Neurvana Mental Health & WellnessNotice of Privacy Practices

Effective Date: May 6th 2026

THIS NOTICE DESCRIBES HOW MEDICAL AND MENTAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Our Responsibilities

Neurvana Mental Health & Wellness (including Allison Bonham, PMHNP-BC) is required by law to:

• Maintain the privacy of your Protected Health Information (PHI).

• Provide you with this Notice of our legal duties and privacy practices.

• Follow the terms of this Notice.

• Notify you in the event of a breach of your unsecured PHI.

PHI includes any individually identifiable information about your past, present, or future physical or mental health, healthcare, or payment for healthcare.

How We May Use and Disclose Your PHI (Without Authorization)

We may use and disclose your PHI for the following purposes:

• Treatment: To provide, coordinate, or manage your mental health care (e.g., medication management, consultations with other providers).

• Payment: To bill and collect payment from you, insurance companies, or third parties.

• Healthcare Operations: For quality improvement, business management, accreditation, and compliance activities.

Other Permitted or Required Disclosures (without your authorization):

• As required by law (e.g., court orders, subpoenas).

• For public health and safety (e.g., reporting abuse/neglect, preventing serious threats to health or safety).

• For health oversight activities, research (with protections), or to coroners/funeral directors.

• In emergencies or to avert serious threats.

• Limited information to family or friends involved in your care (if appropriate).

We will use or disclose only the minimum necessary information.

Psychotherapy Notes: Separate notes from counseling sessions receive extra protection and generally require your authorization for disclosure.

Uses and Disclosures Requiring Your Written Authorization

We will obtain your written authorization for:

• Marketing purposes.

• Sale of your PHI.

• Most disclosures of psychotherapy notes.

• Any other uses/disclosures not described above.

You may revoke your authorization in writing at any time (except to the extent we have already relied on it).

Your Rights Regarding Your PHI

You have the right to:

• Access and copy your PHI (with limited exceptions; reasonable fees may apply).

• Request amendments if you believe information is inaccurate or incomplete.

• Request restrictions on certain uses/disclosures (we are not always required to agree, but must honor requests for services you pay for out-of-pocket).

• Request confidential communications (e.g., by alternative means or locations).

• Receive an accounting of certain disclosures of your PHI.

• Receive a paper copy of this Notice at any time.

• File a complaint if you believe your privacy rights have been violated (with us or the U.S. Department of Health and Human Services). We will not retaliate against you.

Changes to This Notice

We reserve the right to change our privacy practices and this Notice. Revised Notices will apply to all PHI we maintain. We will post the current Notice on our website and make it available upon request.

Contact Information

For questions or to exercise your rights:

Allison Bonham, PMHNP-BCPrivacy Officer Neurvana Mental Health & Wellness

50 W. Broadway Ste 333
PMB 538043
Salt Lake City, Utah 84101-2027

Phone: (385)-329-7410

Email: Allison@neurvanapsychiatry.com

You may also file complaints with:
Secretary, U.S. Department of Health and Human Services
200 Independence Avenue, S.W. Washington, D.C. 20201