CHIMES
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 IT CAREFULLY
Purpose of the Notice:
This Notice of Privacy Practices describes how Chimes International, Ltd., and its affiliated entities, including Holcomb Associates, Inc., The Chimes, Inc., Chimes Metro, Inc. and Chimes Virginia, Inc. (hereinafter referred to collectively as “Chimes”) may share your “protected health information” (PHI) to carry out treatment, payment, health care operations, and for other purposes that are permitted or required by law. It also describes your rights to see and control your PHI.
Chimes is required by law to:
Make sure PHI is kept private,
Give you this Notice of our legal duties and privacy practices that affect your PHI,
Follow the terms of the notice that is currently in effect,
Notify affected individuals following a breach of unsecured protected health information.
Uses and disclosures not described in this Notice will be made only with your written authorization, which may be revoked as provided below.
Definitions:
Protected Health Information (PHI) is medical information that identifies you or may provide a basis for identifying you, including demographic information. Your PHI relates to your past, present, or future physical or mental health condition, including but not limited to Substance Use Disorder treatment, and related health care services. Chimes is required by law to keep records of the care which is provided to you.
You/Your/Patient/Client is defined as any person receiving a health-related service through Chimes. If the subject of the PHI is a minor, “patient/client” means the parent (unless subject to a limiting court decree or custody agreement) or authorized legal representative(s). If the subject of the PHI is incapable of making an informed decision, “patient /client” means the authorized legal representative(s).
Treating Clinician is defined as the individual primarily responsible for providing the patient’s/client’s health services at Chimes.
Medical Record is defined as a record of clinical services provided. This may be in electronic or paper form. Billing records are separate from the medical record. In addition, psychotherapy notes are separated from the rest of the patient’s medical record. Psychotherapy notes are notes recorded (in any medium) by a health care provider who is a mental health professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint, or family counseling session. Psychotherapy notes exclude medication prescription and monitoring, counseling session start and stop times, the modalities and frequencies of treatment furnished, results of clinical tests, and any summary of the following items: diagnosis, functional status, the treatment plan, symptoms, prognosis, and progress to date.
Who Will Follow this Notice:
Any Chimes health care professional authorized to enter information into your medical record
All Chimes employees, contractors, temporary employees, physicians, departments, and units that have access to PHI
Any Chimes volunteer who is permitted to provide you services or assistance and volunteers providing Chimes operational services assistance
All these entities, sites, and locations defined as Chimes
How We May Use and Share PHI About You:
These categories describe different ways that Chimes uses and shares your PHI. For each category we will explain what we mean and try to give some examples. Not every use in a category will be listed. However, all of the ways Chimes is permitted to use and disclose information will fall within one of the categories.
For Treatment: Chimes will use and share your PHI to provide, coordinate, or manage your health care and related services. We may use and disclose your PHI to tell you about or recommend possible treatment options or alternatives that may be of interest to you. We may share PHI about you with:
Health care practitioners such as doctors, nurses, technicians, student trainees, or other personnel who are involved in taking care of you at Chimes.
Different departments of or contract personnel with Chimes in order to coordinate the different things you need such as prescriptions, lab work, and x-rays.
People outside of Chimes who may be involved in your medical care, such as referrals to aftercare placement or providers outside of Chimes who are treating and or otherwise providing services to you.
Should these services include treatment for Substance Use Disorder, we will obtain the necessary consent from you to share this information first.
For Payment: Your PHI will be used to obtain payment for health care services provided by Chimes. This will include contacting your insurance company to get approval for payment of recommended services, to determine eligibility for benefits, to review services for medical necessity, and to undertake utilization review activities. This also may include sharing information with others, such as Medicare or Medicaid, for the purposes of obtaining payment. Should these services include treatment for Substance Use Disorder, we will obtain the necessary consent from you to share this information first.
Healthcare Operations: We may use and share your PHI to support healthcare operations of Chimes. For example, we may use PHI to review our treatment and to evaluate the performance of our staff in caring for you. This helps to make sure all of our patients/clients receive quality care and services. We may also combine PHI about many patients/clients to decide what additional services Chimes should offer, what services are not needed, and whether certain treatments are effective. We may also share information with health care practitioners such as doctors, nurses, technicians, student trainees, and other personnel for review and learning purposes. We may also share your PHI with state, federal, or accrediting agencies for activities such as audits, inspections, and licensure.
