Notice of Privacy Practices

Template — review with counsel before publishing.

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.

Our responsibilities

• We are required by law to maintain the privacy and security of your protected health information (PHI).
• We will let you know promptly if a breach occurs that may have compromised your information.
• We must follow the duties and privacy practices described in this notice.

How we may use and disclose your information

• Treatment: to provide and coordinate your care.
• Payment: to bill and get payment from health plans.
• Health care operations: to run our practice and improve care.
• As required by law, for public health and safety, to avert a serious threat, and other permitted purposes.

Substance use disorder records

Records relating to substance use disorder treatment may receive additional protection under federal law (42 CFR Part 2).

Your rights

• Get a copy of your health and claims records.
• Ask us to correct your records.
• Request confidential communications.
• Ask us to limit what we use or share.
• Get a list of those with whom we've shared information.
• Get a copy of this notice.
• Choose someone to act for you.
• File a complaint if you feel your rights are violated.

Complaints

You can complain to us at (317) 289-5253 or info@everriserecovery.com, or to the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.

Changes to this notice

We can change the terms of this notice, and changes will apply to all information we have about you.

This draft's effective date is awaiting practice approval. Call EverRise for the current approved Notice of Privacy Practices.