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.
THE HOSPICE’S DUTIES
Hospice Care Corporation (the “Hospice”) is required by law to maintain the privacy of your health information, to provide to you (or your representative) this Notice of our duties and privacy practices, and to notify you (or your representative) following a breach of your unsecured health information. The Hospice is required to abide by terms of this Notice as may be amended from time to time. The Hospice reserves the right to change the terms of our Notice and to make the new Notice provisions effective for all health information that it maintains. Any revision or amendment to this Notice will be effective for all of your records the Hospice has created or maintained in the past, and for any records the Hospice may create or maintain in the future.
USE AND DISCLOSURE OF HEALTH INFORMATION
THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH THE HOSPICE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION:
To Provide Treatment. The Hospice may use your health information to treat you and coordinate your care within the Hospice. For example, your attending physician or members of the Hospice interdisciplinary team may use information about your symptoms in order to prescribe appropriate medications. The Hospice also may disclose your health information to individuals outside of the Hospice involved in your care including family members, clergy whom you have designated, pharmacists, suppliers of medical equipment or other health care professionals.
To Obtain Payment. The Hospice may use or disclose your health information in order to bill or collect payment for the services and items you receive from the Hospice. For example, the Hospice may be required by your health insurer to provide information regarding your health care status so that the insurer will reimburse you or the Hospice. The Hospice also may need to obtain prior approval from your insurer and may need to explain to the insurer your need for hospice care and the services that will be provided to you.
To Conduct Health Care Operations. The Hospice may use or disclose your health information for our own operations in order to facilitate the function of the Hospice and as necessary to provide quality care to all of the Hospice’s patients. For example, the Hospice may use your health information to evaluate our staff performance, combine your health information with other Hospice patients to evaluate how to more effectively serve all Hospice patients, disclose your health information to Hospice staff and contracted personnel for training purposes, or use your health information to contact you or your family as part of general community information mailings. The Hospice also may disclose your health information to a health oversight agency performing activities authorized by law, such as investigations or audits. These agencies include governmental agencies that oversee the health care system, government benefit programs, and organizations subject to government regulation and civil rights laws. In addition, the Hospice may disclose your health information to another health care provider subject to Federal privacy protection laws, as long as the provider has or has had a relationship with you and the health information is for that provider’s health care operations.
For Fundraising Activities. In support of our charitable mission, the Hospice may use certain health information about you (e.g., demographic information, dates of health care provided, department of service information, treating physician, outcome information and health insurance status) to contact you or your family to raise money for the Hospice. The Hospice may also release this information to an organizationally?related foundation for the same purpose. You may choose to “opt-out” of receiving these fundraising communications by notifying the Hospice’s Quality Control Director that you do not wish to be contacted at P.O. Box 760, Arthurdale, WV 26520, by phone at 1-800-350-1161 or via email at email@example.com .
Facility Directory. If you are receiving care at one of the Hospice’s facilities, unless you request otherwise, the Hospice may disclose certain information about you (e.g., your name and room number) in our facility directory and such information may be released to anyone who asks for you by name.
For Appointment Reminders. The Hospice may use or disclose your health information to contact you to remind you about an appointment.
To Inform You About Information That May be of Interest to You. The Hospice may use or disclose your health information to tell you about or recommend possible treatment options or alternatives, or to inform you of other information that may be of interest to you. For example, we may call you to remind you of an expired prescription or to inform you about the availability of alternative drugs or other products that may benefit your health.
Release of Information to Family/Friends. Unless you specifically ask the Hospice not to in writing, the Hospice may release your health information to a family member or friend who is involved in your treatment or who is helping you pay for your care.
Business Associates. The Hospice may disclose your health information to our business associates that perform functions on our behalf or provide it with services if the information is necessary for them to provide such functions or services. The Hospice requires our business associates to agree in writing to protect to privacy of your health information and to use and disclose your health information only as specified in that written agreement.
Health Information Exchanges. The Hospice participates in an arrangement of health care organizations who have agreed to work with each other to facilitate access to health information that may be relevant to your care. For example, if you are admitted on an emergency-basis to a hospital that participated in the exchange and you cannot provide important information about your condition, the arrangement will allow the hospital to access the health information the Hospice maintains about you to treat you at the hospital.
THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH THE HOSPICE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION WITHOUT YOUR CONSENT OR AUTHORIZATION:
When Legally Required. The Hospice will disclose your health information to the extent that it is required to do so by any Federal, state or local law.
When There Are Risks To Public Health. The Hospice may disclose your health information for public activities and purposes in order to:
- Prevent or control disease, injury or disability, report disease, injury, vital events such as death, and the conduct of public health surveillance, investigations and interventions.
