Notice of Privacy Practices
Effective date: ____2/1/2026______________
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.
Core Lifestyle Clinic | Privacy contact: Dr. Neil Crane
5600 W Lovers Lane, Suite 218, Dallas, TX 75209
(214) 506-0525 | drcrane@corelifestyleclinic.com | www.corelifestyleclinic.com
This notice applies to the health information maintained by Core Lifestyle Clinic. Contact Dr. Crane for a copy,
questions, requests, or complaints. Please request a secure way to send sensitive information rather than placing
detailed health information in an initial ordinary email.
Your right to see and obtain records
You may inspect or obtain an electronic or paper copy of your health record and other information in our designated
record set, subject to limited legal exceptions. Send a written request to Dr. Crane by email, mail, or in person. Tell us
which records and dates you want, who should receive them, and your preferred format and delivery method. Our
request form is available but is not required.
We verify identity and any representative's authority using reasonable methods. We provide records promptly, no later
than the applicable Texas 15-business-day deadline, unless a lawful exception applies. Where law requires earlier
access, including qualifying parental access to a minor's EHR, we follow that requirement. If we cannot provide your
requested format, we will work with you on an available alternative. We provide a summary instead only with your
agreement.
We may charge only a lawful, reasonable cost-based copying fee and will explain any applicable fee in advance. We do
not deny access because you owe money for care. If access is denied in whole or part, we explain the basis, any review
right, and how to complain, and provide the portion that can be released.
Ask for a correction
You may ask us in writing to amend information you believe is incorrect or incomplete and explain why. We act within
60 days, with a single additional 30-day period if permitted and explained in writing before the original deadline. We
may deny a request on a lawful basis and will explain the reason and how you may submit a statement of
disagreement. We preserve the original record and link accepted amendments.
Request confidential communications
You may ask us to contact you in a particular way or at a different location. We accommodate reasonable requests.
Contact Dr. Crane and tell us a safe way to reach you; you need not explain why you want the change. Email: drcrane@corelifestyleclinic.com

Your choices and additional rights
Ask us to limit sharing
You may request limits on how we use or disclose information for treatment, payment, or health care operations. We
generally do not have to agree, but will explain our decision. If we agree, we follow the restriction unless a permitted
exception, such as emergency treatment, applies.
If you pay for a service or item out of pocket in full and ask us not to disclose related information to your health plan for
payment or operations, we will honor that request unless law requires disclosure. Tell us before a claim or other
disclosure is sent when possible. This does not prevent legally permitted treatment-related sharing.
Obtain an accounting and a copy of this notice
You may request an accounting of certain disclosures during up to the six years before your request. The accounting
excludes categories the law excludes, such as many treatment, payment, and operations disclosures and disclosures
made with your authorization. The first accounting in a 12-month period is free. We will explain a permitted fee for
additional requests and let you withdraw or change the request. We respond within 60 days, subject to one legally
permitted 30-day written extension.
You may obtain a paper copy of this notice promptly at any time, even if you previously agreed to an electronic copy.
You may also view the current notice in our clinic or on our website.
Choose someone to act for you
A legally authorized personal representative may exercise your rights within the scope of that authority. We verify that
authority before acting. A parent or guardian generally has access to a minor's records, but state or federal law or a
court order may limit access. We apply those protections and any lawful exception concerning abuse, neglect, or
endangerment.
Family and others involved in care
You may tell us whether we may share information directly relevant to a family member's, friend's, or other person's
involvement in your care or payment. We may share relevant information when you agree, do not object when given
an opportunity, or when another legal basis applies. If you cannot express a preference, we may use professional
judgment to share information in your best interests, as law permits. Similar rules may permit disaster-relief
communications.
Uses requiring authorization
We obtain written authorization for uses and disclosures not otherwise permitted or described here, including
marketing when required by law, sale of PHI where legally permitted and requiring authorization, and most uses of
psychotherapy notes. A sale authorization, if legally permissible, must disclose remuneration. Texas law can impose
additional restrictions. We do not interpret a treatment consent, privacy acknowledgment, or AI consent as
authorization for patient advertising.
You may revoke an authorization in writing to Dr. Crane. Revocation applies prospectively, except to the extent we
have already acted in reliance on it or another legal exception applies. If fundraising is undertaken, you may opt out of
further fundraising communications; for Part 2 information, we will first provide clear notice and a choice about
receiving them.

How information may be used and shared

We may use or disclose information electronically or in other forms for the purposes below when permitted by
applicable law. We apply required safeguards and any more protective federal or Texas rule.
Treatment payment and clinic operations
Treatment: we use information to evaluate you and plan care and may share it with providers involved in your
treatment, such as a practitioner receiving a referral.
Payment: we use information to collect payment, prepare statements or superbills, and make other permitted payment
disclosures. Any required paid-in-full restriction is honored.
Operations: we use information for recordkeeping, quality review, administration, compliance, and other permitted
health care operations. Approved service providers may assist under required agreements and safeguards. We may
contact you about appointments, treatment alternatives, or health-related services where permitted.
Other permitted or required purposes
Public health and safety: reporting diseases or product problems, responding to recalls, reporting abuse or neglect, or
addressing a serious and imminent threat, when legal conditions are met.
Health oversight and legal duties: authorized audits, investigations, inspections, licensing activities, and disclosures
required by law, including to HHS for compliance review.
Legal proceedings and law enforcement: legally permitted responses to court orders, subpoenas, or law-enforcement
requests only after applicable conditions are met. A request does not automatically authorize release of every record.
Other authorized purposes: workers' compensation, certain military or national-security functions, correctional settings
where applicable, organ donation, medical examiners and funeral directors, and research satisfying applicable
authorization or waiver requirements. These permissions do not mean the clinic routinely participates in every activity
listed.
Substance use disorder records
If we receive or maintain substance use disorder records protected by 42 CFR Part 2, we follow the additional rules
applicable to those records. We do not use or disclose those records, or testimony describing their contents, in civil,
criminal, administrative, or legislative proceedings against you without your appropriate written consent or a qualifying
court order and subpoena or other required legal mandate. Any consent required for use in a proceeding must be
separate from consent for other purposes.
Other uses and disclosures of Part 2 records must also satisfy applicable Part 2 requirements. A general HIPAA
permission does not automatically override them. We provide advance clear notice and an opportunity to decline
fundraising communications using Part 2 information.
Additional Texas protections
Texas law may impose additional limits on electronic disclosures and on records involving mental-health services, HIV
and communicable diseases, genetic information, or services for which a minor can independently consent. We obtain
additional authorization when required and honor applicable exceptions and restrictions. An ordinary release form
does not waive all special protections.