HB Harford Belair Community Mental Health Center, Inc.
Notice of Information
The Federal Health Insurance Portability and
Accountability Act (HIPAA) Privacy Rule establishes a foundation of Federal
protection for personal health information, carefully balanced to avoid creating
unnecessary barriers to the delivery of quality health care. The Rule generally
prohibits this program from using or disclosing your protected health
information unless authorized by you, except what is outlined below.
This notice describes how information about you
may be used and disclosed and how you can get access to this information.
Please review it carefully.
Understanding Your Health Record/Information
Each time you visit a hospital, physician, or
other healthcare provider, a record of your visit is made. Typically, this
record contains your symptoms, examinations and test results, diagnoses,
treatment, 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 professional who contribute to
Legal document describing the care you receive
Means by which you or a third party payer can verify that services billed were
tool in educating health professional
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 1) ensure its accuracy, 2) better understand who, what, when,
where, and why others may access your health information, and 3) make more
informed decisions when authorizing disclosures to others
Your Health Information Rights
Although your health record is the physical
property of the healthcare practitioner or facility that compiled it, the
information belongs to you. You have the right to:
You have the right to request a restriction or
limitation on the health information we use or disclose about you for treatment,
payment or healthcare operations. You also have the right to request a limit on
the health information we disclose about you to someone who is involved in your
care or the payment for it, like family members or friend.
You have the right to a paper copy of this
notice. You may ask us to give you a copy of this notice at anytime. To obtain
a copy, contact Teresa Donzella, MS, MBA, Privacy Officer at 410-426-5650.
You have the right to inspect and copy your
health information, such as medical records and billing records that we use to
make decisions about your care. You must submit a written request to Teresa
Donzella, MS, MBA, Privacy Officer in order to inspect and or copy your health
information. If you request a copy of the information, we charge a fee of $.50
cents per copy to cover the cost of copying, mailing and for other associated
supplies. We may deny your request to inspect and or copy in certain limited
circumstances. If you are denied access to your health information, you may ask
the denial to be reviewed.
If you believe health information we have about
you is incorrect or incomplete, you may ask us to amend the information. You
have the right to request amendment as long as the information is kept by this
To request an amendment, complete and submit a
Medical Record Amendment/Correction Form to Teresa Donzella, MS, MBA, Privacy
Officer at 4308 Harford Road, Baltimore, MD 21214. We may deny your request for
an amendment if it is not in writing or does not include a reason to support the
In addition, we may deny your request if you ask
us to amend the information that:
We did not create, unless the person or entity that created the
information is no longer available to make the amendment.
Is not part of the health information that we keep
You would not be permitted to inspect or copy
Is accurate and complete
You have the right to request an “accounting of
disclosures”. This is a list of the disclosures we made of medical information
about you for the purposes other than treatment, payment, and healthcare
operations. To obtain this list you must submit your request in writing to
Teresa Donzella, MS, MBA, Privacy Officer. It must state a time period, which
may not be longer than six years and may not include dates before April 14,
2003. We may charge you for the cost of providing the list. We will notify you
of the cost involved and you may choose to withdraw or modify your request at
that time before any costs are incurred.
You have the right to request that we communicate
with you about medical matters in certain ways or at certain location. For
example, you can ask that we only contact you at work or by mail.
To request confidential communications, you may
complete and submit the Request for Restriction On Use/Disclosure of Medical
Information and /or Confidential Communications to Teresa Donzella, MS, MBA,
Privacy Officer. We will not ask the reason for your request. We will
accommodate all reasonable requests. Your request must specify how or where you
wish to be contacted
This organization is required to:
Maintain the privacy of your health information
Provide you with a notice as to our legal duties and privacy practices with
respect to information that we collect and maintain about you
Abide by terms of this notice
Notify you if we are unable to agree to a requested restriction
Accommodate reasonable requests you may have to communicate health information
by alternative means or at alternative locations
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 distribute a revised
notice to you.
We will not use or disclose your health
information without your consent, except as described in this notice.
