NOTICE OF PRIVACY PRACTICES Revive Behavioral Health Solutions LLC Effective Date: June 1, 2025
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Who This Notice Applies To This Notice applies to the privacy practices of Revive Behavioral Health Solutions LLC ("Revive BHS"), a licensed behavioral health practice located at 2255 Crain Highway, Suite 105, Waldorf, MD 20601. It covers all clinical services provided by Revive BHS, including behavioral health evaluations, DOT Substance Abuse Professional (SAP) assessments, court-compliance services, and employee assistance programs.
Your Protected Health Information "Protected Health Information" (PHI) includes any information we create or receive that relates to your past, present, or future physical or mental health condition, the provision of health care to you, or payment for your health care, when that information can identify you.
How We May Use and Disclose Your Health Information
Treatment. We may use and share your health information to provide and coordinate your care. For example, we may share evaluation findings with a treating provider, referring physician, or treatment facility involved in your care.
Payment. We may use and share your health information to bill and receive payment for services. This may include submitting claims to insurance companies or employee assistance programs.
Health Care Operations. We may use and share your health information to operate our practice, including quality review, staff training, licensing compliance, and legal services.
Court-Mandated and Legal Reporting. As a provider of forensic and court-compliance services, we are required or permitted by law to disclose certain information to courts, probation officers, attorneys of record, and regulatory bodies (including the U.S. Department of Transportation) in connection with court-ordered evaluations, DOT return-to-duty processes, and compliance monitoring. You will be informed of required disclosures to the extent permitted by law.
As Required by Law. We will disclose your health information when required to do so by federal, state, or local law, including mandatory reporting obligations.
Public Health Activities. We may share information with public health authorities for activities such as disease prevention or reporting.
Business Associates. We may share your information with vendors and service providers ("business associates") who perform services on our behalf, such as billing or records management. These parties are required by contract to protect your information.
Uses and Disclosures Requiring Your Written Authorization We will obtain your written authorization before using or disclosing your health information for purposes not described in this Notice, including most marketing communications, sale of your information, and disclosures of psychotherapy notes. You may revoke an authorization at any time in writing; revocation does not affect disclosures already made.
Special Protections for Substance Use Disorder Records Records related to substance use disorder treatment are subject to additional federal protections under 42 CFR Part 2. These records may not be disclosed without your written consent except in limited circumstances permitted by law, including medical emergencies, court orders, and audits. Revive BHS complies fully with 42 CFR Part 2 where applicable.
Your Rights Regarding Your Health Information
You have the right to:
Request access to your health information and receive a copy in paper or electronic form.
Request corrections to your health information if you believe it is inaccurate or incomplete.
Request restrictions on certain uses and disclosures. We are not required to agree, except in limited circumstances required by law.
Request confidential communications — for example, asking us to contact you only by phone or only at a specific address.
Receive an accounting of disclosures we have made of your health information for purposes other than treatment, payment, or operations.
Receive a paper copy of this Notice upon request, even if you agreed to receive it electronically.
File a complaint if you believe your privacy rights have been violated (see below).
Our Duties Revive BHS is required by law to maintain the privacy of your health information, to provide you with this Notice of our legal duties and privacy practices, and to notify you if a breach of your unsecured health information occurs. We are required to follow the terms of the Notice currently in effect. We reserve the right to change our privacy practices and the terms of this Notice at any time. Changes will apply to all health information we maintain. The current version will be posted on our website and available upon request.
How to Exercise Your Rights or File a Complaint To exercise any of your rights, or if you have questions about this Notice, contact our Privacy Officer:
Revive Behavioral Health Solutions LLC Attn: Privacy Officer 2255 Crain Highway, Suite 105 Waldorf, MD 20601 Email: info@revivebhs.org Phone: (301) 609-2675
If you believe your privacy rights have been violated, you may file a complaint with us using the contact information above, or with the U.S. Department of Health and Human Services Office for Civil Rights at www.hhs.gov/ocr or 1-800-368-1019. We will not retaliate against you for filing a complaint.