- Report adverse events, product defects, to track products or enable product recalls, repairs and replacements and to conduct post-marketing surveillance and compliance with requirements of the Food and Drug Administration.
- Notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease.
- Notify an employer about an individual who is a member of the workforce as legally required.
To Report Abuse, Neglect Or Domestic Violence. The Hospice is allowed to notify government authorities if the Hospice reasonably believes a patient is the victim of abuse, neglect or domestic violence. The Hospice will make this disclosure only when specifically required or authorized by law or when you authorize the disclosure.
To Conduct Health Oversight Activities. The Hospice may disclose your health information to a health oversight agency or other organization for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action. If you are the subject of a health oversight agency investigation, the Hospice may disclose your health information only if it is directly related to your receipt of health care or public benefits.
In Connection With Judicial And Administrative Proceedings. The Hospice may disclose your health information in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order. Under certain conditions, the Hospice may also disclose your health information in the course of a judicial or administrative proceeding in response to a subpoena, discovery response or other lawful process.
For Law Enforcement Purposes. As permitted or required by state law, the Hospice may disclose your health information to a law enforcement official for certain law enforcement purposes as follows:
- As required by law for reporting of certain types of wounds or other physical injuries.
- Pursuant to the court order, warrant, subpoena or summons or similar process.
- For the purpose of identifying or locating a suspect, fugitive, material witness or missing person.
- Under certain limited circumstances, when you are the victim of a crime.
- To a law enforcement official if the Hospice has a suspicion that your death was the result of criminal conduct.
- To a law enforcement official if the Hospice believes the information constitutes evidence of criminal conduct that occurred at the Hospice.
- In an emergency in order to report a crime.
To Coroners And Medical Examiners. The Hospice may disclose your health information to coroners and medical examiners for purposes of determining your cause of death or for other duties, as authorized by law.
To Funeral Directors. The Hospice may disclose your health information to funeral directors consistent with applicable law and if necessary, to carry out their duties with respect to your funeral arrangements. If necessary to carry out their duties, the Hospice may disclose your health information prior to and in reasonable anticipation, of your death.
For Organ, Eye Or Tissue Donation. The Hospice may use or disclose your health information to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of organs, eyes or tissue for the purpose of facilitating the donation and transplantation.
For Research Purposes. The Hospice may, under very select circumstances, use your health information for research. Before the Hospice discloses any of your health information for such research purposes, the project will be subject to an extensive approval process.
In the Event Of A Serious Threat To Health Or Safety. The Hospice may, consistent with applicable law and ethical standards of conduct, disclose your health information if the Hospice, in good faith, believes that such disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or to the health and safety of the public.
For Specified Government Functions. In certain circumstances, the Federal regulations authorize the Hospice to use or disclose your health information to facilitate specified government functions relating to military and veterans, national security and intelligence activities, protective services for the President and others, medical suitability determinations and inmates in law enforcement custody.
For Workers’ Compensation. The Hospice may release your health information for Workers’ Compensation or similar programs.
AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION
Other than is stated above, the Hospice will not disclose your health information other than with your written authorization. Your authorization (or the authorization of your representative) is specifically required before the Hospice: (i) uses or discloses your psychotherapy notes; (ii) uses your health information to make a marketing communication to you for which it receives financial remuneration from a third party, unless such communication is face-to-face or in other limited circumstances; or (iii) discloses your health information in any manner which constitutes the sale of such information under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA“). Also, some types of health information are particularly sensitive, and the law, with limited exceptions, may require that the Hospice obtain your authorization to use or disclose that information. Sensitive information may include information dealing with genetics, HIV/AIDS, mental health, developmental disabilities, and alcohol and substance abuse. If required by law, the Hospice will ask that you (or your representative) sign an authorization before it uses or discloses such information. If you (or your representative) authorizes the Hospice to use or disclose your health information, you (or your representative) may revoke that authorization in writing at any time, except to the extent that it has already been acted upon.
YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION
You have the following rights regarding your health information that the Hospice maintains:
– Right To Confidential Communications. You (or your representative) have the right to request that the Hospice communicate with you about your health and related issues in a particular manner or at a certain location. Such requests shall specify the requested method of contact or the location where you wish to be contacted. For instance, you (or your representative) may ask that the Hospice contact you on a cellular phone rather than a home phone. All requests for confidential communications must be made in writing using the appropriate Hospice form. The form can be requested by contacting the Hospice’s Quality Control Director at 1-800-350-1161. The Hospice will accommodate reasonable requests. You (or your representative) do not need to give a reason for your request.