Appointment Reminders, Treatment Alternatives, and Health-Related Benefits and Services: We may use PHI to remind you that you have an appointment for treatment or services at Chimes. We may also tell you about possible treatment options that may be of interest to you, such as Substance Use Disorder treatment services, clinical research studies, or services to address domestic violence.
Fundraising Activities: We may use PHI about you to contact you in an effort to raise money for Chimes. We only would use contact information, such as your name, address, and phone number, treating physician, and the dates you received treatment or services at Chimes. If you do not want Chimes to contact you for fundraising efforts, you must notify the Chimes Development Team at development@chimes.org in writing or by calling 410-358-6400. If you opt out, we will take reasonable measures to ensure you don’t receive further fundraising communication.
Individuals Involved in Your Care or Payment for Your Care: With your agreement, we may share your PHI with a family member, relative, close friend, or any other person you identify. Only information that directly relates to that person’s involvement in your healthcare will be shared. If you are unable to agree or object, we may share information, if based on professional judgment we determine that it is in your best interest. In addition, in the event of a disaster, we may share PHI related to your status and location with your family and/or organization assisting in disaster relief effort.
Research: In special cases, we may use and share your PHI for current or future research purposes. For example, a research project may compare the health and recovery of all patients /clients who received one medication to those who received a different medication for the same condition. However, all research projects must be approved through an Institutional Review Board. This process evaluates a proposed research project and its use of medical information. The patients’/ clients’ need for privacy is balanced with the researcher’s need for medical information. The Institutional Review Board will review and set up rules for using PHI before any information is released. If you volunteer to participate in a research study, the consent form you sign to participate in the research study will inform you of any special uses to be made of your PHI.
As Required By Law and Public Health Activities: We may use or share your PHI to comply with local, state, or federal law. Only information that is required will be released. Examples of this would include reporting for public health activities; notification of abuse, neglect, or domestic violence; health oversight activities; judicial and administrative proceeding; and law enforcement activities.
To Avert a Serious Threat to Health or Safety: We may use and share PHI about you when, in our judgment, it is necessary to prevent a serious threat to your health and safety or to the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
Military Activity and National Security and Intelligence Activities: Under certain circumstances we may share your PHI with authorized federal officials involved in national security and intelligence activities. This may include activities such as providing protective services to the President or foreign heads of state. Information may also be given to federal officials to conduct special investigations. When appropriate conditions apply, we may use or share PHI of Armed Forces personnel (I) for activities deemed necessary by military command authorities, (2) to determine your eligibility for benefits by the Department of Veterans Affairs, or (3) to foreign military authority if you are a member of that foreign military services.
Workers’ Compensation: Your PHI may be disclosed to comply with workers’ compensation laws and other similar legally established programs. These programs provide benefits for work related injuries or illness.
Your Rights Regarding PHI About You:
You have the following rights regarding the PHI we maintain about you:
Facility Directory: At admission for inpatient services, such as crisis residential care, you will be asked if you want your name listed in the Facility Directory. The Facility Directory is used to reveal your location in the Chimes crisis center to outside callers not otherwise legally entitled to the information. If you desire to be listed in our Facility Directory, your name and location will be given to those calling to speak to you or visit you. If you do not want to be listed, you must inform your treatment team.
Right to See and Copy Your PHI: For as long as we keep your PHI, you have the right to see and get a copy of your PHI that is contained in your medical and/or billing records. In most cases, the use or disclosure of psychotherapy notes requires your specific written permission.
To read and copy PHI: You must contact the administrative staff or medical records designee at the Chimes location where you received treatment.
If you request a copy of the information, we may charge a reasonable fee for the associated costs of copying and mailing your request. You have the right to an electronic copy of the electronic medical record in a form that is readily producible
by Chimes. If you request that we provide you your records in an electronic format, we will do so free of charge
In certain limited situations, we may deny your request to read and copy your PHI. In some circumstances, you may have a right to have this decision reviewed, and the decision to deny access may be reversed. Please contact the Privacy Officer or medical records designee where you received treatment if you have questions about access to your PHI.
Right to Amend Your PHI: You have a right to amend by adding to your PHI in your medical record for as long as we keep this information. To request to add information, your request must be in writing to the Privacy Officer or medical records designee where you received treatment. You must include a reason for your request. If your request is not in writing or does not include a satisfactory reason, we may deny your request to amend the record. In addition, we cannot permit you to amend information that:
Was not created by us,
Is not part of the PHI kept by or for Chimes,
Is not part of the information which you would be permitted to inspect and copy,
Is accurate and complete.
