 |
 |
 |
 |
 |
 |
 |
 |
Notice of Privacy Practices
For Bayes Achievement Center, Inc.
Effective April 14, 2003
THIS NOTICE DESCRIBES HOW MENTAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Bayes Achievement Center, Inc. (BAC) is required by law to maintain the privacy of your protected health information (PHI) and to provide you with notice of your privacy rights and BAC’s legal duties and privacy practices with respect to your PHI. BAC is required to abide by the terms of this notice with respect to your PHI but reserves the right to change the terms of this notice and make the new notice provisions effective for all PHI that BAC maintains. BAC will provide you with a copy of the revised notice sent by regular mail to the last address you have provided to BAC for this communication purpose.
Understanding Your Personal Health Information
Each time you visit a hospital, physician, mental health professional or other healthcare provider, a record of your visit and/or treatment is made. Typically, this record contains your symptoms, examination and test results, diagnoses, and treatment records, including, in the case of a mental health professional, psychotherapy notes, and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a:
· basis for planning your care and treatment
· means of communication among the many health professionals who contribute to your care
· legal document describing the care you received
· means by which you or a third-party payer can verify that services billed were actually provided
· tool in educating health professionals
· source of data for medical research
· source of information for public health officials charged with improving the health of the nation
· source of data for facility planning and marketing
· tool with which we can assess and continually work to improve the care we render and the outcomes we achieve
Understanding what is in your record and how your health information is used helps you to:
· ensure its accuracy
· better understand who, what, when, where, and why others may access your health information
· make more informed decisions when authorizing disclosure to others
Your Health Information Rights
Although your health record is the physical property of Bayes Achievement Center, Inc., the facility that compiled it, the information belongs to you. You have the following privacy rights:
1. The right to request restrictions on the use and disclosure of your PHI to carry out treatment, payment or health care operations.
You should note that BAC is not required to agree to be bound by any restrictions that you request but is bound by each restriction to which BAC does agree.
2. In connection with any patient directory, the right to request restrictions on the use and disclosure of your name, location at this treatment facility, description of your condition and your religious affiliation (BAC does not maintain a client directory).
3. To receive confidential communication of your PHI unless BAC determines that such disclosure would be harmful to you.
4. To inspect and copy your PHI unless BAC determines in the exercise of the professional judgment of the clinical staff that the access requested is reasonably likely to endanger your life or physical safety (Note: if state law allows, “emotional safety” may be included as well) or that of another person.
You may request copies of your PHI by providing BAC with a written request for such copies. BAC will provide you with copies within ten (10) business days of your request at the BAC administrative offices. You will be charged $.25 for each page copied and you will be expected to pay for the copies at the time you pick them up.
5. To amend your PHI upon your written request to BAC setting forth your reasons for the requested amendment. BAC has the right to deny the request if the information is accurate and complete or has been created by another entity.
BAC is required to act on your request to amend your PHI within sixty (60) days but this deadline may be extended for another thirty (30) days upon written notice to you. If BAC denies your requested amendment BAC will provide you with written notice of the decision and the basis for BAC’s decision. You will then have the right to submit a written statement disagreeing with BAC’s decision which will be maintained with your PHI. If you do not wish to submit a statement of disagreement you may request that BAC provide your request for amendment and BAC’s denial with any future disclosures of your PHI.
6. Upon written request, you are entitled to receive an accounting of disclosures of your PHI made within the past 6 years of your request for an accounting. Disclosures that are exempted from the accounting requirement include the following:
· Disclosures necessary to carry out treatment, payment and health care operations
· Disclosures made to you upon request
· Disclosures made pursuant to your authorization
· Disclosures made for national security or intelligence purposes
· Permitted disclosures to correctional institutions or law enforcement officials
· Disclosures that are part of a limited data set used for research, public health or health care operations
BAC is required to act on your request for an accounting within sixty (60) days, but this deadline may be extended for another thirty (30) days upon written notice to you of the reason for the delay and the date by which BAC will provide the accounting. You are entitled to one (1) accounting in any twelve (12) month period free of charge. For any subsequent request in a twelve (12 ) month period you will be charged $.25 for each page copied and you will be expected to pay for the copies at the time you pick them up.
7. To receive a paper copy of this privacy notice even if you agreed to receive a copy electronically.
8. The right to complain to BAC and to the Secretary of the U.S. Department of Health & Human Services (HHS) if you believe your privacy rights have been violated. You may submit your complaint to BAC Administration in writing setting out the alleged violation. BAC is prohibited by law from retaliating against you in any way for filing a complaint with BAC or HHS.