– Right To Request Restrictions. You (or your representative) have the right to request restrictions on certain uses and disclosures of your health information. You (or your representative) have the right to request a limit on the Hospice’s disclosure of your health information to someone who is involved in your care or the payment of your care. All requests for restrictions must be made in writing using the appropriate Hospice form. The form can be requested by contacting the Hospice’s Quality Control Director at 1-800-350-1161. The Hospice is not required to agree to your request; however, if the Hospice does agree, it is bound by that agreement except when otherwise required by law or in emergencies. Except as otherwise required by law, the Hospice must agree to a restriction request if: (i) the disclosure is to a health plan for purposes of carrying out payment or health care operations (and not for purposes of carrying out treatment); and (ii) the health information pertains solely to a health care item or service for which the Hospice has been paid out of pocket in full by you or someone else on your behalf (not the health plan). If you self-pay and request a restriction, it will apply only to those health records created on the date that you received the item or service for which you, or another person (other than the health plan) on your behalf, paid in full, and which document the item or service provided on such date.
– Right To Inspect And Copy Your Health Information. You (or your representative) have the right to inspect and copy your health information, including billing records. All requests to inspect and copy records must be made in writing using the appropriate Hospice form. All requests for restrictions must be made in writing using the appropriate Hospice form. The form can be requested by contacting the Hospice’s Quality Control Director at 1-800-350-1161. If you (or your representative) request a copy of your health information, the Hospice will provide you (or your representative) copies of your health information in the format you request unless we cannot practicably do so. The Hospice may charge a reasonable fee for copying and assembling costs associated with your request. The Hospice may deny your request to inspect and/or copy your health information in certain limited circumstances. If the Hospice denies your request, you (or your representative) may request that it provide you with a review of our denial. Reviews will be conducted by a licensed health care professional who the Hospice has designated as a reviewing official, and who did not participate in the original decision to deny the request.
– Right To Amend Health Care Information. If you (or your representative) believe that your health information is incorrect or incomplete, you (or your representative) have the right to request that the Hospice amend your records. The request may be made so long as the Hospice still maintains your records and it must include a reason for the amendment. All requests for amendment must be made in writing using the appropriate Hospice form. All requests for restrictions must be made in writing using the appropriate Hospice form. The form can be requested by contacting the Hospice’s Quality Control Director at 1-800-350-1161. The Hospice may deny the request if it is not in writing or does not include a reason for the amendment. The request also may be denied if the requested amendment pertains to health information that was not created by the Hospice, if the records you are requesting to amend are not part of the Hospice’s records, if the health information you wish to amend is not part of the health information you (or your representative) are permitted to inspect and copy, or if, in the opinion of the Hospice, the records containing your health information are accurate and complete.
– Right To An Accounting. You (or your representative) have the right to request an accounting of disclosures of your health information made by the Hospice for certain reasons, including reasons related to public purposes authorized by law and certain research. All requests for an accounting must be made in writing using the appropriate Hospice form. The form can be requested by contacting the Hospice’s Quality Control Director at 1-800-350-1161. The request should specify the time period for the accounting, which may not be in excess of six (6) years. The Hospice will provide the first accounting you request during any 12-month period without charge. Subsequent accounting requests may be subject to a reasonable cost-based fee.
– Right To A Paper Copy Of This Notice. You (or your representative) have a right to a separate paper copy of this Notice at any time even if you (or your representative) have received this Notice previously (either in paper or electronic format). To obtain a separate paper copy, please contact Hospice Care Corporation’s Quality Control Director at 1-800-350-1161. You (or your representative) may also obtain a copy of the current version of the Hospice’s Notice of Privacy Practices at our website, www.hospicecarecorp.org.
– Right to Breach Notification. You (or your representative) have the right to be notified of any breach of your unsecured health information. Notification of a breach may be delayed or not provided if so required by a law enforcement official. You may request that such notice be provided to you be electronic mail. If you are deceased and there is a breach of your health information, the notice will be provided to your next of kin or personal representative if the Hospice knows the identity and address of such individual.
If you have any questions or feel that your privacy rights as stated in this Notice have been violated, please contact the Hospice’s Quality Control Director at P.O. Box 760, Arthurdale, WV 26520 or at 1-800-350-1161.
You (or your representative) have the right to express complaints to the Hospice or to the Secretary of Health and Human Services if you (or your representative) believe that your privacy rights have been violated. All complaints to the Hospice should be made in writing and submitted to the Hospice’s Quality Control Director at P.O. Box 760, Arthurdale, WV 26520. The Hospice encourages you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way for filing a complaint.
EFFECTIVE DATE: This Notice is effective August 1, 2013.
IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT HOSPICE CARE CORPORATION’S QUALITY CONTROL MANAGER @ 1-800-350-1161 or via email at firstname.lastname@example.org .