Notice of Privacy Practices
For Bayes Achievement Center, Inc.
Effective April 14, 2003

THIS NOTICE DESCRIBES HOW MENTAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Bayes Achievement Center, Inc. (BAC) is required by law to maintain the privacy of your protected health information (PHI) and to provide you with notice of your privacy rights and BAC's legal duties and privacy practices with respect to your PHI. BAC is required to abide by the terms of this notice with respect to your PHI but reserves the right to change the terms of this notice and make the new notice provisions effective for all PHI that BAC maintains. BAC will provide you with a copy of the revised notice sent by regular mail to the last address you have provided to BAC for this communication purpose.

    Understanding Your Personal Health Information

Each time you visit a hospital, physician, mental health professional or other healthcare provider, a record of your visit and/or treatment is made. Typically, this record contains your symptoms, examination and test results, diagnoses, and treatment records, including, in the case of a mental health professional, psychotherapy notes, and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a:
    • basis for planning your care and treatment
    • means of communication among the many health professionals who contribute to your care
    • legal document describing the care you received
    • means by which you or a third-party payer can verify that services billed were actually provided
    • tool in educating health professionals
    • source of data for medical research
    • source of information for public health officials charged with improving the health of the nation
    • source of data for facility planning and marketing
    • tool with which we can assess and continually work to improve the care we render and the outcomes we achieve
Understanding what is in your record and how your health information is used helps you to:
    • ensure its accuracy
    • better understand who, what, when, where, and why others may access your health information
    • make more informed decisions when authorizing disclosure to others

Your Health Information Rights

Although your health record is the physical property of Bayes Achievement Center, Inc., the facility that compiled it, the information belongs to you. You have the following privacy rights:

  1. The right to request restrictions on the use and disclosure of your PHI to carry out treatment, payment or health care operations.

    You should note that BAC is not required to agree to be bound by any restrictions that you request but is bound by each restriction to which BAC does agree.

  2. In connection with any patient directory, the right to request restrictions on the use and disclosure of your name, location at this treatment facility, description of your condition and your religious affiliation (BAC does not maintain a client directory).

  3. To receive confidential communication of your PHI unless BAC determines that such disclosure would be harmful to you.

  4. To inspect and copy your PHI unless BAC determines in the exercise of the professional judgment of the clinical staff that the access requested is reasonably likely to endanger your life or physical safety (Note: if state law allows, "emotional safety" may be included as well) or that of another person.

    You may request copies of your PHI by providing BAC with a written request for such copies. BAC will provide you with copies within ten (10) business days of your request at the BAC administrative offices. You will be charged $.25 for each page copied and you will be expected to pay for the copies at the time you pick them up.

  5. To amend your PHI upon your written request to BAC setting forth your reasons for the requested amendment. BAC has the right to deny the request if the information is accurate and complete or has been created by another entity.

    BAC is required to act on your request to amend your PHI within sixty (60) days but this deadline may be extended for another thirty (30) days upon written notice to you. If BAC denies your requested amendment BAC will provide you with written notice of the decision and the basis for BAC's decision. You will then have the right to submit a written statement disagreeing with BAC's decision which will be maintained with your PHI. If you do not wish to submit a statement of disagreement you may request that BAC provide your request for amendment and BAC's denial with any future disclosures of your PHI.

  6. Upon written request, you are entitled to receive an accounting of disclosures of your PHI made within the past 6 years of your request for an accounning. Disclosures that are exempted from the accounting requirement include the following:
*Disclosures necessary to carry out treatment, payment and health are operations
*Disclosures made to you upon request
*Disclosures made pursuant to your authorization
*Disclosures made for national security or intelligence purposes
*Permitted disclosures to correctional institutions or law enforcement officials
*Disclosures that are part of a limited data set used for research, public health or health care operations

BAC is required to act on your request for an accounting within sixty (60) days, but this deadline may be extended for another thirty (30) days upon written notice to you of the reason for the delay and the date by which BAC will provide the accounting. You are entitled to one (1) accounting in any twelve (12) month period free of charge. For any subsequent request in a twelve (12 ) month period you will be charged $.25 for each page copied and youuwill be expected to pay for the copies at the time you pick them up.

To receive a paper copy of this privacy notice even if you agreed to receive a copy electronically.

The right to complain to BAC and to the Secretary of the U.S. Department of Health & Human Services (HHS) if you believe your privacy rights have been violated. You may submit your complaint to BAC Administration in writing setting out the alleged violation. BAC is prohibited by law from retaliating against you in ny way for filing a complaint with BAC or HHS.

If you have any questions and would like additional information you should bring this to the attention of BAC Administration or Designee at the first opportunity. The designated Privacy Officer for BAC is the Administrator and she or he will be glad to respond to your questions or request for information.