Patient Rights & Notice of Privacy Practices
You have the right to receive treatment free of discrimination on the basis of race, sex, sexual orientation, age, creed, mental or physical handicapped status, national origin, marital status, or religious or political opinions or affiliations.
You have the right not to be exploited for fiduciary gains by any QCI provider or member.
You have the right to be treated with courtesy, respect, and full recognition of your human dignity and individuality.
You have the right to a treatment plan and active participation in its development.
You have the right to receive treatment according to your treatment plan.
You have the right to be free from mental, physical, or sexual abuse.
You have the right to legal redress in the event of any abuse.
Recording devices are not employed at QCI. You have a right to know if their use will be introduced.
You have a right to know about the risks and/or side effects of your medication(s) and any prescribed medical procedure.
You have the right to refuse medication.
You have the right to refuse treatment.
You are entitled to be informed of alternative types of treatment.
You have a right to receive treatment and services free of neglect by your providers.
You have the right to be treated free of humiliation, exploration, physical and sexual abuse, harassment and physical punishment, or any other type of indignity.
You have the right to receive treatment and other services in the least restrictive environment possible
You have the right to be free from any means of coercion, discipline, constraint or retaliation by staff, including free from restraint and seclusion.
You have the right to report any concerns you may have with your treatment and file a grievance if you feel the need to do so.
You have a right to know and understand the grievance process and procedures.
You have a right to be notified regarding the outcome and solution of your grievance.
You have the right to no retaliation if a grievance is filed.
You have a right to formulate an “Advanced Directive”
You are not required to have an “Advanced Directive” to receive treatment or services.
You have the right to every consideration of confidentiality regarding your services and personal information.
You have the right to know which staff members are directly responsible for your care and have a list of expected services.
You have the right to full information on the availability of known financial resources of your health care.
You have the right to access of other adjunctive services and resources in the community, to included but not limited to: legal services, dental care, food closets, clothing closets, shelters, employment fairs, etc.
You have the right to QCI’s cooperation with you and/or your attorney in matters relating to your condition or its treatment (e.g. pursuit of disability or other entitlements).
You have the right to access your medical record.
You have the right to petition for a change in your medical record. The change will be taken under review by the provider/treatment team and determined if appropriate.
You have the right to bring prescription medications into the QCI office at the request of your medical provider(s). You also have the right to bring essential, medically necessary, somatic prescription medications into the QCI office.
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.
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.
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.
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 Compliance Officer 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.
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.
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 Compliance 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.
If you have any questions about QCI’s Privacy Rights or NPP, please contact our Compliance Officer (443-226-8439).
NOTE: When using the email addresses below, your information is not encrypted. Your responses may be read by others using your Internet service. Please do not include any sensitive information.