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.
Effective date: September 22, 2026
01Understanding your health record and information
This notice describes the practices of the Institute for Translational Therapeutics, a Texas nonprofit health organization certified under Section 162.001(b) of the Texas Occupations Code (the "Practice"), and of any provider with staff privileges here, with respect to the health information created while you are a patient at MindForge. The Practice, providers with staff privileges, and personnel authorized to access your chart are subject to this notice, and may share medical information with one another for treatment, payment, or health care operations as described below.
Administrative, technology, and business services for the Practice are performed by MindForge, LLC, which acts under a written agreement requiring it to safeguard your information and limiting how it may use and disclose it. Clinical decisions are made solely by the Practice's licensed physicians and clinicians.
We create a record of the care and services you receive. We understand that information about you and your health is personal, and we are committed to protecting it. This notice applies to all records of your care at the Practice.
02Why we give you this notice
The Practice does not bill health insurance and does not participate in any federal health care program. Because of that, we are not required to follow the federal HIPAA privacy rules. Texas law requires us to give you notice before your health information is disclosed electronically, and to give you electronic access to your own records on request.
We have chosen to go further than Texas law requires and to follow the federal HIPAA privacy standards as our own policy — in how we use and disclose your information, in the rights we give you, and in what we require of the vendors who handle information for us. Everything described in this notice is a commitment you can hold us to, whether or not a federal agency could enforce it.
03Your health information rights
Although your health record is the physical property of MindForge, the information belongs to you. You have the right to:
- Inspect and get a copy of your health record, on paper or electronically. If you ask in writing for an electronic copy of your electronic health record, Texas law requires us to provide it within 15 business days. We will provide it electronically unless you would rather have it another way;
- Ask us to amend your record. We will tell you in writing if we cannot grant the request;
- Ask us to communicate with you differently — at another address, another number, or by another method. We will accommodate reasonable requests;
- Ask us to restrict how we use or disclose your information for treatment, payment, or health care operations, or to people involved in your care. We are not required to agree, except that we must agree to restrict disclosure to your health plan for care you paid for out of pocket and in full;
- Get an accounting of certain disclosures we have made;
- Get a paper copy of this notice, even if you agreed to receive it electronically;
- Choose someone to act for you — someone with medical power of attorney or a legal guardian. We will verify that person's authority first.
To exercise any of these rights, write to us at 5301 Alpha Rd, Suite A-10, Dallas, TX 75240.
04Our responsibilities
We maintain the privacy of your health information; we notify you of a breach of unsecured health information as the law requires; we give you this notice of our duties and privacy practices; we follow the terms of the notice currently in effect; and we tell you if we cannot agree to a restriction you requested.
We reserve the right to change our practices and to make the new terms apply to all health information we maintain, including information created before the change. If we make a material change, we will post the revised notice here and at the brain center, and it will be available on request.
05Uses and disclosures that do not require your authorization
Treatment. We may share your information with doctors, nurses, technicians, and others involved in your care, and with providers who treat you after you leave us.
Payment. We may use and share your information to bill and collect payment from you or a third party. MindForge does not bill insurance; where we provide a superbill for you to submit to your own plan, it contains the information your plan requires, including diagnosis and procedure codes.
Health care operations. We may use your information to review and improve the care we provide, to train staff, for quality assessment, and for business planning.
We may also use or disclose your information without your authorization for: business associates (vendors who perform services for us under written agreements requiring them to safeguard your information); notification of and people involved in your care, unless you object; disaster relief organizations; research approved by an institutional review board with privacy protections; appointment reminders and treatment alternatives; reports to the Food and Drug Administration; workers' compensation as authorized by law; public health authorities; abuse, neglect, or domestic violence reporting as required by law; judicial, administrative, and law enforcement purposes consistent with applicable law; health oversight such as audits and licensure; serious and imminent threats to health or safety; specialized government functions; and as otherwise required or permitted by law.
06Electronic health information exchange
We use a third-party system to maintain our electronic medical records and to store electronic health information about you. We monitor who can view your record and limit access to personnel with an actual need to see it.
Notice under Texas Health & Safety Code § 181.154. Your health information may be disclosed electronically. Texas law does not require your separate authorization for an electronic disclosure to another covered entity for treatment, payment, health care operations, or the performance of an insurance or HMO function, or where the disclosure is otherwise authorized or required by state or federal law. For electronic disclosures outside those categories, we will obtain your written authorization first.
07When we need your written authorization
Other uses and disclosures require your written authorization, including most uses and disclosures for marketing purposes, any sale of your health information, and most uses and disclosures of psychotherapy notes. You may revoke an authorization in writing at any time, except to the extent we have already acted on it.
08Complaints
If you have questions or want more information, call (214) 730-6463.
If you believe your privacy rights have been violated, you may complain to: the Practice — the Practice Manager, at 5301 Alpha Rd, Suite A-10, Dallas, TX 75240 or (214) 730-6463 (we would rather hear it and fix it); the Office of the Texas Attorney General, Consumer Protection Division, which enforces the Texas medical records privacy law; or the Texas Medical Board for concerns about a physician's conduct.
There will be no retaliation against you for filing a complaint.