or lessen a serious and imminent threat to health or safety. Your written authorization generally is required for: most uses and disclosures of psychotherapy notes; uses or disclosures of PHI for marketing purposes; and the sale of PHI. I do not sell your protected health information.
How I May Use and Disclose Your Health Information
Treatment
I may use your health information and disclose it to other health care professionals as permitted by law for purposes of providing, coordinating, or managing your treatment. For example, I may consult with another health care provider involved in your care when permitted by applicable confidentiality laws.
Payment
I may use or disclose your health information as necessary to obtain payment for services. For example, if you use health insurance, I may provide information to your health plan as necessary for claims, eligibility, authorization, or payment.
Health Care Operations
I may use or disclose your health information as necessary to operate my practice. This may include practice administration, professional consultation, quality improvement, compliance activities, and services provided by business associates who assist with practice operations and are required, where applicable, to safeguard your information.
Other Uses and Disclosures Permitted or Required by Law
I may use or disclose health information without your written authorization when federal or Texas law permits or requires me to do so. Depending on the circumstances, these situations may include: reporting suspected abuse or neglect when required by law; preventing or reducing a serious threat to health or safety; certain public-health activities; health-oversight activities; certain judicial or administrative proceedings; certain lawful law-enforcement requests; workers' compensation matters; disclosures to coroners or medical examiners when permitted by law; and other disclosures required by federal or state law. Mental-health information receives additional confidentiality protection under Texas law. I will follow applicable Texas confidentiality requirements when they provide greater privacy protection than HIPAA.
Psychotherapy Notes
Psychotherapy notes, as that term is specifically defined by HIPAA, receive special protection. Your written authorization generally is required before psychotherapy notes may be used or disclosed, except for limited uses and disclosures permitted by law, including certain uses for treatment by me, professional training or supervision, defending myself in legal proceedings brought by you, governmental oversight of HIPAA compliance, or other circumstances specifically permitted or required by law. Psychotherapy notes are separate from the information ordinarily maintained in your clinical record, such as diagnosis, treatment plans, session dates and times, symptoms, progress, and other information about your treatment.
Substance Use Disorder Records
To the extent that I maintain substance use disorder patient records that are subject to the federal confidentiality protections of 42 CFR Part 2, those records receive additional protection. Information from such records generally may not be used or disclosed in civil, criminal, administrative, or legislative investigations or proceedings against you without your written consent or a qualifying court order and subpoena, as required by federal law.
Appointment Reminders and Treatment Information
I may use your health information to contact you about appointments. I may also contact you with information about treatment alternatives or health-related services that may be relevant to your care, as permitted by law.
Other Uses of Your Information
Uses and disclosures of your protected health information that are not described in this Notice and are not otherwise permitted or required by law will be made only with your written authorization. If you give me written authorization, you may revoke that authorization in writing at any time, except to the extent I have already acted in reliance on it.
Questions or Complaints
For questions about this Notice, requests involving your health information, or privacy complaints, contact:
Tishna Rollo, LPC
Tishna Rollo Psychotherapy PLLC
hello@tishnarollo.com
(512) 710-9781
You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. Information about filing a HIPAA complaint is available at the HHS Office for Civil Rights website. You will not be retaliated against for exercising your privacy rights or filing a complaint.