Notice of Privacy Practices
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.
Effective Date: May 1, 2026
Who this notice covers
This Notice of Privacy Practices applies to Alchemy Psychotherapy and Shayan Salar, LCSW, LCADC (the Practice). It describes how the Practice uses and discloses your protected health information (PHI), your rights regarding your PHI, and the Practice's legal duties with respect to your PHI.
Uses and disclosures of your health information
The Practice uses and discloses your PHI primarily for treatment, payment, and healthcare operations. For treatment, your PHI may be used to provide, coordinate, or manage your mental health care, including sharing information with other healthcare providers involved in your care with your written authorization. For payment, if you are seeking out-of-network reimbursement from an insurance carrier, your PHI may appear on the Superbill provided to you monthly, which you are responsible for submitting to your insurer. For healthcare operations, PHI may be used for administrative and quality improvement purposes, including reviewing treatment records to improve care and resolving complaints.
In short, your health information is used to provide you with care, process any out-of-network claims you initiate, and maintain the practice's operations.
Other uses and disclosures
The Practice may use or disclose your PHI without your authorization only in specific circumstances required or permitted by law. These include mandatory reporting of suspected child or elder abuse or neglect, disclosures required by public health authorities, disclosures required by law enforcement in limited circumstances, and disclosure to prevent a serious imminent threat to your safety or the safety of an identifiable third party.
All other uses and disclosures of your PHI require your specific written authorization. You have the right to revoke any authorization you have given, in writing, at any time.
Your rights regarding your health information
You have the right to inspect and obtain a copy of your PHI held by the Practice. Written requests will be responded to within 30 days. You have the right to request amendment of PHI you believe is inaccurate or incomplete, though the Practice may deny requests under certain circumstances. You have the right to request a list of disclosures made by the Practice in the past six years, excluding disclosures for treatment, payment, or healthcare operations. You have the right to request restrictions on uses and disclosures of your PHI, though the Practice is not required to agree to all requested restrictions. You may request that the Practice communicate with you at a specific address or phone number, and reasonable requests will be accommodated. You may request a paper copy of this Notice at any time.
The Practice's duties
The Practice is required by law to maintain the privacy of your PHI and to abide by the terms of this Notice. The Practice reserves the right to change the terms of this Notice, with changes effective for all PHI it maintains. Revised Notices will be posted on this website and provided to you upon request.
How to file a complaint
If you believe your privacy rights have been violated, you may file a complaint with the Practice or with the U.S. Department of Health and Human Services Office for Civil Rights at hhs.gov/ocr/privacy/hipaa/complaints. You will not be retaliated against for filing a complaint.
To contact the Practice with questions or complaints:
Shayan Salar, LCSW, LCADC Alchemy Psychotherapy 4424 Gaines Ranch Loop, Austin, TX 78735 (720) 663-0103 ssalar@alchemypsychotherapy.com