Community Mental Health Center Inc.

 Located off the 19 bus route     MTA's web site                                           

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HB    Harford Belair Community Mental Health Center, Inc.

Notice of Information Practices

    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 your care

  • Legal document describing the care you receive

  • Means by which you or a third party payer can verify that services billed were actually provided

  • A tool in educating health professional

  • A source of data for medical research

  • A source of information for public health officials charged with improving the health of the nation

  • A source of data for facility  planning and marketing

  • A 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:

  • Request a restriction on certain uses and disclosures of your information

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.

  • Obtain a paper copy of the notice of information practices upon request

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.

  • Inspect and obtain a copy of your health record (excluding psychotherapy notes)

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.

  • Amend your health record

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 office.

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 request.

In addition, we may deny your request if you ask us to amend the information that:

a.        We did not create, unless the person or entity that created the information is no longer available to make the amendment.

b.       Is not part of the health information that we keep

c.        You would not be permitted to inspect or copy

d.       Is accurate and complete

  • Obtain an accounting of disclosures of your health record

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.

  • Request communications of your health information by alternative means or at alternative locations

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

  • Revoke your authorization to use or disclose health information except to the extent that action has already been taken

Our Responsibilities

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 410-426-5650.

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 a complaint.

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

For Example:  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 health information

We will use your health information for payment

For example: 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 health operations

For Example:  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

For Example:  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.

Business associates:  There are some services provided in our organization through contracts with business associated. 

For Example: 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. 

For example:  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.

Contacting you

For example:  We may disclose information in order to contact you.  This may include making appointments, canceling appointments, evolution of the services that we provide, etc.

Public Health:  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.

Correctional Institution:  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.

Law Enforcement:  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

Psychotherapy notes

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.

Please E-mail questions or comments to: Teresa Donzella

                                                                         Copyright © 2009 Harford-Belair Inc. All rights reserved.

Harford Belair Community Mental Health Center
4308 Harford Rd. 
Baltimore, MD 21214
Main Office: 410-426-5650  
Fax: 410-426-5143
TDD: 410-426-5669

Web Site Maintained by Dean Assid  DAssid1.1@verizon.net                                                                                                              updated on:  01/10/2012