NOTICE OF PRIVACY PRACTICES
Shady Tree Psychology LLC
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.
Shady Tree Psychology LLC is committed to protecting the privacy and confidentiality of your health information. This Notice of Privacy Practices describes how protected health information about you may be used and disclosed, your rights regarding your health information, and Shady Tree Psychology LLC's responsibilities for protecting that information.
This Notice applies to psychological services provided by Shady Tree Psychology LLC.
NOTICE OF PRIVACY PRACTICES
Shady Tree Psychology LLC
Isabella Savage, PsyD, Licensed Psychologist (Texas License #40961)
318-200-0533 | dr.savage@shadytreepsychology.com
Effective 9/30/2026 — Version 2
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.
I. PLEDGE REGARDING HEALTH INFORMATION:
Shady Tree Psychology LLC, operated by Dr. Isabella Savage, understands that your health information is personal. The practice creates records of the psychological services it provides to support your care and meet legal obligations. This Notice describes how the practice may use or disclose your protected health information, your rights concerning that information, and the practice’s legal duties. The practice is required by law to:
Maintain the privacy and security of protected health information (“PHI”) that identifies you, and notify affected individuals following a breach of unsecured PHI.
Provide this Notice of its legal duties and privacy practices regarding your health information.
Follow the terms of the notice that is currently in effect.
Shady Tree Psychology LLC may change the terms of this Notice and make the revised terms effective for all PHI it maintains. The revised Notice will be available upon request on or after its effective date, through the SimplePractice client portal, and on the practice website.
II. HOW YOUR HEALTH INFORMATION WILL BE USED:
The practice may use or disclose your protected health information (PHI) without your written authorization for treatment, payment, and health care operations, subject to applicable legal limits:
Treatment: The practice may use or share PHI with other health care professionals involved in your care to provide, coordinate, or manage treatment, as permitted by law. For example, when permitted by law, the practice may share relevant information with another treating professional to coordinate your care.
Payment: The practice may use or share PHI as needed to bill for services and receive payment, as permitted by law. For example, the practice may use service dates and billing information to prepare invoices or statements of services.
Health Care Operations: The practice may use or share PHI to manage its operations, maintain records, improve services, and perform administrative activities related to your care, as permitted by law. For example, the practice may use information in your record to review the quality of care and manage its clinical records.
The practice may also use or disclose PHI as permitted or required by law. Additional federal or state protections may limit disclosure of mental health records. HIPAA permission alone does not authorize a disclosure prohibited by applicable state law. When Texas or Louisiana mental-health confidentiality or privilege protections apply, the practice will obtain legally sufficient consent before disclosing protected information unless an applicable legal exception permits or requires disclosure, such as certain treatment-related disclosures, mandatory reporting, or qualifying safety emergencies. These limits also apply to disclosures for payment and health care operations. If the practice receives substance use disorder patient records subject to 42 CFR Part 2, those records, or testimony relaying their contents, will not be used or disclosed in civil, criminal, administrative, or legislative investigations or proceedings against you without your written consent meeting Part 2 requirements or a qualifying court order issued after notice and an opportunity to be heard are provided to you or the holder of the records as required by Part 2. A court order authorizing use or disclosure must be accompanied by a subpoena or other legal requirement compelling disclosure before the records are used or disclosed. Receiving such records does not mean the practice is a Part 2 program.
Lawsuits and Disputes: If the practice receives a subpoena, discovery request, court order, or other legal demand for a client’s information, Dr. Savage will evaluate it under applicable federal and state confidentiality and privilege laws. A subpoena alone does not necessarily authorize disclosure. When appropriate, Dr. Savage may assert the client’s privilege on the client’s behalf or seek clarification from the court. Information will be disclosed only when authorized or required by applicable law, and only to the extent permitted or required.
III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:
Dr. Savage may keep separate “psychotherapy notes” as defined by HIPAA. Most uses or disclosures of those notes require your written authorization, subject to limited exceptions, including:
Use by Dr. Savage in treating you.
Use by Dr. Savage to defend a legal proceeding brought by you.
Use by the U.S. Department of Health and Human Services to investigate the practice’s HIPAA compliance.
Required by law and the use or disclosure is limited to the requirements of such law.
For certain health oversight activities concerning the originator of the psychotherapy notes, as permitted by law.
For a coroner or medical examiner performing duties authorized by law.
As permitted by law to avert a serious threat to health or safety.
Marketing Purposes. The practice does not use or disclose your PHI for marketing purposes. Uses or disclosures that legally qualify as marketing would require your written authorization.
Sale of PHI. The practice does not sell your PHI. A sale of PHI, as defined by law, would generally require your written authorization.
