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Chrysalis Counseling & Wellness, PLLC
Effective Date: September 7, 2026
Your Information. Your Rights. Our Responsibilities.
This notice describes how health information about you may be used and disclosed, how you can access this information, and your rights regarding your protected health information. Please review it carefully.
Questions or concerns?
Katherine Gomez, MA, LPC
Chrysalis Counseling & Wellness, PLLC
Your Rights
You have the right to:
See or obtain an electronic or paper copy of your health record.
Ask us to correct information you believe is incorrect or incomplete.
Ask us to communicate with you in a specific way or at a different address.
Ask us to limit certain uses or disclosures of your information. We are not always required to agree, except in certain circumstances when you pay for a service in full and ask us not to disclose it to your health plan.
Request an accounting of certain disclosures of your health information made during the previous six years.
Receive a paper copy of this Notice at any time.
Choose someone legally authorized to act on your behalf.
File a complaint if you believe your privacy rights have been violated.
We will not retaliate against you for exercising your rights or filing a complaint.
Your Choices
In certain situations, you may tell us how you would like your health information shared, including sharing information with family members or others involved in your care.
We generally will not use or disclose your information for marketing, sell your information, or disclose most psychotherapy notes without your written authorization.
If you are unable to communicate your preference, we may disclose information when permitted by law and when necessary to protect your health or safety or the health or safety of others.
How We May Use and Disclose Your Information
We may use or disclose your protected health information as permitted or required by law, including to:
Provide and coordinate your treatment.
Operate the practice and manage your care.
Bill and obtain payment for services.
Comply with applicable federal or state law.
Address certain public health or safety concerns.
Report suspected abuse or neglect when required or permitted by law.
Respond to certain health oversight, workers' compensation, law enforcement, or government requests.
Respond to court or administrative orders, subpoenas, lawsuits, or other legal proceedings when permitted or required by law.
Work with a medical examiner, coroner, or funeral director when legally appropriate.
Conduct health research when applicable legal requirements have been satisfied.
Other uses or disclosures not described in this Notice will generally require your written authorization. You may revoke an authorization in writing at any time, except to the extent that we have already acted in reliance upon it.
Psychotherapy Notes
Psychotherapy notes receive additional protections under federal law. In most circumstances, your written authorization is required before psychotherapy notes may be used or disclosed, except where otherwise permitted or required by law.
Substance Use Disorder Records
To the extent that Chrysalis Counseling & Wellness, PLLC creates or maintains substance use disorder patient records that are protected by 42 CFR Part 2, those records receive additional federal confidentiality protections.
Such Part 2 records generally may not be used or disclosed in civil, criminal, administrative, or legislative investigations or proceedings against you without your written consent or a qualifying court order and subpoena, as required by applicable federal law.
Our Responsibilities
We are required by law to maintain the privacy and security of your protected health information.
We will notify you as required by law if a breach occurs that may have compromised the privacy or security of your information.
We must follow the privacy practices described in the Notice currently in effect.
We may change the terms of this Notice. Any changes may apply to health information we already maintain as well as information we receive in the future. The current Notice will be available upon request and on our website.
Complaints and Questions
If you have questions about this Notice or believe your privacy rights have been violated, you may contact:
Katherine Gomez, MA, LPC
Chrysalis Counseling & Wellness, PLLC
4204 Gardendale St., Suite 207
San Antonio, TX 78229
Phone: (210) 446-9250
Email: connect@chrysaliscounselingwellness.com
You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. Filing a complaint will not affect your care, and Chrysalis Counseling & Wellness, PLLC will not retaliate against you for filing a complaint.
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