|BAY SHORE SERVICES, INC.
NOTICE OF PRIVACY PRACTICES FOR Bay Shore Services, Inc. and affilicated programs including the Community Dental clinic
THIS NOTICE DESCRIBES HOW PRIVATE INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE READ CAREFULLY
Effective February 6, 2017
BAY SHORE SERVICES, INC. and affiliated programs including the Community Dental Clinic use private information about you to implement services, coordinate medical care, provide treatment, order medications, obtain service payments, evaluate services provided, and access additional services on your behalf. Information about you may be used for administrative and financial purposes. Your private information is contained in records that are the physical property of Bay Shore Services, Inc.
HOW BAY SHORE SERVICES, INC. MAY USE OR DISCLOSE YOUR PRIVATE INFORMATION
For Services. BAY SHORE SERVICES, INC. may use your private information to provide care or obtain services for you in accordance with your Individual Plan. For example, information obtained from or released to a medical professional involved in your care, will be recorded in your record. This exchange of information is necessary for the medical professional and our staff to determine what treatment you should receive.
For Payment. We may use and disclose information about you so the treatment and services you receive from Bay Shore Services, Inc. may be billed to and payment collected from you, an insurance company or a third party. For example, we may need to give your health plan information about treatment you received at Bay Shore Services, Inc. so your health plan will pay us or reimburse you for the treatment. We may also tell your health plan about a services you are going to receive to obtain prior approval or to determine whether your plan will cover the service.
For Health Care Operations. Bay Shore Services, Inc. may use and disclose health information about you for operational purposes. For example, your health information may be disclosed to members of our staff, quality improvement personnel, and others to:
• Evaluate the performance of our staff;
Appointment Reminders. We may use and disclose information to contact you as a reminder that you have an appointment at BAY SHORE SERVICES, INC and affiliated programs including the Community Dental Clinic.
Research/Program Evaluation. Under certain circumstances, we may use and disclose private information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the same condition. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of clinical information, trying to balance the research needs with client’s need for privacy of their clinical information. Before we use or disclose clinical information for research, the project will have been approved through this research approval process, but we may, however, disclose information about you to people preparing to conduct a research project, for example to help them look for patients with specific clinical needs, so long as the clinical information they review does not leave Bay Shore Services, Inc. We will ask for your specific permission if the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care at Bay Shore Services, Inc.
As Required By Law. We may use and disclose information about you as required by law.
To Avert a Serious Threat to Health or Safety. We may use and disclose information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure however would only be to someone able to help prevent the threat.
As required by Agencies Funding our Services. We may disclose information about you as required by agencies and regulatory authorities that fund our services.
Workers’ Compensation. We may release information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
Public Health Risks. We may disclose information about you for public health activities. These activities generally include the following:
Oversight Activities. We may disclose clinical and financial information to oversight agency for activities authorized by law and required by our funding guidelines These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, fiscal mandates, and civil rights laws compliance.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose information about you in response to a court order.
Law Enforcement. We may release information if asked to do so by a law enforcement official:
National Security and Intelligence Activities. We may release information about you to authorized federal officials.
RIGHTS REGARDING YOUR PRIVATE INFORMATION.
You have the following rights regarding information we maintain about you:
Right to Inspect and Copy. You have the right to inspect and copy information that may be used to make decisions about your care. Usually, this includes clinical, financial and billing records. To inspect and copy information potentially used to make decisions about you, you must submit your request in writing to the Privacy Officer at Bay Shore Services, Inc. If you request a copy of the information, we may charge a reasonable fee for the costs of copying, mailing or other supplies associated with your request. We may deny your request to inspect and copy in certain circumstances. If you are denied access to information, you may request that the Quality Management Committee review the denial of your request. The Quality Management Committee will conduct a review and notify you of the outcome. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
Right to Amend. If you feel that information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for Bay Shore Services, Inc. To request an amendment, please contact the Privacy Officer. We may deny your request if you ask us to amend information that:
• Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures.” This is a list of the disclosures we made of private information about you. To request this list of accounting of disclosures, you must submit your request in writing to the Privacy Officer at Bay Shore Services, Inc. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. 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. 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. Disclosure lists are not kept to information released to your team, health care professional, state officials and other actively involved in your care.
Right to Request Restrictions. You have the right to request a restriction or limitation on the clinical and financial information we use or disclose about you for treatment, payment, service coordination or care operations. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you must make your request in writing to the Privacy Officer at Bay Shore Services, Inc. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply.
Right to Request Confidential Communications. You have the right to request that we communicate with you about clinical 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 the Privacy Officer at Bay Shore Services, Inc. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. You may obtain a copy of this notice at our web site, www.bayshoreservices.org
Salisbury, MD 21801
A PAPER COPY OF THIS NOTICE IS AVAILABLE UPON REQUEST.