For More Information or to Report a Problem
If you have a question and would like additional
information, you may contact the Privacy Officer, Teresa Donzella MS,MBA at
If you believe your privacy rights have been
violated, you can file a complaint with the Privacy Officer or with the
Secretary of Health and Human Services. There will be no retaliation for filing
Examples of Disclosures for Treatment, Payment
and Health Operations
As required by law
We are required by law to disclose your protected
information in certain circumstances, for example, to report abuse and neglect,
and to warn about dangerous behavior.
We will use your health information for treatment
Information obtained by a nurse, physician, therapist or other treatment team
member will be recorded in your record and used to determine the course of
treatment that should work best for you. Your physician will document in your
record his or her expectations of the members of your treatment team. Members
of your treatment team will then record the actions they took and their
observations. In that way, the physician will know how you are responding to
treatment. Members will have access to your record in order to record personal
We will use your health information for payment
A bill may be sent to you or a third-party-payer. The information will usually
include information that identifies you, as well as the diagnosis for which you
are being treated and the type of treatment.
We will use your health information for regular
Members of the medical staff, the risk or quality improvement manager, or
members of the quality improvement team may have access to your health record in
order to assess the care and outcomes in your case and others like it. This
assessment will then be used in an effort to continually improve the quality and
effectiveness of the healthcare and service we provide.
We will use your health information to
communicate with other healthcare professionals that you see
At times it may be necessary for your therapist or physician to discuss your
condition with other professional who you may see for help, but not done without
a signed Release of Information. The exception may involve emergency
treatment. You may go to an emergency room or a hospital inpatient unit or
another clinic for help and the staff at those facilities may need to urgently
obtain information about your condition or your medications from the Center.
There are some services provided in our
organization through contracts with business associated.
This includes the pharmacy we work with or the
labs. When these services are contracted, we may disclose your identifying
information such as date of birth, telephone number or medications, and
insurance to our business associate so that they can perform the job we’ve ask
them to do and bill you or your third-party payer for services rendered. To
protect you health information, however, we require the business associate to
appropriately safeguard your information.
Communication with family, care providers, etc.
Health professional, using their best judgment,
may disclose to a family member, care provider, or any other person you
identify, health information.
If at any time, you are having side-effects of
the medications or if your condition worsens it may be necessary for our health
professionals to speak with your family or care provider about your condition or
medications. We will do this whenever we feel that this is necessary for proper
treatment of your condition.
We may disclose information in order to contact you. This may include making
appointments, canceling appointments, evolution of the services that we provide,
As required by law, we may disclose certain limited information to public health
or legal authorities charged with preventing or controlling certain contagious
disease, injury, or disability.
Should you be an inmate of a correctional institution, we may disclose to the
institution or agents thereof health information necessary for your health and
the health and safety of other individuals.
We may disclose health information for law enforcement purposes as required by
law or in response to a valid subpoena.
Facsimile and Email Transmission:
During the course of business we may disclose information to other entities via
facsimile and email
Your psychotherapy notes are maintained
separately from the rest of your medical record. Psychotherapy notes are the
record of the statements made during a counseling session and your therapist’s
analysis of those statements (this does not include documentation of
medications, the treatment rendered, treatment plans, progress notes and
statements about your progress). You may review and copy your psychotherapy
notes only if consent is given to you by your treatment team; unlike the rest of
your medical record, you may not see your psychotherapy notes without the
expressed permission of your treatment team. Psychotherapy notes may be used by
your therapist for your treatment without your authorization. The notes may
also be used by the program without your authorization for certain other limited
health care operations. Otherwise, the use and disclosure of your psychotherapy
notes requires your written authorization.
Other uses and disclosures of Health Information
We will not use or disclose your health
information for any purposes other than those identified in the previous
sections without your specific written Authorization. We must obtain
your Authorization separate from any Consent we may have obtained from you. If
you give us Authorization to use or disclose health information about you, you
may revoke that Authorization, in writing, at any time. If you revoke your
Authorization, we will no longer use or disclose information about you for the
reasons covered by your written Authorization, but we cannot take back any uses
or disclosures already made with your permission.
E-mail questions or comments to: