Notice of Privacy Practices
Effective Date: January 1, 2026
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.
This Notice applies to Kidsville Pediatrics (Kidsville Pediatrics PLLC) and its locations, providers, and workforce. It covers our pediatric and integrated behavioral health services at our Mansfield, McKinney East, McKinney West, and Southlake, Texas offices, and any telemedicine services we provide.
Our Pledge
We understand that information about you and your health is personal. We are required by law to maintain the privacy and security of your protected health information (PHI), to give you this Notice of our legal duties and privacy practices, to follow the terms of the Notice currently in effect, and to notify you if a breach affects your unsecured PHI.
How We May Use and Disclose
Your Health Information
The following describes the ways we are permitted to use and disclose PHI without your written authorization. Not every use is listed, but each falls into one of these categories.
For Treatment
We use and share PHI to provide, coordinate, and manage your care, including with doctors, nurses, therapists, pharmacists, laboratories, specialists, hospitals, and other providers involved in your care.
For Payment
We use and share PHI to bill and collect for services, verify insurance coverage, obtain prior authorizations, and respond to payer audits and claim questions.
For Health Care Operations
We use and share PHI to run our practice, including quality assessment and improvement, training, licensing and credentialing, compliance, legal services, business planning, and customer service.
Other Permitted Uses and Disclosures
• Appointment reminders and treatment information, by phone, text, email, or mail, using the contact information you give us.
• Business associates, vendors that perform services for us under written agreements requiring them to protect your PHI.
• Family, friends, and others involved in your care or payment, when you agree or do not object, or when we reasonably believe it is in your best interest if you are unable to agree.
• Required by law, including court orders, subpoenas, and lawful requests from government agencies.
• Public health and safety, such as reporting diseases, immunizations, injuries, product problems, and preventing serious threats to health or safety.
• Abuse, neglect, or domestic violence, as required or permitted by law.
• Health oversight activities, such as audits, inspections, and licensure.
• Judicial and administrative proceedings, and law enforcement, as permitted by law.
• Coroners, medical examiners, funeral directors, and organ and tissue donation.
• Research, when approved through a process that protects privacy, or when information is de identified.
• Workers’ compensation, military and veterans’ activities, national security, and correctional institutions, as permitted by law.
Uses and Disclosures That Require Your Written Authorization
We will obtain your written authorization before the following, and you may revoke an authorization at any time in writing (this will not affect disclosures already made):
• Most uses and disclosures of psychotherapy notes (a clinician’s separate notes of counseling sessions), with limited exceptions allowed by law.
• Uses and disclosures of PHI for marketing, and any sale of PHI.
• Photographs, video, testimonials, and similar materials that identify you or your child for any purpose other than treatment. We share these only under a signed consent and authorization.
• Any other use or disclosure not described in this Notice.
Special Protections
Mental and behavioral health information. Information about mental health care receives additional protection under certain federal and state laws. We share it only as those laws allow.
Substance use disorder records. If we receive or create records from a federally assisted substance use disorder program covered by 42 C.F.R. Part 2, those records have additional protections. Generally, we may use and disclose them for treatment, payment, and health care operations based on your single written consent, and they may not be used against you in civil, criminal, administrative, or legislative proceedings without your consent or a qualifying court order. You will be told separately if this applies to your care.
State law. Texas law may be more protective of your privacy than HIPAA, and we follow the stricter rule. In Texas, your PHI may be subject to electronic disclosure, for example through electronic health records, secure messaging, and health information exchanges, and we do not sell PHI. Mental health records are also subject to confidentiality protections under Texas law, and we release them only as state and federal law permit or require.
Minors, Parents, and Guardians
A parent or legal guardian is generally the “personal representative” of a minor child and may exercise the child’s privacy rights and receive the child’s PHI. There are exceptions. In certain situations, state law allows a minor to consent to specific types of care on their own, and in those cases information about that care may be controlled by the minor and may not be shared with a parent or guardian except as the law allows. We may also limit a parent’s or guardian’s access if we reasonably believe it could endanger the child or another person. When a patient turns 18, the patient, not the parent, holds the privacy rights over their record, and the parent will need the patient’s written permission to receive information.
Your Rights Regarding Your Health Information
• Access and copies. You may inspect and obtain a paper or electronic copy of your medical and billing records, and ask that a copy be sent to another person you designate. We will respond within 30 days and may charge a reasonable, cost-based fee. In limited cases we may deny access, and you may ask for that decision to be reviewed.
• Amendment. You may ask us to correct information you believe is wrong or incomplete. We may deny the request in certain cases, and you may submit a statement of disagreement.
• Accounting of disclosures. You may request a list of certain disclosures we made of your PHI in the six years before your request.
• Request restrictions. You may ask us to limit how we use or share your PHI. We are not required to agree, except that we must agree to your request not to disclose PHI to a health plan for payment or operations when the care has been paid for in full out of pocket and the disclosure is not required by law.
• Confidential communications. You may ask that we contact you in a particular way or at a particular place, such as a different phone number or address. We will accommodate reasonable requests.
• Paper copy of this Notice. You may ask for a paper copy at any time, even if you agreed to receive it electronically.
• Choose someone to act for you. If you have given someone medical power of attorney, or someone is your legal guardian, that person may exercise your rights. We will verify their authority first. To exercise any of these rights, submit a written request to our Privacy Officer using the contact information below.
Our Responsibilities
• We keep your PHI private and secure and train our workforce on privacy.
• We will notify you promptly if a breach occurs that may have compromised the privacy or security of your information.
• We will follow this Notice and will not use or share your information other than as described unless you tell us in writing that we may. You may change your mind at any time by telling us in writing.
• We may change the terms of this Notice and apply the change to all PHI we hold. The current Notice will be posted in our offices and on our website, and available on request.
Questions and Complaints
If you have questions about this Notice, want to exercise a right, or believe your privacy rights have been violated, contact our Privacy Officer:
Mr. Ali Shah, Executive Manager (Privacy Officer)
Kidsville Pediatrics
Email: officemf@kidsvillepeds.org
Mail: Kidsville Pediatrics, Attn: Privacy Officer, 1759 Broad Park Circle South, Suite 201, Mansfield, TX 76063 Office locations and phone numbers:
• Mansfield: 1759 Broad Park Circle S., Suites 201 & 205, Mansfield, TX 76063; Phone (682) 341-3910; Fax (682) 400-1288
• McKinney East: 5881 Virginia Pkwy, Suite 300, McKinney, TX 75071; Phone (469) 885-9400; Fax (469) 886-1944
• McKinney West: 1400 N. Coit Rd, Suite 1604, McKinney, TX 75071; Phone (682) 868-1020; Fax (682) 219-0556
• Southlake: 2813 W. Southlake Blvd, Suite 100, Southlake, TX 76092; Phone (682) 345-8010; Fax (682) 345-5051
Medical records requests: Medicalrecords@kidsvillepeds.org.
You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights: 200 Independence Avenue S.W., Washington, D.C. 20201; 1-877-696-6775; www.hhs.gov/ocr/privacy/hipaa/complaints. We will not retaliate against you for filing a complaint.