Notice of Privacy Practices
Got it. Here’s a more complete version with your contact info plugged in and the standard HIPAA-required elements added. I’ll flag the additions at the end so you know what changed.
Notice of Privacy Practices
Effective Date: January, 1 2026
Please Read Carefully
THIS NOTICE EXPLAINS HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND SHARED, AND HOW YOU CAN ACCESS THAT INFORMATION. PLEASE TAKE A MOMENT TO REVIEW IT.
Your health record contains personal information about you and your care. Both state and federal law safeguard the confidentiality of this information. Protected Health Information (PHI) covers details related to your past, present, or future physical and mental health, as well as the services you receive. Federal law and regulations provide additional protection for the confidentiality of alcohol and drug treatment records under 42 CFR Part 2. Bonus Round Recovery is required to follow these added safeguards, which generally prohibit us, except in very narrow circumstances, from disclosing that you are receiving treatment or sharing any information that would identify you as someone seeking care for a substance use condition. Violations of these laws are considered criminal offenses, and if you believe a breach has occurred, you may report it to the appropriate authorities as described in federal regulations.
Our Legal Duties
Bonus Round Recovery is required by law to:
- Maintain the privacy and security of your PHI.
- Provide you with this Notice describing our legal duties and privacy practices regarding your PHI.
- Notify you promptly if a breach occurs that may have compromised the privacy or security of your information.
- Follow the terms of the Notice currently in effect.
How We May Use and Share Information About You
For Treatment. We may use your medical and clinical information to deliver care and related services, and to coordinate care among the professionals involved in your treatment.
For Payment. With your written permission, we may use and share your information to obtain payment for the services you receive, including verifying coverage and billing your insurance.
For Health Care Operations. We may use and share your PHI when necessary to support the day to day operation of our program, such as quality assessment, staff training, and program evaluation.
Without Your Authorization. In certain limited situations, the law permits us to share information about you without your authorization. Examples include medical emergencies, reporting suspected child abuse or neglect, complying with a valid court order that meets the requirements of 42 CFR Part 2, certain audits and evaluations, and research that has been properly authorized. Additional details about these exceptions are available upon request.
With Your Authorization. For any purpose not already permitted by law, we will obtain your written authorization before using or sharing your PHI. You may revoke that authorization in writing at any time, except to the extent we have already acted in reliance on it.
Your Rights Regarding Your PHI
Right to Access, Inspect, and Copy. You have the right, with some limitations, to review and request copies of the PHI used in making decisions about your care. Reasonable, cost based fees may apply for copies.
Right to Request an Amendment. If you believe any of your PHI is inaccurate or incomplete, you may ask us to amend it. We are not required to approve every request, but we will review each one in good faith.
Right to an Accounting of Disclosures. You may request a list of certain disclosures we have made of your PHI.
Right to Request Restrictions. You may ask us to limit how your PHI is used or shared for treatment, payment, or health care operations. We are not obligated to agree to every request.
Right to Request Confidential Communications. You may ask us to contact you about medical matters in a particular way or at a specific location.
Right to Be Notified of a Breach. You have the right to be notified if a breach occurs that may have compromised the privacy or security of your PHI.
Right to a Paper Copy of This Notice. You may request a paper copy of this Notice of Privacy Practices at any time, even if you have agreed to receive it electronically.
Contact for Questions and Complaints
If you have questions about this Notice of Privacy Practices, or if you would like to exercise any of the rights described above, please contact our Privacy Officer at:
Email: info@bonusroundrecovery.com Phone: 855-210-0008
If you believe your privacy rights have been violated, you may file a written complaint with us using the contact information above. We will not retaliate against you in any way for filing a complaint.
You may also file a complaint with the U.S. Secretary of Health and Human Services at:
U.S. Department of Health and Human Services Office for Civil Rights 200 Independence Avenue, S.W. Washington, D.C. 20201 (855) 977-6335