Notice of Privacy Practices
This notice describes how information about you may be used and disclosed and how you can gain access to this information. Please review it carefully.
At Next Level Recovery, we are committed to treating and using protected health information about you responsibly. This Notice of Privacy Practices describes the personal information we collect and how and when we use or disclose the information. It also describes your rights as they relate to your protected health information. This notice is effective as of September 24, 2015 and applies to all protected health information as defined by federal regulations.
Understanding Your Health Record/Information
Each time you visit Next Level Recovery, a record of your visit is made. Typically, this record contains symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information often referred to as your health and medical record and serves as:
- Basis for planning your care and treatment.
- Means of communication among the health professionals at Next Level Recovery who contribute to your care.
- Legal document describing the care you received.
- Means by which you or a third-party payee can verify that services billed were actually provided.
- In order for Next Level Recovery to obtain payment for health and treatment services that were provided to you.
- A source of date for our planning and marketing.
- A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve. Understanding what is in your record and how your health information is used helps you to ensure accuracy, better understand who, what, when, where and why others may access your health information; and make more informed decisions when authorizing disclosure to others.
Your Health Information Rights
Although your health record is the physical property of Next Level Recovery, the information belongs to you. You have the right to:
- Obtain a paper copy of this notice of information practices upon request.
- Inspect and obtain copies of your health record as provided for in 45 CFR 164.524.
- Amend your health record as provided in 45 CFR 164.528.
- Obtain an accounting of disclosures of your health information as provided by 45 CFR 164.528.
- Request communication of your health information by alternative means or at alternative locations.
- Request a restriction on certain uses and disclosures of your information as provided by 45 CFR 164.522.
- Revoke your authorization to use or disclose health information except to the extent the action has already been taken.
Next Level Recovery is required to:
- Maintain the privacy of your health information.
- Provide you with this Notice as to our legal duties and privacy practices with respect to information we collect and maintain about you.
- Abide by the terms of this Notice.
- Notify you if we are unable to agree to requested restriction.
- Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations. We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. You may request a copy of the then-current Notice. We will not use or disclose your health information without your authorization except as described below. We will also discontinue to use or disclose your health information after we have received a written revocation of the authorization according to the procedures included in the authorization.
Your health information will be shared with third party payers in order to receive reimbursement for services rendered. Your health information will be shared with outside agencies and individuals in the following events without your consent:
- Medical emergency
- Report of child or elder abuse
- Active suicidality or homicidal intent
- Threat of violence towards Next Level Recovery and its staff members
- Destruction of property or violence towards staff at Next Level Recovery
- Intentional infection of other individuals with Communicable disease
- Under court subpoena.
For More Information or to Report a Problem
If you have questions or would like additional information, you may contact the Next Level Recovery Privacy Officer, Christina Malters, at (801)-386-9799 ext. 209 or at firstname.lastname@example.org.
If you believe your privacy rights have been violated, you can file a complaint with the Next Level Recovery Privacy Officer or with the Office of Civil Rights, U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint with either the Privacy Officer or the Office for Civil Rights.
6771 South 900 East
Midvale, Utah 84047