UBCSS Privacy Notice

Federal Privacy Laws:

This Notice of Privacy Practices is provided to you as a requirement of the Health Insurance and Portability Act (HIPAA). There are several other privacy laws that also apply to impose obligations on us, including the Health Information Technology for Economic & Clinical Health Act (HITECH), the Freedom of Information Act, the Privacy Act, and the Alcohol, Drug Abuse, and Mental Health Reorganization Act. These laws have not been superseded and have been taken into consideration in developing our policies, as well as this notice of how we will use and disclose your protected health information.

Upper Bay Counseling & Support Services, Inc. (UBCSS) takes your privacy very seriously. We follow very strict rules from the State and from the United States Government about when we can release your medical information – your protected health information (PHI).

Upon Intake you will be asked to sign a form acknowledging that you have received a copy of our Privacy Notice. If you choose not to sign the acknowledgment, we will continue to provide treatment, and will use and disclose your protected health information as necessary, and within the law for treatment, payment, and health care operations as necessary.

“Protected Health Information” is individually identifiable health information. This information includes demographics about you, for example, age, address, e-mail address. It relates to your past, present, or future physical and/or mental health, as well as related health care services. UBCSS is required to:

• Make sure your protected health information is kept private;

• Give you this notice of our legal duties and privacy practices related to the use and disclosure of your protected health information;

• Follow the terms of the notice currently in effect;

• Communicate any changes in this notice to you.

We reserve the right to change this notice. Its effective date is at the top of this page. You may request a copy of our Privacy Notice at any time. It is also posted on our website at http://www.upperbay.org

Chesapeake Regional Information System for our Patients, Inc. (CRISP):

We have chosen to participate in the Chesapeake Regional Information System for our Patients, Inc. (CRISP), a statewide health information exchange. As permitted by law, your health information will be shared with this exchange in order to provide faster access, better coordination of care and assist providers and public health officials in making more informed decisions. You may “opt-out” and disable all access to your health information available through CRISP by calling 1-877-952-7477 or completing and submitting an Opt-Out form to CRISP by mail, fax or through their website at: www.crisphealth.org.

Greenspace Measurement-Based Care:

Participation in Greenspace measurement-based care is a condition of treatment at UBCSS. Measurement-based care is a clinical process which involves tracking client progress throughout treatment, using patient-reported outcome measures. The client’s therapist will select clinical surveys which will be sent to the client through text, email, or in session based on their preference. Client responses will be recorded in Greenspace Health and will allow the client and the client’s therapist to track client results over time and will provide additional information to the client’s therapist about the client’s progress in treatment.

How We May Use or Disclose Your Protected Health Information:

The following are examples of some permitted uses and disclosures of your protected health information.

By law, we must disclose your health information to you unless an UBCSS staff psychiatrist feels that it would be harmful to you.

We will provide you with a copy of the electronic record in the form and format you authorize and request. If you decline an electronic format we will provide a hard copy.

Fees for Obtaining a Copy of Your Medical Record:

UBCSS maintains a fee schedule for the costs associated for the disclosure of records in both paper and electronic format. These fees are in keeping with both State and Federal Law. Contact the UBCSS Health Information Manager for a fee schedule.

Treatment:

We will use and disclose your protected health information to provide, coordinate and/or manage your health care and any related services. We may disclose your protected health information to another doctor, or health care provider (for example, a specialist, pharmacist or laboratory) who, at the request of your physician, becomes involved in your care by providing assistance with your health care diagnosis or treatment. This includes pharmacists who may be provided information on other drugs you have been prescribed to identify potential interactions.

In emergencies, we will use and disclose your protected health information to provide the treatment you require.

Payment:

Your protected health information will be used, as needed, to obtain payment for your health care services.

Effective on and after February 17, 2010, we will honor the request of an individual not to disclose to their health plan the protected health information related to a particular treatment if the individual is paying for the full cost of the treatment out-of-pocket.

Health Care Operations:

We may use and/or disclose, as needed, your protected health information to support the daily activities related to health care. Unless you provide us with alternative instructions, UBCSS may leave a telephone message to remind you of an appointment at UBCSS. We may also use your protected health information to assess your satisfaction with our services.

We may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that might interest you. For example, your name and address may be used to send you a UBCSS newsletter.

Health Oversight Activities:

UBCSS may disclose your health information to the Department of Health and Mental Hygiene or any of its divisions or other agencies for oversight activities required by law. Examples of these oversight activities are audits, inspections, investigations, and licensure.

To Avert Serious Threats to Health or Safety:

UBCSS may disclose protected health information to avert a serious threat to someone’s health or safety. We may also disclose protected health information to federal, state or local agencies engaged in disaster relief to assist in carrying out their responsibilities in specific disaster situations.

Abuse or Neglect:

Disclosure is mandated in the following:

Child abuse – If the case involves physical or sexual abuse of a child up to age 18 by a parent, guardian, other person with permanent or temporary custody, or family or household member, then health care professionals are mandated to report to Child Protective Services (CPS) or law enforcement.

Vulnerable adult abuse – If the case involves neglect, self-abuse, or exploitation of a vulnerable adult (adult aged 18 or older lacking the physical or mental capacity to provide for daily needs), then medical personnel, police, and human service workers should report to Adult Protective Services (APS) or law enforcement.

Coroners, Medical Examiners, and Funeral Directors;

We may release medical information to a coroner or medical examiner to identify a deceased person or determine the cause of death. We may also release medical information about clients of UBCSS to funeral directors as necessary to carry out duties.

Research Purposes:

We are permitted to use and disclose protected health information for research with individual authorization, or without individual authorization under limited circumstances set forth in the Privacy Rule.