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Notice of Privacy Practices


This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review carefully.

QCI is dedicated to maintaining the privacy of your personal health information (PHI) as a key element of providing professional care. For additional details, please direct inquiries to QCI’s Quality Control Officer who is a certified in the Health Insurance Portability and Accountability Act (HIPAA), a U.S. law designed to provide privacy standards to protect patients' medical records and other health information provided to health plans, doctors, hospitals, and other health care providers.

After you have read this notice, we ask you to sign the Consent Statement (aka Intake Release) via electronic signature to let QCI use and share information for the treatment, payment, and daily operations of the clinic (TPO):
  • Treatment allows providers to share information to provide the best care possible.
  • Payment allows QCI to obtain payment from insurance companies who are also bound by strict privacy laws.
  • Operations permit QCI’s administrative staff to also support your care through scheduling, transportation, etc.

This Consent must be signed in order for QCI to treat you.

If QCI needs to use or disclose (send, share, release) your medical information for any purposes, we will discuss this with you and ask you to sign a specific form (Release of Information aka ROI) authorizing to do so.

Although QCI will endeavor to keep your PHI private, there are exceptions:

  • Some lawsuits and legal or court proceedings.
  • If a law enforcement official requires use to do so.
  • For Worker’s Compensation or similar benefit.

Only your medical records may be released in the above situations. Personal therapy notes and therapeutic admission summaries are governed by a specific HIPAA clauses and state of Maryland regulations that prevents the release of personal therapy documentation. QCI may provide a written summary by your therapist and may only address your participation in treatment.

The only exceptions to these guidelines:

  • In the event of an emergency when there is a serious threat to your health and safety or the health and safety of another individual or the public. Your information will only be shared with a person or organization that is able to prevent or reduce the threat. 
     
  • QCI’s participation in the Chesapeake Regional Information System for our Patients (CRISP), a regional health information exchange serving Maryland and Washington, D.C. 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 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. Public health reporting and Controlled Dangerous Substances information, as part of the Maryland Prescription Drug Monitoring Program (PDMP), will still be available to providers.

Your rights regarding your PHI:

  1. You may ask to communicate about your health and related issues in a particular way or at a certain place which is more private for you. Example, you may ask QCI to call you at home and not at work to schedule or cancel an appointment. QCI will never leave a message mentioning behavioral health. The message will simply say QCI.
  2. You have the right to request QCI to limit what QCI tells people and entities involved in your care without an ROI, which includes family member and friends, unless there is a safety emergency.
  3. You have the right to look at your medical information including billing records per paragraph two. There may be an administrative charge for QCI to print your records and QCI has up to 10 days to respond to such requests. A written request is mandatory when requesting records. These are available at the office front desk.
  4. If you believe your information in your medical records is incorrect or missing important information, you may request some changes (called amending) to your PHI. You must request this information in writing and send to QCI’s Quality Control Office and explain the reasoning. Such requests will not be kept in your record but will remain on file with the CEO and will not be disclosed. Changes will not be granted if there is a serious threat to the safety of yourself or others.
  5. You have a right to a copy of this notice, and the entire QCI new patient paperwork. If we change the NPP, QCI will post the new version in our waiting area.
  6. You have the right to file a complaint if you believe your privacy rights have been violated. You may file a compliant with our CEO or Quality Control Officer and with the Secretary of the Department of Health. All complaints must be in writing. Filing a complaint will not change the health care we provide to you in any way.
  7. If you have any questions about QCI’s NPP, please contact our Quality Control Officer.
















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