HIPAA Notice of Privacy Practices
Alchemical Transformations Health Services, P.C.
Effective Date: July 2, 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.
1. INTRODUCTION
Alchemical Transformations Health Services, P.C., (“we,” “our,” or “us”) is dedicated to maintaining the privacy of your Protected Health Information (“PHI”) in accordance with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), as amended, and applicable state and federal laws. PHI is any information that identifies you and relates to your past, present, or future physical or mental health condition, the provision of healthcare to you, or payment for that provision of healthcare.
We provide telemedicine services, which involve the electronic transmission of medical information via various secure platforms (e.g., video conferencing, secure messaging, remote patient monitoring). This Notice applies to all telemedicine-related interactions, in addition to any in-person services we may provide. We are required by law to provide you with this Notice of Privacy Practices (“Notice”) and to abide by the terms described herein while it is in effect.
2. OUR DUTIES
2A. Legal Obligations
We are required by law to maintain the privacy of your PHI, to provide you with this Notice explaining our legal duties and privacy practices regarding your PHI, and to comply with the terms of our current Notice.
2B. Duty to Provide Notice of a Breach
In the event of a breach of your unsecured PHI, we will notify you in accordance with the breach notification requirements of 45 C.F.R. §§ 164.400–164.414. This notice will be provided without unreasonable delay and in no case later than sixty (60) days following the discovery of the breach. Our notification to you will include, to the extent possible:
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- A brief description of the breach.
- A description of the type(s) of information that were involved in the breach (e.g., name, date of birth, treatment information).
- Steps you can take to protect yourself from potential harm resulting from the breach.
- A description of the actions we are taking to investigate, mitigate, and prevent any further unauthorized disclosures.
- Contact procedures for you to ask questions or obtain additional information.
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2C. Duty to Not Use or Disclose PHI Beyond Listed Purposes
Except as described in this Notice or as otherwise permitted or required by law, we will not use or disclose your PHI for any purpose without first obtaining your written authorization. If you authorize us to use or disclose your PHI for a purpose not described here, you may revoke that authorization at any time by contacting us in writing.
2D. Changes to this Notice
Our practices regarding revisions or amendments to this Notice, and how we will notify you of significant changes, are described in Section 7 of this Notice.
For more information, please visit: https://www.hhs.gov/hipaa/for-individuals/notice-privacy-practices/index.html
3. USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
The following categories describe various ways in which we may use or disclose your PHI without your specific, written authorization, to the extent permitted or required by law.
3A. Treatment
We may use or disclose your PHI to provide, coordinate, or manage your healthcare.
For instance, healthcare professionals (including physicians, nurses, or specialists) involved in your care may communicate about your condition and share relevant PHI via telemedicine platforms to facilitate diagnosis, treatment plans, or follow-up care.
3B. Payment
We may use or disclose your PHI to bill and collect payment directly from you for healthcare services provided.
Because we do not accept insurance, all financial transactions are handled through a secure, online payment processor. In such cases, we may share only the minimum necessary information about you (such as your name or unique transaction details) with the payment processor in order to process and document your payment. We maintain records of these transactions for internal accounting and compliance purposes and protect any related PHI in accordance with our privacy and security policies.
3C. Healthcare Operations
We may use or disclose your PHI to conduct our administrative, financial, and quality improvement activities. This may include evaluating the performance of our staff, auditing billing processes, or reviewing the effectiveness of telemedicine services.
We may also disclose PHI to attorneys, accountants, or consultants to ensure we are in compliance with applicable laws.
3D. Emergency Treatment or When Communication is Limited
If you require urgent care or are unable to communicate due to your condition, we may use or disclose your PHI as necessary for your treatment or to facilitate emergency services.
3E. Family Members, Friends, or Caregivers
We may disclose your PHI to a family member, friend, or any other individual identified by you who is involved in your care or payment for your care, unless you object. In such cases, we will only disclose the minimum necessary information that is directly relevant to their involvement.
For example, if a relative or caregiver assists you in scheduling appointments or purchasing medications, we may share appointment details or relevant billing information with that individual.
Patient’s Right to Object: You have the right to direct us not to share any information with a particular individual. If you choose to exercise this right, we will honor your request unless it is required in an emergency situation.
We may also disclose your PHI to a public or private entity authorized by law to assist in disaster relief efforts, such as the American Red Cross, so that your family or others responsible for your care can be notified of your location and condition. If you object, we will honor your objection to the extent we can practicably do so under the emergency circumstances.
3F. Incapacitated Patients
If you are unable to agree or object due to incapacity or another emergency circumstance, we may disclose PHI to a family member, friend, or caregiver based on our professional judgment of the individual’s involvement in your care and in your best interests. Once you regain capacity, you will have the opportunity to agree or object to future disclosures.
3G. Disclosures Required by Law
We will use or disclose your PHI when federal, state, or local law requires the use or disclosure. This includes disclosures to the Secretary of the U.S. Department of Health and Human Services when the Secretary requires the information to investigate or determine our compliance with federal privacy law.
