NOTICE OF PRIVACY PRACTICES

PAX Counseling & Wellness, PLLC Matthew Terra, M.Psy., LPC-Associate

Supervised by Stephen Kim, LPC-S

NOTICE OF PRIVACY PRACTICES

Effective Date: September 15, 2026

THIS NOTICE DESCRIBES HOW YOUR PROTECTED HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS YOUR INFORMATION. PLEASE REVIEW IT CAREFULLY.

YOUR INFORMATION. YOUR RIGHTS. OUR RESPONSIBILITIES.

PAX Counseling & Wellness, PLLC is committed to protecting the privacy of your health information. This Notice of Privacy Practices describes how your protected health information (“PHI”) may be used and disclosed, your rights regarding your PHI, and certain responsibilities of PAX Counseling & Wellness, PLLC under applicable federal and Texas law.

This Notice applies to the health information and records created or maintained in connection with the counseling services you receive from PAX Counseling & Wellness, PLLC.

OUR RESPONSIBILITIES

We are required by law to:

  • Maintain the privacy and security of your PHI.

  • Provide you with this Notice describing our legal duties and privacy practices.

  • Follow the terms of the Notice currently in effect.

  • Notify you promptly if a breach occurs that may have compromised the privacy or security of your PHI, when required by law.

  • Comply with applicable federal and Texas laws governing the confidentiality of mental health information.

Texas law provides additional protections for communications between a patient and a mental health professional and for mental health records. Your confidential communications and mental health records will be used and disclosed only as permitted by applicable law.

We may change the terms of this Notice. Any revised Notice will apply to PHI that we maintain. The current Notice will be available upon request and will be made available on our website.

I. HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION

We may use or disclose your PHI without your written authorization when permitted or required by applicable law. The following are some of the most common circumstances.

Treatment

We may use and disclose your PHI to provide, coordinate, or manage your counseling and other health care services.

For example, we may discuss your treatment with another health care professional when permitted by law and when doing so is necessary for your care.

As an LPC-Associate, I practice under the clinical supervision of Stephen Kim, LPC-S. As permitted by applicable law, your clinical information may be reviewed or discussed with my supervisor for purposes of clinical supervision, oversight, consultation, and compliance with professional licensing requirements.

Payment

We may use or disclose your PHI as permitted by law to obtain payment for services we provide to you.

If you pay for a health care item or service entirely out of pocket, you may request that we not disclose information relating solely to that item or service to your health plan for payment or health care operations purposes, unless disclosure is required by law.

Health Care Operations

We may use or disclose your PHI for health care operations when permitted by law. These activities may include quality assessment, administrative activities, compliance with professional licensing requirements, and other activities necessary to operate our practice.

As Required by Law

We may use or disclose your PHI when required to do so by federal, state, or local law.

Public Health and Safety

We may disclose PHI when permitted or required by law for public health purposes or to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.

This may include legally required reporting of suspected abuse, neglect, or exploitation of children, elderly persons, or other vulnerable individuals.

Judicial and Administrative Proceedings

We may disclose PHI in connection with judicial or administrative proceedings when permitted or required by applicable law, including when responding to a court order or other lawful process.

Texas law provides specific protections and requirements concerning the disclosure of mental health records and confidential communications. We will comply with those requirements.

Law Enforcement

We may disclose PHI to law enforcement officials when permitted or required by applicable law.

Workers' Compensation

We may disclose PHI as necessary to comply with workers' compensation laws.

Coroners and Medical Examiners

We may disclose PHI to coroners or medical examiners when permitted or required by law.

Appointment Reminders and Health-Related Communications

We may use your PHI to contact you regarding appointments, scheduling, billing, treatment-related matters, or other health-related services or benefits that we provide.

II. USES AND DISCLOSURES THAT REQUIRE YOUR WRITTEN AUTHORIZATION

Some uses and disclosures of PHI require your written authorization.

These may include:

  • Certain disclosures of psychotherapy notes, when applicable.

  • Certain uses or disclosures for marketing purposes.

  • The sale of PHI.

  • Other uses or disclosures not otherwise permitted by applicable law.

If you provide an authorization, you generally may revoke it in writing at any time, except to the extent that we have already relied upon the authorization.

Psychotherapy Notes

Psychotherapy notes receive special protection under HIPAA when they meet the definition of “psychotherapy notes” under federal law.

Routine clinical documentation, such as progress notes, treatment plans, assessments, and other records maintained as part of your medical record, is not necessarily considered psychotherapy notes under HIPAA.

