Notice of Privacy Practices
Notice of Privacy Practices (“NPP”) – Short Version (Effective 02/01/2026)
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Notices and Statements
As a covered entity, Silverado Counseling Services, LLC and its associates (hereinafter referred to as “Silverado”, “We”, “Our”) is providing this “short version” summary notice. The “long version” NPP, which contains additional information, is available upon request. This notice informs individuals about: (1) how protected health information (“PHI”) may be used and disclosed; (2) their rights under the Health Insurance Portability and Accountability Act (“HIPAA”); and (3) Silverado’s legal duties regarding PHI. Silverado must provide this notice in “plain language” and has attempted to do so.
Uses and Disclosures
The following describe common ways we may use and/or disclose PHI. This is not a complete list and Silverado may be permitted or required to use or disclose PHI in other ways as allowed by law.
Treatment, Payment and Health Care Operations (“TPO”)
• “Treatment” includes providing, coordinating, or managing your care and consulting with other health care providers involved in your treatment.
• “Payment” includes activities such as billing your insurance, determining eligibility or coverage, and collecting payment for services provided.
• “Health Care Operations” include our internal administrative, clinical, and business activities necessary to run our practice, such as quality improvement, staff training, compliance activities, and appointment reminders or other routine administrative communications.
• We may use or disclose PHI for TPO purposes without your written authorization as permitted by law. See Silverado’s “Notice of Exceptions to Confidentiality” for more information.
Individual Rights
You have the right to receive notice of how Silverado may use and disclose your PHI, your privacy rights, and Silverado's legal duties regarding PHI.
• Request restrictions on uses and/or disclosures - You may request restrictions on how we use or disclose certain PHI for TPO. We are not required to agree to all requests and may deny them, except in certain situations required by law. If you pay for a service in full out-of-pocket, you may request that we not disclose information about that service to your health plan, and we will honor that request when required by law.
• Receive confidential communications - You may request that we contact you in a specific way or send communications to an alternative address. We will accommodate reasonable requests when required by law.
• Inspect and obtain a copy - You may request to inspect or obtain a paper or electronic copy of your medical record or other PHI we maintain about you. We will provide access or a summary within 30 days of your request, with a possible one-time 30-day extension as permitted by law. Access may be limited or denied in certain circumstances under HIPAA. Psychotherapy notes are not part of your medical record and are not subject to access.
• Request amendments - You may request that we correct or amend PHI you believe is incorrect or incomplete. We may deny your request, but will provide a written explanation. If denied, you may submit a written statement of disagreement, which will be included in your record.
• Receive an accounting of disclosures - You may request a list of certain disclosures of your PHI, including the date, recipient, and purpose of each disclosure. This does not include disclosures made for TPO or certain other permitted disclosures (e.g., any you asked us to make).
• Obtain a copy of this notice - You may request a paper copy of this notice at any time, even if you previously agreed to receive it electronically. We will provide a copy promptly.
• Receive notification of a breach – You have the right to be notified following a breach of unsecured PHI when required by law.
Silverado’s Duties
• Silverado is required by law to maintain the privacy and security of PHI, provide individuals with notice of our privacy practices and legal duties, notify affected individuals following a breach of unsecured PHI when required by law, and abide by the terms of the Notice of Privacy Practices currently in effect.
• Silverado reserves the right to change the terms of its notice and to make the new notice provisions effective for all PHI that it maintains, including PHI that we created or received prior to issuing a revised notice.
Substance Use Disorder (“SUD”) Records
Silverado is an outpatient behavioral and mental health services clinic and is not a SUD clinic. However, some individuals may receive services involving SUD. When applicable, records related to SUD treatment services may be protected by additional federal confidentiality rules under 42 CFR Part 2, which generally require patient consent for disclosure except as permitted by law.
Complaints
If you believe your privacy rights, including rights relating to SUD records protected by federal law, have been violated, you can file a written grievance with Silverado and/or the U.S. Department of Health and Human Services. See Silverado’s “Concerns and Grievances Policy” for more information. An individual will not be retaliated against for filing a complaint.
Contact
If you have questions or would like additional information, please contact Silverado’s Administration at (801)983-5540.
Silverado Counseling Services, LLC
Attn: Administration
PO Box 824
Draper, UT 84020
Payment & Collection Policies
Payment Policy
1. Payment in full is required at the time of service and is past due within thirty (30) days from the date of service. If payment in full is not made as required, then in addition to all other amounts that may be due the undersigned agrees to pay a collection fee of up to forty percent (40%) of the principal amount as provided by §12-1-11 of the Utah Code Annotated, and further agree to pay all other costs of collection (whether incurred by Silverado or its assigns) including but not limited to court costs, reasonable attorney fees, and interest (both pre- and post-judgment).
2. Any interest due hereunder shall be calculated at a rate equal to eighteen percent (18%) per annum and may, as determined by Silverado or its assigns: (a) accrue on some or all amounts due, (b) and compound as frequently as daily - meaning that accruing interest may be added to the balance owing as frequently as daily such that it shall thereafter constitute part of the amount upon which interest accrues during the next accrual period.
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Collection Agreement
Silverado has contracted with Mountain Land Collections for collection services. They may be contacted at #801-492-0136 or PO Box 1280, American Fork, UT 84003.
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The responsible party for payment hereby consent to:
1. being contacted by telephone at any phone number (including but not limited to wireless/cellular phone numbers) provided to Silverado by the responsible party or anyone associated with or acting on their behalf. I understand and agree that such calls may be initiated by Silverado or any of its affiliates, agents, contractors or assigns, including but not limited to billing companies and/or third-party collection agency(ies), and that the methods of contact may include using pre-recorded/artificial voice messages and/or the use of an automated dialing device and/or the use of text messages - some or all of which may result in data charges.
2. receiving e-mails under the same terms at any e-mail address provided by the responsible party or anyone associated with or acting on their behalf.
3. In granting each and all of the foregoing permissions, I understand that I am responsible for ensuring my own level of privacy.