Sandra Golaszewski, DNP, APRN, CNM
Privacy Officer, AVENORA Health
info@avenorahealth.com
361.728.1609
HIPAA Notice
HIPAA Notice of Privacy Practices
Effective Date: June 1, 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.
My Duty to Protect Your Health Information
I am required by federal law to maintain the privacy of your protected health information (PHI), provide you with notice of my legal duties and privacy practices regarding your PHI, and abide by the terms of the Notice of Privacy Practices currently in effect. I will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
How I May Use and Disclose Your Health Information
For Treatment
I may use your PHI to provide you with medical care, including evaluation, diagnosis, treatment recommendations, and follow-up. I may share your PHI with other healthcare providers involved in your care, such as specialists I refer you to, the laboratory processing your tests, or community midwives I collaborate with on your case.
For Payment
I may use and disclose your PHI to process payment for the services I provide. Because my practice operates on a direct-pay model and does not bill insurance, this typically means processing the payment you make at the time of service. If you choose to submit a superbill to your insurance for out-of-network reimbursement, the information on that superbill includes your diagnosis and the services provided.
For Health Care Operations
I may use your PHI for activities necessary to run my practice, including quality assessment, training, business planning, and case review. I will use the minimum information necessary for these purposes.
As Required by Law
I may disclose your PHI when required by federal, state, or local law. This includes mandatory reporting of certain conditions, court orders, and public health requirements.
For Public Health Activities
I may disclose your PHI to public health authorities for activities such as preventing or controlling disease, reporting child abuse or neglect, reporting adverse drug reactions, or notifying a person who has been exposed to a communicable disease.
For Health Oversight Activities
I may disclose your PHI to agencies that oversee healthcare, such as the Texas Board of Nursing, in connection with audits, investigations, inspections, or licensure activities.
For Workers' Compensation
I may disclose your PHI as authorized by workers' compensation laws.
To Avoid a Serious Threat to Health or Safety
I may use and disclose your PHI when necessary to prevent a serious and imminent threat to your health and safety or the health and safety of others.
For Specialized Government Functions
I may disclose your PHI for specialized government functions, including military and veterans activities, national security, and protective services.
Uses and Disclosures That Require Your Written Authorization
For uses and disclosures of your PHI not described above, I will obtain your written authorization. This includes most uses and disclosures of psychotherapy notes, uses and disclosures of PHI for marketing purposes, and disclosures that constitute the sale of PHI. If you provide written authorization, you may revoke it at any time in writing, except to the extent I have already acted in reliance on it.
Your Rights Regarding Your Health Information
Right to Request Restrictions
You have the right to request that I limit the use or disclosure of your PHI for treatment, payment, or healthcare operations. I am not required to agree to your request, except when the disclosure would be to a health plan for payment or healthcare operations and the PHI pertains solely to a service you have paid for in full out of pocket.
Right to Confidential Communications
You have the right to request that I communicate with you about your PHI in a specific way or at a specific location. For example, you can ask me to contact you only by email rather than phone, or only at a particular address. I will accommodate reasonable requests.
Right to Access Your Information
You have the right to inspect and copy your PHI that I maintain in my designated record set. To request access, contact me in writing at info@avenorahealth.com. I will respond within 30 days. A reasonable, cost-based fee may apply for copies.
Right to Amend
If you believe your PHI is incorrect or incomplete, you have the right to request that I amend it. To request an amendment, contact me in writing with the reason for the amendment. I may deny your request under certain circumstances, but I will tell you in writing if I do.
Right to an Accounting of Disclosures
You have the right to request a list of certain disclosures I have made of your PHI in the six years prior to your request. To request an accounting, contact me in writing. The first accounting in any 12-month period is free. Reasonable, cost-based fees may apply for additional requests.
Right to a Paper Copy of This Notice
You have the right to a paper copy of this Notice of Privacy Practices, even if you have agreed to receive it electronically. Contact me at info@avenorahealth.com or 361.728.1609 to request a copy.
Right to Be Notified of a Breach
You have the right to be notified if a breach of your unsecured PHI occurs. I will notify you promptly and provide information about what happened and what steps are being taken.
Texas-Specific Patient Rights
In addition to your federal HIPAA rights, Texas law provides additional patient privacy protections. Under Texas Health & Safety Code Chapter 181, sensitive health information including mental health, substance use, HIV/AIDS, and reproductive health information may require specific written authorization for disclosure. I will follow both federal and Texas requirements when handling your information. If federal and state laws differ, I will apply the more protective standard.
My Duties
I am required by law to maintain the privacy and security of your PHI, provide you with this Notice of my legal duties and privacy practices, follow the terms of the Notice currently in effect, and notify you if a breach occurs that may have compromised the privacy or security of your information. I reserve the right to change the terms of this Notice. If I make significant changes, the new terms will apply to all PHI I maintain. A revised Notice will be posted on this website and made available in my practice.
How to File a Complaint
If you believe your privacy rights have been violated, you have the right to file a complaint. You will not be retaliated against for filing a complaint.
To file a complaint with my practice, contact me directly:
To file a complaint with the federal government, contact:
U.S. Department of Health and Human Services, Office for Civil Rights
200 Independence Avenue, S.W., Washington, D.C. 20201
1-877-696-6775
www.hhs.gov/ocr/privacy/hipaa/complaints/
To file a complaint with the Texas Attorney General regarding violations of Texas health privacy law:
Office of the Attorney General of Texas, Consumer Protection Division
P.O. Box 12548, Austin, TX 78711-2548
1-800-621-0508
Privacy Officer
Sandra Golaszewski, DNP, APRN, CNM serves as the Privacy Officer for AVENORA Health. To contact the Privacy Officer with questions about this Notice, your privacy rights, or any concern about how your information is being handled, reach out directly at info@avenorahealth.com or 361.728.1609.
Acknowledgment
This Notice of Privacy Practices is in effect as of the date above. By receiving care at AVENORA Health, you acknowledge that you have been provided with a copy of this Notice or have had the opportunity to review it on this website. A paper copy is available on request.