3H. Public Health Activities
We may disclose your PHI to public health or government authorities authorized by law to carry out their public health responsibilities, including activities to prevent or control disease, injury, or disability. Examples include reporting communicable diseases to local, state, or federal health departments and reporting information about potential exposure to a communicable disease that may otherwise threaten the health or safety of a community.
3I. Vital Events Reporting
Recording births or deaths in compliance with mandatory government reporting requirements.
3J. Monitoring and Preventing Health Problems
Sharing limited, necessary information with agencies like the Centers for Disease Control and Prevention (CDC) to investigate outbreaks or track vaccination statuses.
Coordinating with entities responsible for monitoring adverse events related to medications or medical devices (e.g., the Food and Drug Administration, “FDA”).
3K. Reporting of Abuse, Neglect or Domestic Violence
Where required or authorized by law, reporting suspected child abuse or neglect, or instances of abuse or domestic violence involving a vulnerable adult.
3L. Regulatory Activities
Informing regulatory agencies about deficiencies or compliance issues related to quality, safety, or the effectiveness of a product or activity regulated by those agencies.
In all instances, we will only disclose the minimum amount of PHI necessary to achieve the stated public health goal, as permitted or required by federal, state, or local laws.
3M. Disclosures for Coroners, Medical Examiners, and Funeral Directors
We may disclose your PHI to coroners or medical examiners as necessary to identify a deceased individual, determine the cause of death, or otherwise carry out their legal obligations. We may also disclose PHI to funeral directors, consistent with applicable law, to enable them to carry out their duties.
3N. Organ, Eye, and Tissue Donation
We may disclose your PHI to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs, eyes, or tissue for the purpose of facilitating donation and transplantation.
3O. Health Oversight Activities
We may disclose your PHI to a health oversight agency, such as a state or federal agency authorized by law, for oversight activities including, but not limited to, audits, investigations, inspections, licensure or disciplinary actions, civil or administrative proceedings, or other activities necessary to ensure the appropriate functioning of the healthcare system, regulatory compliance, and enforcement of civil rights laws.
These disclosures enable the relevant government or regulatory authority to monitor and oversee healthcare organizations, healthcare programs (e.g., Medicaid, if applicable), and compliance with legal requirements, thereby helping to prevent fraud, waste, or abuse in the healthcare system.
3P. Legal Proceedings and Court Orders
We may disclose your PHI when required to do so by a court order, an order of an administrative tribunal, or a valid subpoena. In such cases, we will limit the PHI disclosed to the minimum necessary to comply with the legal requirement, and, where feasible, we will make reasonable efforts to notify you of the request or to seek a qualified protective order to safeguard your information.
3Q. Reporting Certain Injuries or Incidents
We may share information with law enforcement or public safety authorities if mandated by law (e.g., reporting gunshot wounds) or when necessary to protect you or others from harm.
3R. Providing Information to Law Enforcement
We may disclose limited PHI to help law enforcement identify or locate a suspect, fugitive, material witness, or missing person.
3S. Victims of a Crime
If you are the victim of a crime and unable to agree to disclosure due to incapacity or other emergency circumstances, we may disclose PHI if permitted by law and if we determine it is in your best interests.
3T. Serious Threat to Health or Safety
We may use or disclose your PHI if we believe it is necessary to prevent or lessen a serious and imminent threat to the health or safety of you or another individual, consistent with applicable law and ethical standards.
3U. Workers’ Compensation
We may disclose your PHI as authorized by law and only to the extent necessary to comply with workers’ compensation or similar programs that provide benefits for work-related injuries or illnesses. This may include disclosing relevant information to insurance carriers or claims administrators for the purpose of processing or adjudicating a workers’ compensation claim, in accordance with applicable legal requirements.
3V. Specialized Government Functions
If you are or were a member of the United States Armed Forces, we may disclose your PHI as required by United States military command authorities. We may also disclose PHI to authorized federal officials for intelligence or other national security activities, as required by law.
3W. Inmates and Individuals in Custody
If you are an inmate of a correctional institution or in the custody of a law enforcement official, we may disclose your PHI to the institution or official where the disclosure is necessary to provide you with health care, to protect your health and safety or the health and safety of others, or to maintain the safety and security of the correctional institution.
3X. Research
Under certain circumstances, and only with appropriate safeguards, we may disclose your PHI for research purposes in compliance with federal regulations governing research.
3Y. Appointment Reminders and Health-Related Benefits
We may contact you to remind you of upcoming appointments or inform you of treatment alternatives or other health-related benefits and services that may be of interest to you.
4. USES AND DISCLOSURES SUBJECT TO YOUR WRITTEN AUTHORIZATION
Other uses and disclosures of your PHI not described above will only be made with your written authorization. You may revoke your authorization at any time by submitting a written request to us, except to the extent that we have already taken action based on your authorization.
4A. Marketing and Sale of PHI
We never sell your health information, and Texas law prohibits the sale of PHI. We will obtain your written authorization before using or disclosing your PHI for marketing purposes. This ensures that you have full control and transparency regarding any use or disclosure of your PHI beyond what is outlined in this Notice.
