PARTNERS

Patients are our priority, so we make referring them simple.

At BrightView, we’re committed to connecting patients to the quality addiction treatment they need as quickly as possible. That’s why we view our referral partners as just that: partners. We work closely with our referral partners to expedite scheduling, streamline communication, and comply with patient privacy regulations.

Our clinical and medical teams are passionate about offering the highest level of patient-focused, evidence-based care. We continue to do so by contributing to and incorporating the latest research, technologies, and clinical concepts. At BrightView, we believe addiction is a disease we can treat using a biological, psychological, and sociological approach, also called the “biopsychosocial model.”

If you’re looking to refer a patient, become a provider, or learn more about an organization dedicated to helping people overcome addiction, look no further.

JUSTICE CONSENT FOR RELEASE OF CONFIDENTIAL INFORMATION

This form can be completed with a digital signature. It should be used only for patients involved in the justice system, including court mandated treatment.

CONSENT FOR RELEASE OF CONFIDENTIAL INFORMATION

This form can be completed using a digital signature. The standard ROI may be used for any patient to consent for distribution of their treatment information to an assigned party.

Consent for the Release of Information under 42 C.F.R. PART 2


Confidentiality of Substance Use Disorder Patient Records

I,
authorize

INFORMATION TO BE DISCLOSED

I understand the information to be released or disclosed may include information relating to sexually transmitted diseases, acquired immunodeficiency syndrome (AIDS), or human immunodeficiency virus (HIV), mental health and substance use. I authorize the release or disclosure of the substance use disorder records below:
All my substance use disorder records
or only the following specific types of records:
Untitled
To:
For (purpose of disclosure):
I understand that my substance use disorder patient records are protected under federal regulations 42 C.F.R. Part 2- Confidentiality of Substance Use Disorder Patient Records and cannot be disclosed without my written consent. I do not need to sign this form to obtain treatment. I may revoke this consent in writing at any time. I understand that the revocation will not be effective retroactively for information disclosures that have already occurred. If not previously revoked, this consent will terminate either:
Untitled
If the patient is a minor, only the minor can sign this consent.
MM slash DD slash YYYY
MM slash DD slash YYYY
If the individual is unable to sign due to legal incapacity, the signature of the individual’s personal representative is required. Documentation of the personal representative’s legal authority must be attached.
MM slash DD slash YYYY
Max. file size: 50 MB.
Patient Revocation
MM slash DD slash YYYY

Notice of Federal Requirements Regarding the Confidentiality of Substance Use Disorder Patient Information

The confidentiality of substance use disorder patient records maintained by this program is protected by federal law and regulations. Generally, the program may not say to a person outside the program that a patient attends the program, or disclose any information identifying a patient as an alcohol or drug abuser unless:

1. The patient consents in writing; or
2. The disclosure is allowed by a court order accompanied by a subpoena; or
3. The disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit, or program evaluation; or
4. The patient commits or threatens to commit a crime either at the program or against any person who works for the program,

Violation of federal law and regulations by a program is a crime. Suspected violations may be reported to the United States Attorney in the district where the violation occurs.

Federal law and regulations do not protect any information about suspected child abuse or neglect from being reported under state law to appropriate state or local authorities.

The releases of information will remain active and valid for one year from the date of signature OR until 90 days after discharge (whichever comes first) OR until a specific date, event, or condition as listed on the form. There are two ways to revoke a release of information: Come in to the BrightView facility where you were scheduled to receive treatment and sign the revocation, or fax in a written statement with your name, signature, date and release(s) you would like to be revoked.

(See 42 U.S.C. §290dd-2 for federal law and 42 C.F.R. Part 2 for federal regulations governing Confidentiality of Substance Use Disorder Patient Records.)

Frequently Asked Questions

Still have questions about BrightView addiction treatment programs? Find those answers and more in our FAQs.

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BrightView Virtual

For qualifying patients, a comprehensive addiction treatment program is available entirely online through BrightView Virtual.

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Our Innovative Approach to Treatment

We have the experience and the expertise to treat addiction the right way. Learn what sets us apart.

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Schedule a Patient Now

Referring a patient to effective treatment should be simple and instantaneous.

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Illicit Substance Use Drops by 70%

BrightView patients decrease use of illicit substances by nearly 70% on average within the first 90 days, with many patients achieving complete abstinence.

93% Decrease in Arrests

In the first 90 days, BrightView patients experience a decrease in arrests of nearly 60%.  After one year in treatment, average number of arrests were down 93% compared to when patients first started.

50% Decrease in Use of Emergency Departments

Patients report a 1/3 decrease in emergency room visits after just 3 months and a 50% decrease after one year.