USES & DISCLOSURES
Your written authorization is required before BAC can use or disclose any psychotherapy notes, which are defined as notes documenting or analyzing the contents of any conversations during a formal counseling session and that are separated from the rest of your clinical file. Psychotherapy notes do not include medication prescriptions and monitoring, counseling session start and stop times, the modalities and frequencies of treatment furnished, results of clinical tests, and any summary of the following items: diagnosis, functional status, the treatment plan, symptoms, prognosis and progress to date.
It is BAC’s policy to protect the confidentiality of your PHI to the best of our ability and to the extent permitted by law. There are times however, when use or disclosure of your PHI, including, psychotherapy notes, is permitted or mandated by law even without your authorization.
Situations where BAC is not required to obtain your consent or authorization for use or disclosure of your PHI/psychotherapy notes include the following circumstances:
· By BAC staff for treatment, payment or health care operations as they relate to you.
For example: Information obtained by BAC employees will be recorded in your record and used to determine the course of treatment that should work best for you. BAC will maintain documentation in your record of treatment received at BAC, and when appropriate will provide a subsequent treatment center, counselor or healthcare provider with copies of various reports that should assist them in treating you following discharge from BAC.
For example: A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.
· In the event of an emergency, to any treatment provider who provides emergency treatment to you.
· To defend BAC in a legal action or other proceeding brought by you against BAC.
· When required by the Secretary of the Department of Health & Human Services in an investigation to determine BAC’s compliance with the privacy rules.
· When required by law in so far as the use or disclosure complies with and is limited to the relevant requirements of such law.
Examples:
To a public health authority or other government authority authorized by law to receive reports of child abuse or neglect.
If BAC employees reasonably believe an adult individual to be the victim of abuse, neglect or domestic violence BAC may report to a governmental authority, including a social services agency authorized by law to receive such reports to the extent the disclosure is required by or authorized by law or you agree to the disclosure and BAC believes in the exercise of professional judgement disclosure is necessary to prevent serious harm to you or other potential victims. If BAC makes such a report BAC is obligated to inform you unless it is determined that informing you will place the individual at risk of serious injury.
In the course of any judicial or administrative proceeding in response to:
an order of a court or administrative tribunal so long as only the PHI expressly authorized by such order is disclosed, or
a subpoena, discovery request or other lawful process, that is not accompanied by an order of a court or administrative tribunal so long as reasonable efforts are made to give you notice that your PHI has been requested or reasonable efforts are made to secure a qualified protective order, by the person requesting the PHI.
Child custody cases and other legal proceedings in which your mental health or condition is in issue are the kinds of suits in which your PHI may be requested.
In addition, BAC may use your PHI in connection with a suit to collect fees for services rendered by BAC.
In compliance with a court order or court ordered warrant, or a subpoena or summons issued by a judicial officer, a grand jury subpoena or summons, a civil or an authorized investigative demand or similar process authorized by law provided that the information sought is relevant and material to a legitimate law enforcement inquiry, the request is specific and limited in scope to the extent reasonably practicable in light of the purpose for which the information is sought and de-identified information could not reasonably be used.
To a health oversight agency for oversight activities authorized by law as they may relate to BAC (i.e. audits; civil, criminal or administrative investigations, inspections, licensure or disciplinary actions; civil, administrative, or criminal proceedings or actions.)
· To a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death, or other duties as authorized by law.
· To funeral directors consistent with applicable law as necessary to carry out their duties with respect to the decedent.
· To the extent authorized by and the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.
· If use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public and the disclosure is made to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat.
· To a public health authority that is authorized by law to collect or receive such information for the purposes of preventing or controlling a disease, injury or disability, including, but not limited to, the reporting of disease, injury, vital events such as birth, death, and the conduct of public surveillance, public health investigations, and public health interventions.
· To a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition, if the covered entity or public health authority is authorized by law to notify such persons as necessary in the conduct of a public health intervention or investigation.
· To a public health authority or other appropriate governmental authority authorized by law to receive reports of child abuse or neglect.
· To a law enforcement official if BAC believes in good faith that the PHI constitutes evidence of criminal conduct that occurs on BAC grounds.
· Using BAC’s best judgment, to a family member, other relative or close personal friend or any other person you identify, BAC may disclose PHI that is relevant to that person’s involvement in your care or payment related to your care.