Other uses and disclosures of your protected health information that are not described in this Notice will be made only with your written authorization. You may revoke an authorization in writing at any time, except to the extent the practice has already acted in reliance on it.
IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION:
Subject to applicable federal and state limits, the practice may use or disclose PHI without your written authorization in the circumstances below. Additional protections apply to any records the practice receives that are subject to 42 CFR Part 2, particularly for proceedings against the patient.
When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.
For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.
For health oversight activities, including audits and investigations.
For judicial and administrative proceedings when the applicable legal requirements for disclosure are met. The practice will consider any additional protections for mental health and substance use disorder records.
For law enforcement purposes when permitted or required by applicable law.
To coroners or medical examiners, when such individuals are performing duties authorized by law.
Appointment reminders and health-related services. The practice may use your PHI to remind you of appointments or tell you about treatment alternatives and health care services it offers, as permitted by law.
V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT:
Disclosures to family, friends, or others. You may tell the practice your preferences about sharing information with a person involved in your care or payment for your care. The practice will respect your choices as required by law. If you cannot express a preference, the practice may share relevant information when it determines that doing so is in your best interest or is necessary to lessen a serious and imminent threat, as permitted by law. When a child is the client, a parent’s or guardian’s access depends on applicable law and any relevant court order; when a parent receives their own services, that parent is the client for those services.
VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:
To exercise any of the rights below, contact Dr. Isabella Savage at 318-200-0533 or dr.savage@shadytreepsychology.com. The practice will explain the applicable process and any written request needed. Please avoid including sensitive clinical information in ordinary email.
The Right to Request Limits on Uses and Disclosures of Your PHI. You may ask the practice not to use or disclose certain PHI for treatment, payment, or health care operations. The practice is generally not required to agree, and may decline, for example, if the restriction could affect your care. If the practice agrees, it may still disclose the information for emergency treatment as permitted by law.
The Right to Request Restrictions for Services Paid in Full. If you pay out of pocket in full for a service, you may ask the practice not to disclose PHI relating solely to that service to your health plan for payment or health care operations. The practice must agree unless the disclosure is required by law.
The Right to Request Confidential Communications. You may ask the practice to contact you in a specific way or at a different address. The practice will agree to reasonable requests.
The Right to See and Get Copies of Your PHI. You may request access to your treatment record and other PHI in the designated record set, subject to legal exceptions, including for separately maintained psychotherapy notes. The practice will respond to a written records-access request within 15 days of receiving it. The response will provide access or copies, explain any lawful restriction or denial, or provide any extension notice permitted by applicable law. This response commitment does not extend any applicable deadline for providing access. A reasonable, cost-based fee may apply.
The Right to Get an Accounting of Disclosures. You may request an accounting of certain disclosures of your PHI during the six years before your request. Disclosures for treatment, payment, and health care operations, disclosures you authorized, and certain other disclosures are generally excluded. The practice will respond within 60 days, subject to a legally permitted extension. One accounting in a 12-month period is free; additional accountings may involve a reasonable, cost-based fee.
The Right to Correct or Update Your PHI. If you believe PHI in your record is incorrect or incomplete, you may request an amendment. The practice may deny the request but will explain the reason in writing within 60 days, subject to a legally permitted extension.
The Right to Get a Copy of this Notice. You may request a paper copy at any time, even if you agreed to receive it electronically. The practice will provide a paper copy promptly. A person legally authorized to act as your personal representative may exercise your privacy rights; the practice will verify that person’s authority before acting on the request.
VII. RIGHT TO FILE A COMPLAINT
For questions about this Notice or to file a privacy complaint with the practice, contact Dr. Isabella Savage, Privacy Contact, at dr.savage@shadytreepsychology.com or 318-200-0533. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights at hhs.gov/hipaa/filing-a-complaint or 1-877-696-6775. The practice will not retaliate against you for filing a complaint.
You may also raise concerns about professional services with Dr. Isabella Savage at dr.savage@shadytreepsychology.com or 318-200-0533, or contact the appropriate licensing board.
For information about filing a complaint, contact one of the following based on your state:
Texas Behavioral Health Executive Council
1801 Congress Avenue, Ste. 7.300 Austin, Texas 78701
1-800-821-3205
Louisiana State Board of Examiners of Psychologists
4334 S. Sherwood Forest Blvd., Suite C-150 Baton Rouge, LA 70816
225-295-8410
ACKNOWLEDGEMENT OF RECEIPT OF PRIVACY NOTICE
Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information.
You may request a copy of this Notice of Privacy Practices at any time by contacting:
Shady Tree Psychology LLC
Isabella Savage, PsyD
318-200-0533
dr.savage@shadytreepsychology.com