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Release of Protected Health Information (PHI)

Policy:

Balanced Recovery LLC recognizes the client's right to privacy and the protection of personal information from unauthorized disclosure. The medical record is the property of Balanced Recovery LLC and is maintained for the benefit of the client, clinical staff, and the facility. We are committed to maintaining the highest level of confidentiality for all clinical records in accordance with 42 CFR Part 2.

Regulations under 42 CFR Part 2 require the following for authorizations to disclose individually identifiable client health information related to alcohol or drug abuse programs:

Program or Person:

The specific name or general designation of the program or individual authorized to make the disclosure.

Recipient:

The name or title of the individual or organization to whom the disclosure will be made.

Client Identification:

The client’s name.

Purpose:

The purpose of the disclosure.Information: The amount and type of information to be disclosed.Signature: The signature of the client or their legal representative.

Date:

The date the authorization is signed.

Revocation Statement:

A statement that the authorization may be revoked at any time, except to the extent that actions have already been taken based on it. This includes providing services or disclosing information to a third-party payer based on a valid authorization or consent.

Expiration:

The date, event, or condition upon which the authorization will expire if not revoked. This must ensure that the authorization lasts only as long as necessary for its intended purpose.

Redisclosure Warning:

A statement informing the requestor that any disclosed information may be re-disclosed by the recipient and will no longer be protected by the releasing entity.