Notice of Privacy Practices
For Bayes Achievement Center, Inc.
Effective April 14, 2003
THIS NOTICE DESCRIBES HOW MENTAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Bayes Achievement Center, Inc. (BAC) is required by law to maintain the privacy of your protected health information (PHI) and to provide you with notice of your privacy rights and BAC’s legal duties and privacy practices with respect to your PHI. BAC is required to abide by the terms of this notice with respect to your PHI but reserves the right to change the terms of this notice and make the new notice provisions effective for all PHI that BAC maintains. BAC will provide you with a copy of the revised notice sent by regular mail to the last address you have provided to BAC for this communication purpose.
Understanding Your Personal Health Information
Each time you visit a hospital, physician, mental health professional or other healthcare provider, a record of your visit and/or treatment is made. Typically, this record contains your symptoms, examination and test results, diagnoses, and treatment records, including, in the case of a mental health professional, psychotherapy notes, and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a:
· basis for planning your care and treatment
· means of communication among the many health professionals who contribute to your care
· legal document describing the care you received
· means by which you or a third-party payer can verify that services billed were actually provided
· tool in educating health professionals
· source of data for medical research
· source of information for public health officials charged with improving the health of the nation
· source of data for facility planning and marketing
· tool with which we can assess and continually work to improve the care we render and the outcomes we achieve
Understanding what is in your record and how your health information is used helps you to:
· ensure its accuracy
· better understand who, what, when, where, and why others may access your health information
· make more informed decisions when authorizing disclosure to others
Your Health Information Rights
Although your health record is the physical property of Bayes Achievement Center, Inc., the facility that compiled it, the information belongs to you. You have the following privacy rights:
1. The right to request restrictions on the use and disclosure of your PHI to carry out treatment, payment or health care operations.
You should note that BAC is not required to agree to be bound by any restrictions that you request but is bound by each restriction to which BAC does agree.
2. In connection with any patient directory, the right to request restrictions on the use and disclosure of your name, location at this treatment facility, description of your condition and your religious affiliation (BAC does not maintain a client directory).
3. To receive confidential communication of your PHI unless BAC determines that such disclosure would be harmful to you.
4. To inspect and copy your PHI unless BAC determines in the exercise of the professional judgment of the clinical staff that the access requested is reasonably likely to endanger your life or physical safety (Note: if state law allows, “emotional safety” may be included as well) or that of another person.
You may request copies of your PHI by providing BAC with a written request for such copies. BAC will provide you with copies within ten (10) business days of your request at the BAC administrative offices. You will be charged $.25 for each page copied and you will be expected to pay for the copies at the time you pick them up.
5. To amend your PHI upon your written request to BAC setting forth your reasons for the requested amendment. BAC has the right to deny the request if the information is accurate and complete or has been created by another entity.
BAC is required to act on your request to amend your PHI within sixty (60) days but this deadline may be extended for another thirty (30) days upon written notice to you. If BAC denies your requested amendment BAC will provide you with written notice of the decision and the basis for BAC’s decision. You will then have the right to submit a written statement disagreeing with BAC’s decision which will be maintained with your PHI. If you do not wish to submit a statement of disagreement you may request that BAC provide your request for amendment and BAC’s denial with any future disclosures of your PHI.
6. Upon written request, you are entitled to receive an accounting of disclosures of your PHI made within the past 6 years of your request for an accounting. Disclosures that are exempted from the accounting requirement include the following:
· Disclosures necessary to carry out treatment, payment and health care operations
· Disclosures made to you upon request
· Disclosures made pursuant to your authorization
· Disclosures made for national security or intelligence purposes
· Permitted disclosures to correctional institutions or law enforcement officials
· Disclosures that are part of a limited data set used for research, public health or health care operations
BAC is required to act on your request for an accounting within sixty (60) days, but this deadline may be extended for another thirty (30) days upon written notice to you of the reason for the delay and the date by which BAC will provide the accounting. You are entitled to one (1) accounting in any twelve (12) month period free of charge. For any subsequent request in a twelve (12 ) month period you will be charged $.25 for each page copied and you will be expected to pay for the copies at the time you pick them up.
7. To receive a paper copy of this privacy notice even if you agreed to receive a copy electronically.
8. The right to complain to BAC and to the Secretary of the U.S. Department of Health & Human Services (HHS) if you believe your privacy rights have been violated. You may submit your complaint to BAC Administration in writing setting out the alleged violation. BAC is prohibited by law from retaliating against you in any way for filing a complaint with BAC or HHS.
