HIPAA Notice of Privacy Practices

Effective Date: August 2025

This Notice describes how medical and mental health information about you may be used and disclosed and how you can access this information. Please review it carefully.

Our Legal Duties

We are required by federal law to maintain the privacy of your Protected Health Information (PHI),provide you with this Notice, and abide by its terms.

Permitted Uses and Disclosures

We may use or disclose your PHI without your written authorization for the following purposes:

- Treatment: To coordinate or manage your care.

- Payment: To bill and obtain reimbursement for services.

- Healthcare Operations: For quality improvement, audits, and administrative purposes.

Other Uses and Disclosures

Other uses of PHI will only be made with your written authorization. You may revoke such authorization

at any time in writing.

Your Rights

You have the right to:

- Request access to and copies of your records.

- Request amendments to your records.

- Request restrictions on certain uses of your PHI.

- Request confidential communications.

- Receive an accounting of disclosures.

- File a complaint without fear of retaliation.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with:

Kimberly Patlan, MS, LPC

Serene Heart Therapy

Email: kimberly@serenehearttherapy.org

Phone: 210-263-6823

You may also file a complaint with the U.S. Department of Health & Human Services, Office for Civil Rights.

Filing a Complaint

If you believe your privacy rights have been violated, you may file a complaint with:

Texas Behavioral Health Executive Council (BHEC)
333 Guadalupe Street, Suite 3-900
Austin, Texas 78701
Phone: (512) 305-7700
Website: www.bhec.texas.gov