If we should deny your amendment request, you have the right to insert in the record a concise statement of the reason you disagree with the record.
Right to a List of Disclosures: You have a right to receive a list describing specifically who has received PHI about you during the last six (6) years. There are certain restrictions and limitations. This list will not include those who have received PHI for treatment, payment, or healthcare operations, as described in this Notice of Privacy Practices. It also will not include those who have made inquiry of a Facility Directory, family members or friends involved in your care, or to whom notification was given.
To request this list or accounting of disclosures, you must write to the Privacy Officer or medical records designee at the Chimes location in which you received services.
Your request must state a time period that may not be greater than six years.
The first list you request within a 12-month period will be free.
For additional lists, we may charge you for the costs of providing the list.
Right to Request Restrictions: You have the right to request that we limit how we use and disclose your PHI. You may restrict giving your PHI to your health insurance plan if you pay out-of-pocket in full for services. In other circumstances, if you request limiting how we use or disclose your PHI, we will consider your request but, we are not legally required to agree to your request.
To request restrictions, you must make your request in writing at the time of your intake or to your treating clinician for each intake and/or registration for services. Your request must list (I) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) who may not receive information.
If we do agree, we will limit the information unless it is needed to provide you emergency treatment.
Right to Choose Confidential Communications: You have the right to request that we communicate with you about health care matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
To request confidential communications, you must make your request in writing to your treating clinician.
Your request must list how or where you wish to be contacted.
You do not have to give a reason for your request.
We will accommodate reasonable requests.
Right to a Paper Copy of This Notice: You have the right to a paper copy of this Notice at any time, even if you have agreed to receive this Notice electronically. It may be obtained at our website www.chimes.org or you may contact the Privacy Officer.
Changes to This Notice: We have the right to change this Notice. We have the right to make the revised or changed Notice effective for PHI we already have about you, as well as any PHI we receive in the future. The effective date of the notice will be posted in the Notice. In addition, we will offer you a copy of the current Notice in effect each time you register or are readmitted to a Chimes program. Copy of the current Notice will be posted on the Chimes web page and at the facility.
Other Uses of PHI: Other uses of PHI not covered by this notice or the laws that apply to us will be made only with your
written permission.
Right to Revoke Authorization: If you give us permission or authorization to use or share PHI about you, you may take back that permission or authorization in writing at any time. If you take back your permission, we will no longer use PHI about you for the reasons covered by your written authorization. We are unable to take back any disclosures we have already made with your permission. Also, you are unable to take back permission to share PHI if it was to permit the sharing of your PHI to an insurance company as a condition of obtaining coverage to the extent that other laws allow the insurer to contest claims or coverage. We are required to keep records of the care that we provided to you.
To take back your permission or authorization, you must make your request in writing. Send your request to the Privacy Officer or medical records designee at the Chimes location in which you gave your permission to share your PHI.
Written permission to use or share PHI about you is not a condition of receiving treatment at Chimes except:
If the treatment is research-related, provision of treatment may be conditional on receipt of written permission to use or share PHI related to the treatment as necessary for the research or:
If the purpose of the treatment services is to create PHI for disclosure to a third party, provision of the services may be conditioned on receipt of written permission from you to share PHI to that third party.
Complaints: If you believe your privacy rights have been violated, you may file a complaint with Chimes by contacting the Privacy Officer at Chimes.
All complaints must be made in writing
You will not be penalized for filing a complaint
You may also file a complaint directly with the secretary of the U.S. Department of Health and Human Services. If you have questions about this Notice, or would like to exercise your Privacy Rights, please contact the Privacy Officer for Chimes at:
Toya Carter
Privacy Officer
4814 Seton Drive
Baltimore, MD 21215
410-585-2095
Toya.Carter@Chimes.org
If you need language interpretation services, ask our staff in person at the site where you are receiving services or Pam Meadows, Chief Operating Officer at (410) 358-6680 for assistance.
ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia
lingüística. Llame al (410) 358-6680,
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فارسي
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አማርኛ
ማሳሰቢያ፦ አማርኛ የሚናገሩ ከሆነ፣ የቋንቋ ድጋፍ አገልግሎት በነፃ ይቀርብልዎታል። መረጃን በተደራሽ ቅርጸት ለማቅረብ ተገቢ የሆኑ ተጨማሪ እገዛዎች እና አገልግሎቶች እንዲሁ በነፃ ይገኛሉ። በስልክ ቁጥር 410-358-6680
This Notice is effective October 1, 2024
and replaces earlier versions.
