Notice of Privacy Practices
Template — not yet legally reviewed. This is scaffolding showing the required sections of a HIPAA Notice of Privacy Practices. It is not legal advice and must be reviewed and completed with Jaime Telfeyan and a qualified attorney before the site goes live.
Effective date: August 22, 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.
Uses and disclosures
- Treatment. Including review of clinical work with my supervising clinician, Jaime Telfeyan, which is a required part of practicing as an LPC Associate.
- Payment. Billing and claims where applicable.
- Health care operations. Quality and administrative functions.
Disclosures without your authorization
- Suspected abuse or neglect of a child, elderly person, or person with a disability.
- Serious and imminent risk of harm to you or an identifiable other person.
- Court order, subpoena, or other legal requirement.
- Suspected sexual exploitation of a client by a mental health services provider. Texas law requires a report to the prosecuting attorney in the county where the conduct is alleged to have occurred and to the provider’s licensing board within 30 days. You would be told of this duty first, and asked whether you wish to remain anonymous (Tex. Civ. Prac. & Rem. Code § 81.006).
- Suspected abuse, neglect, or unprofessional conduct in a health care facility (Tex. Health & Safety Code ch. 161, subch. L).
- Court-ordered sex offender treatment. Where treatment is court-ordered or a condition of supervision, treatment information is released as that statute requires (Tex. Occ. Code § 109.051).
- To a governmental agency where the disclosure is required or authorized by law (Tex. Health & Safety Code § 611.004(a)(1)).
- To a person or entity handling billing or payment for services provided to you (§ 611.004(a)(6)).
- To the personal representative of a deceased client (§ 611.004(a)(5)).
- For audits, program evaluation, or research, where the results may not identify you in any way (§ 611.004(a)(3), (b)).
Your rights
- Inspect and obtain a copy of your record
- Request an amendment to your record
- Request an accounting of certain disclosures
- Request restrictions or confidential communications
- Obtain a paper copy of this notice
- File a complaint without retaliation
Complaints
You may complain to this practice at wesley@wesleydonaldtherapy.com, to Texas State Board of Examiners of Professional Counselors, under the Texas Behavioral Health Executive Council, or to the U.S. Department of Health and Human Services Office for Civil Rights. You will not be penalised for filing a complaint.
Contact
Privacy contact: Wesley Donald, Licensed Professional Counselor Associate (license no. 102546), supervised by Jaime Telfeyan, LPC-S (license no. 66708).