This organization’s policy is to maintain the privacy of its clients and not disclose an individual’s personally identifiable health information (also referred to as Protected Health Information (PHI)) or their confidential educational information in accordance with current State and Federal regulations. It is also this organization’s policy to allow clients and/or their legally authorized representative(s) to control how their health information is used.


  • Upon admission, the client and/or legal representative will receive for review and sign, as necessary, the following:
    • Admission Agreement
    • Promise of Privacy Notice
    • Authorization for Release of Confidential Protected Health Information and Educational Information
    • HIPAA Client Consent Form
  • Staff will be trained in maintaining PHI for each client.
  • Requests for PHI from any person outside of the client’s treatment team, shall be analyzed and reviewed to ensure compliance with State and Federal regulations. Any such requests shall be forwarded to the Privacy Information Officer to ensure same. No documents or information shall be disclosed prior to review by the Privacy Information Officer.
  • Unauthorized disclosures of PHI will be immediately reported to the Privacy Information Officer and reports made to authorities in accordance with State and Federal regulations.

HIPAA Privacy Notice and Rights


At Evolve Treatment Centers, we understand the importance of privacy and are committed to maintaining the confidentiality of your protected health information. We make a record of the services we provide and some of those services may include information from professional healthcare providers. Further, we may receive protected health information about you from others. We use these records to provide quality services to you and to transmit to other providers to assist with continuity of care. These records are also used to obtain payment for services provided to you which enables us to meet our professional and legal obligations to operate this organization.

We are required by law to maintain the privacy of protected health information, to provide individuals with notice of our legal duties and privacy practices, and to notify affected individuals following a breach of unsecured protected health information.

This Notice also describes your rights with regard to your medical information and our legal obligations and how we may use and disclose medical information.

How we may use and disclose your Protected Healthcare Information (PHI)

Federal privacy law allows us to use and disclose your PHI for:

  • Planning your care and any necessary treatment(s);
  • Law enforcement;
  • Communications among many healthcare providers that will contribute to your care while you are receiving services from us and to improve the quality of care we provide to our clients;
  • Payment for services provided to you by us or others (like your physician) by third party payers. For example: we might give your insurance company PHI about your present conditions so that there can be proper reimbursement;
  • A tool in educating health professionals and staff;
  • A source of data for facility planning and marketing;
  • Assisting business associates, such as physician services, emergency, radiology, laboratory, etc.;
  • Disaster relief, so authorities know about your condition at the time of a disaster;
  • Crime, abuse and neglect reporting;
  • State and Federal healthcare officials and evaluators. We may disclose your PHI/ePHI to State and Federal healthcare oversight agencies as necessary so that these agencies may carry out their job further; and
  • Other individuals as mandated by law.

We may disclose PHI to the following:

  • Public health/legal authorities charged with preventing or controlling disease, injury, or disability;
  • Correctional institutions (if you are on probation or a diversion program);
  • Workers’ Compensation agents;
  • Organ and tissue donation organizations; Military command authorities;
  • Health oversight agencies;
  • Funeral directors, coroners, and medical examiners;
  • National security and intelligence agencies; and
  • Quality Assurance findings within the organization.

Your Health Information Rights:

  • Inspect and copy – With some exceptions, you have the right to inspect and obtain a digital or hard copy of your health information maintained in your designated record set. We may charge a fee for the associated cost of labor, mailing, or other supplies. We may deny your request to inspect and copy in certain limited circumstances. If you are denied access, you may request a review of the denial.
  • Amend – This means you may request an amendment of health information about you for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact the Privacy Information Officer if you have questions about amending your medical record.
  • Accounting of Disclosures – You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or healthcare operations. You also have the right to request a limit on the medical information we disclose about you to someone involved in your care or the payment for your care, such as a family member or friend. For example, you could ask that we not use or disclose information about a procedure or lab test that you had. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
  • Receive confidential communications – You have the right to request to receive communications of health information by alternate means or at alternative locations. We will strive to accommodate all reasonable requests.
  • Paper copy of this Notice – You may request a paper copy of this Notice at any time, even if you have agreed to receive this Notice electronically.

Our Responsibility

  • We are required by law to maintain the privacy of protected health information;
  • Provide you with this Notice of our legal duties and privacy practices with respect to protected PHI/ePHI; and
  • To notify you if you are affected by a breach of unsecured protected health information.

We are required to abide by the terms of this Notice while it is in effect. We reserve the right to change the terms of our Notice and to make the new Notice provisions effective for all protected health information that we maintain. We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will mail a revised Notice to the address you have supplied us with. We will not disclose your health information without your authorization, except as described in this Notice.

If you ever have any questions or concerns about the information contained in this Notice or the services or charges, we encourage you to contact our Privacy Information Officer at 300 N. Pacific Coast Hwy, Suite 2060, El Segundo, CA 90245; Tele: 1-800-665-4769; or by electronic mail at [email protected].