Confidentiality Form

Breathe Life Healing Centers, LLC (BLHC) is committed to protecting the privacy, dignity, and confidentiality of all clients in accordance with the Health Insurance Portability and Accountability Act (HIPAA), The Joint Commission standards, and all applicable federal and state laws.

All guests, employees, interns, and volunteers must maintain strict confidentiality regarding client identities, treatment participation, activities, records, and any Protected Health Information (PHI) obtained during or after their visit, employment, internship, or volunteer service with BLHC.

Protected Health Information includes, but is not limited to, a client's name, image, voice, diagnosis, treatment information, medical or mental health records, payment information, and any information that could reasonably identify a client. PHI may only be accessed, used, or disclosed on a need-to-know basis and solely within the scope of one's assigned role.

A valid, written Release of Information (ROI) signed by the client is required prior to the disclosure of any client information outside of BLHC, unless otherwise permitted or required by law. Unauthorized access, use, or disclosure of PHI is strictly prohibited.

Violations of this policy may result in immediate corrective action, including termination, denial of future visits, and potential legal consequences.

Questions about confidentiality? Admissions@BreatheLHC.org or call (877) 239-8684.