If psychotherapy notes are maintained separately from your medical record, applicable federal law may require your written authorization for their use or disclosure except in specifically permitted circumstances.

III. SUBSTANCE USE DISORDER RECORDS

Certain substance use disorder records may be subject to additional confidentiality protections under 42 C.F.R. Part 2. If Part 2 applies to your records, PAX Counseling & Wellness, PLLC will comply with the applicable federal and state requirements governing the use and disclosure of those records.

IV. YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

You have the following rights regarding your PHI, subject to certain exceptions under federal and Texas law.

1. Right to Access Your Health Information

You generally have the right to inspect and obtain a copy of your PHI maintained in your designated record set.

Texas law also provides patients with rights concerning access to mental health records. In certain circumstances, access to a portion of a record may be denied when permitted by Texas law.

We may charge a reasonable, cost-based fee when permitted by law.

2. Right to Request an Amendment

You may request that we correct or amend health information that you believe is incorrect or incomplete.

We may deny your request in certain circumstances permitted by law. If we deny your request, we will provide you with a written explanation.

3. Right to Request Restrictions

You may request that we limit how we use or disclose your PHI for treatment, payment, or health care operations.

We are not required to agree to every requested restriction.

However, if you pay for a health care item or service entirely out of pocket, you may request that we not disclose information relating solely to that item or service to your health plan for payment or health care operations purposes, unless disclosure is otherwise required by law.

4. Right to Request Confidential Communications

You may request that we contact you in a specific way or at a specific location.

For example, you may request that we contact you by telephone rather than by mail, or that we contact you at a particular telephone number or address.

We will accommodate reasonable requests.

5. Right to an Accounting of Certain Disclosures

You generally have the right to request a list of certain disclosures of your PHI made by us during the preceding six years.

Certain disclosures are excluded from an accounting, including disclosures made for treatment, payment, and health care operations and certain other disclosures permitted by law.

6. Right to Receive a Copy of This Notice

You have the right to receive a paper or electronic copy of this Notice of Privacy Practices at any time.

7. Right to Choose a Personal Representative

If you have a legally authorized personal representative, that individual may exercise certain rights regarding your PHI on your behalf, subject to applicable law.

8. Right to File a Complaint

You have the right to file a complaint if you believe your privacy rights have been violated.

You may file a complaint with PAX Counseling & Wellness, PLLC by contacting:

Matthew Terra, M.Psy., LPC-Associate

PAX Counseling & Wellness, PLLC

Email: matthew.terra@paxcounseling.org

Phone: 956.332.3732

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

Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 1-877-696-6775
Website: https://www.hhs.gov/hipaa/filing-a-complaint/

You will not be retaliated against for filing a complaint.

V. DISCLOSURES TO FAMILY MEMBERS, FRIENDS, OR OTHERS INVOLVED IN YOUR CARE

When permitted by applicable law, we may disclose limited PHI to a family member, close friend, or another person whom you identify as being involved in your care or payment for your care.

When appropriate, we may provide an individual with the opportunity to agree or object to such disclosures.

In an emergency or other circumstances permitted by law, we may make such disclosures when appropriate and in your best interest.

VI. MARKETING AND SALE OF PHI

We will not use or disclose your PHI for marketing purposes when authorization is required by law.

We will not sell your PHI without your written authorization when authorization is required by law.

VII. TEXAS CONFIDENTIALITY REQUIREMENTS

In addition to federal HIPAA protections, Texas law provides specific confidentiality protections for mental health communications and records.

Texas Health and Safety Code Chapter 611 provides that communications between a patient and a mental health professional, as well as records concerning the identity, diagnosis, evaluation, or treatment of a patient, are confidential except as authorized by law.

PAX Counseling & Wellness, PLLC will comply with applicable Texas confidentiality requirements, including applicable provisions governing the disclosure and access to mental health records.

VIII. CHANGES TO THIS NOTICE

We reserve the right to change this Notice of Privacy Practices.

Any changes will apply to PHI that we maintain, including information created or received before the revised Notice becomes effective.

The current version of this Notice will be available upon request and will be posted on our website when applicable.

IX. CONTACT INFORMATION

If you have questions about this Notice, your privacy rights, or how your health information is used or disclosed, please contact:

Matthew Terra, M.Psy., LPC-Associate

PAX Counseling & Wellness, PLLC
Email: matthew.terra@paxcounseling.org

Phone: 956.332.3732

Website: paxcounseling.org