USES & DISCLOSURES
Your written authorization is required before BAC can use or disclose any psychotherapy notes, which are defined as notes documenting or analyzing the contents of any conversations during a formal counseling session and that are separated from the rest of your clinical file. Psychotherapy notes do not include medication prescriptions and monitoring, counseling session start and stop times, the modalities and frequencies of treatment furnished, results of clinical tests, and any summary of the following items: diagnosis, functional status, the treatment plan, symptoms, prognosis and progress to date.
It is BAC’s policy to protect the confidentiality of your PHI to the best of our ability and to the extent permitted by law. There are times however, when use or disclosure of your PHI, including, psychotherapy notes, is permitted or mandated by law even without your authorization.
Situations where BAC is not required to obtain your consent or authorization for use or disclosure of your PHI/psychotherapy notes include the following circumstances:
· By BAC staff for treatment, payment or health care operations as they relate to you.
For example: Information obtained by BAC employees will be recorded in your record and used to determine the course of treatment that should work best for you. BAC will maintain documentation in your record of treatment received at BAC, and when appropriate will provide a subsequent treatment center, counselor or healthcare provider with copies of various reports that should assist them in treating you following discharge from BAC.
For example: A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.
· In the event of an emergency, to any treatment provider who provides emergency treatment to you.
· To defend BAC in a legal action or other proceeding brought by you against BAC.
· When required by the Secretary of the Department of Health & Human Services in an investigation to determine BAC’s compliance with the privacy rules.
· When required by law in so far as the use or disclosure complies with and is limited to the relevant requirements of such law.
Examples:
To a public health authority or other government authority authorized by law to receive reports of child abuse or neglect.
If BAC employees reasonably believe an adult individual to be the victim of abuse, neglect or domestic violence BAC may report to a governmental authority, including a social services agency authorized by law to receive such reports to the extent the disclosure is required by or authorized by law or you agree to the disclosure and BAC believes in the exercise of professional judgement disclosure is necessary to prevent serious harm to you or other potential victims. If BAC makes such a report BAC is obligated to inform you unless it is determined that informing you will place the individual at risk of serious injury.
In the course of any judicial or administrative proceeding in response to:
an order of a court or administrative tribunal so long as only the PHI expressly authorized by such order is disclosed, or
a subpoena, discovery request or other lawful process, that is not accompanied by an order of a court or administrative tribunal so long as reasonable efforts are made to give you notice that your PHI has been requested or reasonable efforts are made to secure a qualified protective order, by the person requesting the PHI.
Child custody cases and other legal proceedings in which your mental health or condition is in issue are the kinds of suits in which your PHI may be requested.
In addition, BAC may use your PHI in connection with a suit to collect fees for services rendered by BAC.
In compliance with a court order or court ordered warrant, or a subpoena or summons issued by a judicial officer, a grand jury subpoena or summons, a civil or an authorized investigative demand or similar process authorized by law provided that the information sought is relevant and material to a legitimate law enforcement inquiry, the request is specific and limited in scope to the extent reasonably practicable in light of the purpose for which the information is sought and de-identified information could not reasonably be used.
To a health oversight agency for oversight activities authorized by law as they may relate to BAC (i.e. audits; civil, criminal or administrative investigations, inspections, licensure or disciplinary actions; civil, administrative, or criminal proceedings or actions.)
· To a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death, or other duties as authorized by law.
· To funeral directors consistent with applicable law as necessary to carry out their duties with respect to the decedent.
· To the extent authorized by and the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.
· If use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public and the disclosure is made to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat.
· To a public health authority that is authorized by law to collect or receive such information for the purposes of preventing or controlling a disease, injury or disability, including, but not limited to, the reporting of disease, injury, vital events such as birth, death, and the conduct of public surveillance, public health investigations, and public health interventions.
· To a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition, if the covered entity or public health authority is authorized by law to notify such persons as necessary in the conduct of a public health intervention or investigation.
· To a public health authority or other appropriate governmental authority authorized by law to receive reports of child abuse or neglect.
· To a law enforcement official if BAC believes in good faith that the PHI constitutes evidence of criminal conduct that occurs on BAC grounds.
· Using BAC’s best judgment, to a family member, other relative or close personal friend or any other person you identify, BAC may disclose PHI that is relevant to that person’s involvement in your care or payment related to your care.
