HIPAA Notice of Privacy Practices

Neurvana Psychiatry & Wellness, LLC Notice of Privacy Practices

Effective Date: September 15, 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 Psychiatry & Wellness, LLC (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 or permitted by law, including certain judicial or administrative proceedings, subject to applicable legal requirements.

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

  • For workers’ compensation, law enforcement, and other government requests as permitted or required by law.

  • Substance Use Disorder Records: To the extent we maintain substance use disorder patient records protected by 42 CFR Part 2, those records receive additional confidentiality protections. We will not use or disclose Part 2 records in civil, criminal, administrative, or legislative investigations or proceedings against you unless permitted by applicable law, including with your written consent or an appropriate court order and subpoena.

  • 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).

When the HIPAA minimum necessary standard applies, we will make reasonable efforts to limit the pHI we use, disclose, or request to the minimum necessary for the intended purpose.

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 or disclosures. We are generally not required to agree. However, if you pay for a health care service or item out-of-pocket in full, you may request that we not disclose information about that service or item to your health plan for payment or health care operations, and we will honor that request unless disclosure is required by law.

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

  • Receive an accounting of certain disclosures of your PHI.

  • Receive an electronic or 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.

  • Choose someone to act for you. If a person has legal authority to act on your behalf, such as a legal guardian or authorized personal representative, that person may exercise your HIPAA rights as permitted by law.

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-BC

Neurvana Psychiatry & Wellness, LLC

7533 S. Center View Ct.
#6290
West Jordan, UT 84084

Phone: (435) 681-5121

Email: Allison@neurvanapsychiatry.com

You may also file a complaint with:

U.S. Department of Health and Human Services

Office for Civil Rights

200 Independence Avenue, S.W.

Washington, D.C. 20201

Phone: 1-877-696-6775

http://hhs.gov/hipaa/filing-a-complaint

We will not retaliate against you for filing a complaint.