5. YOUR RIGHTS REGARDING YOUR PHI
You have the following rights with respect to your PHI. To exercise these rights, please contact us at the address provided below. We will respond to written requests within the timeframes described in this Section. For some requests, federal law allows us a single thirty (30) day extension; if we need one, we will tell you in writing why and when to expect our response.
5A. Right to Inspect and Obtain a Copy of Your Medical Records
You have the right to inspect and obtain a copy, in paper or electronic form, of certain PHI that we maintain about you, including your medical and billing records. Because we maintain our records electronically, you may request your copy in electronic form, and we will provide it in the form and format you request if we can readily produce it that way. Under Texas law, when you submit a written request for an electronic copy of records held in our electronic health record system, we will provide the copy no later than the fifteenth (15th) business day after we receive your request. For all other access requests, we will provide a copy or a summary of your health information within thirty (30) days. You may also direct us in writing to transmit an electronic copy of your records to a person or entity you clearly designate; your request must be signed and must identify the designated recipient. We may charge a reasonable, cost-based fee as permitted by law for copying and mailing expenses. Please submit requests in writing to [email protected].
5B. Right to Request Amendments
If you believe your PHI is incorrect or incomplete, you may request that we amend it. We will respond to your request in writing within sixty (60) days. We may deny your request if we determine the information is accurate and complete or if the PHI was not created by us; if we deny it, we will explain the basis for the denial and how you may respond, including your right to submit a statement of disagreement. Please submit amendment requests in writing to [email protected].
5C. Right to an Accounting of Disclosures
You have the right to request a list of certain disclosures of your PHI made by us in the six (6) years prior to your request date, excluding disclosures for treatment, payment, healthcare operations, and certain other exceptions. We will provide the accounting within sixty (60) days of your request. The first accounting in any twelve (12) month period is free of charge; for additional requests within that period, we may charge a reasonable, cost-based fee, and we will notify you of the cost in advance so that you may withdraw or modify your request. Please submit requests to [email protected].
5D. Right to Request Restrictions
You have the right to request additional restrictions on the use or disclosure of your PHI for treatment, payment, or healthcare operations. You also have the right to request that we limit the PHI we disclose to certain family members, friends, or others involved in your care or payment for your care.
While we will consider your request, we are not legally required to agree to it unless the disclosure pertains solely to a service you fully paid for out of pocket and you request that the information not be disclosed to your health plan. If we agree to a restriction, we may nonetheless use or disclose the restricted information where it is needed to provide you with emergency treatment.
5E. Right to Request Confidential Communications
You have the right to request that we communicate with you by alternative means or at alternative locations (e.g., only calling your personal mobile phone, not a shared phone, or to contact you via e-mail only). We will accommodate all reasonable requests. Please submit confidential communications requests to [email protected].
5F. Right to Notice of Breach
In the event of a breach of your unsecured PHI, we will notify you in accordance with federal and applicable state law. Please refer to the section entitled ‘Duty to Provide Notice of a Breach,’ found above, for more information.
5G. Right to a Paper Copy of this Notice of Privacy Practices
You have the right to obtain a paper copy of this Notice at any time, even if you have agreed to receive it electronically. You may request a copy by contacting us directly at [email protected] or by downloading it from our website.
5H. Right to Have a Personal Representative Act for You
If someone has the authority to act as your personal representative, for example under a medical power of attorney or as your legal guardian, that person may exercise your rights and make choices about your PHI on your behalf. We will verify the person’s authority before taking action at their direction.
6. TELEMEDICINE SECURITY MEASURES
We use secure, HIPAA-compliant telemedicine platforms to protect your PHI. Although we employ encryption and other safeguards, no method of electronic transmission or storage is absolutely secure. By using our telemedicine services, you acknowledge and accept these inherent risks. If you have questions regarding the security of your PHI in a telemedicine context, please contact us.
7. CHANGES TO THIS NOTICE
We reserve the right to revise or amend this Notice at any time, and to make the revised or amended Notice effective for all PHI that we maintain. If we make a significant revision to our privacy practices, we will promptly post the updated Notice on our website and provide any other notice required by law. The date of the latest revision will be indicated at the top of this Notice.
8. QUESTIONS, CONCERNS, OR COMPLAINTS
If you have any questions about this Notice, or if you believe your privacy rights have been violated and wish to file a complaint, you may contact our Privacy Officer at:
Alchemical Transformations Health Services, P.C.
Attn: Privacy Officer
5301 Alpha Rd., Suite 80-112
Dallas, Texas 75240
Email: [email protected]
Phone: (972) 846-0705
You also have the right to file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, by calling 1-877-696-6775, or by visiting https://www.hhs.gov/hipaa/filing-a-complaint/index.html. We will not retaliate against you for filing a complaint.
9. ACKNOWLEDGMENT OF RECEIPT
We will ask you to provide an electronic acknowledgment confirming that you have received this Notice. This acknowledgment documents your receipt or review of this Notice of Privacy Practices and does not constitute consent to any use or disclosure of your PHI.
By using our telemedicine services, you affirm that you have had the opportunity to review this Notice and understand how your PHI may be used and disclosed.