NOTICE OF PRIVACY PRACTICES
THIS
NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU
If you have any questions regarding this notice,
please contact the Fiscal Services Director,
AUTHORIZATION
TO USE OR DISCLOSE HEALTH INFORMATION
Other
than is stated below, Hope Hospice, Inc. will not disclose your health
information other than with your written authorization. If you or your
representative authorizes Hope Hospice, Inc. to use or disclose your health
information, you may revoke that authorization in writing at any time.
USE
Hope
Hospice, Inc. may use your health information, information that
constitutes protected health information as defined in the HIPAA Privacy Rule
Act of 1996, for purposes of providing your treatment, obtaining payment for
your care and conducting health care operations. Hope Hospice, Inc. has
established policies to guard against unnecessary disclosure of your health
information.
THE
FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH YOUR HEALTH INFORMATION
-- WITH YOUR PERMISSION --
To
Provide Treatment. Hope Hospice,
Inc. may use your health information to coordinate care within Hope Hospice, Inc.
and with others involved in your care, such as your attending physician,
members of Hope Hospice, Inc. interdisciplinary team and other health care
professionals who have agreed to assist Hope Hospice, Inc. in coordinating
care. For example, physicians involved in your care will need information about
your symptoms in order to prescribe appropriate medications. Hope Hospice, Inc.
also may disclose your health care information to individuals outside of Hope
Hospice, Inc. involved in your care including family members, clergy who you
have designated, pharmacists, suppliers of medical equipment or other health
care professionals.
To
Obtain Payment. Hope Hospice,
Inc. may include your health information in invoices to collect payment from
third parties for the care you receive from Hope Hospice, Inc. For example,
Hope Hospice, Inc. may be required by your health insurer to provide
information regarding your health care status so that the insurer will
reimburse you or Hope Hospice, Inc. Hope Hospice, Inc. 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.
Hope Hospice, Inc. may use and disclose health information for its own
operations in order to facilitate the function of Hope Hospice, Inc. and as
necessary to provide quality care to all of Hope Hospice, Inc.'s patients.
Health care operations include such activities as:
· Quality assessment
and improvement activities
· Activities designed
to improve health or reduce health care costs
· Protocol development,
case management and care coordination
· Contacting health
care providers and patients with information about treatment alternatives and
other related functions that do not include treatment
· Professional review
and performance evaluation
· Training programs
including those in which students, trainees or practitioners in health care
learn under supervision
· Training of
non-health care professionals
· Accreditation,
certification, licensing or credentialing activities
· Review and auditing,
including compliance reviews, medical reviews, legal services and compliance
programs
· Business planning and
development including cost management and planning related analyses and
formulary development
· Business management
and general administrative activities of Hope Hospice, Inc.
For
example Hope Hospice, Inc. may use your health information to evaluate its
staff performance, combine your health information with other Hospice patients
in evaluating how to more effectively serve all Hospice patients, disclose your
health information to Hospice staff and contracted personnel for training
purposes, use your health information to contact you as a reminder regarding a
visit to you, or contact you as part of general community information mailings
(unless you tell us you do not want to be contacted).
For
Appointment Reminders. Hope
Hospice, Inc. may use and disclose your health information to contact you as a
reminder that you have an appointment for a home visit.
For
Treatment Alternatives. Hope
Hospice, Inc. may use and disclose your health information to tell you about or
recommend possible treatment options or alternatives that may be of interest to
you.
THE FOLLOWING IS A SUMMARY OF THE
ONLY OTHER CIRCUMSTANCES UNDER WHICH YOUR HEALTH INFORMATION -- WITHOUT
YOUR PERMISSION --
When
Legally Required. Hope Hospice, Inc. will disclose your health information
when it is required to do so by any Federal, State or local law.
When
There Are Risks To Public Health. Hope Hospice, Inc. 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 birth or
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. Hope Hospice, Inc. is allowed to notify government
authorities if Hope Hospice, Inc. believes a patient is the victim of abuse,
neglect or domestic violence. Hope Hospice, Inc. will make this disclosure only
when specifically required or authorized by law or when the patient agrees to
the disclosure.
To
Conduct Health Oversight Activities.
Hope Hospice, Inc. may disclose your health information to a health oversight
hospice for activities including audits, civil administrative or criminal
investigations, inspections, licensure or disciplinary action. Hope Hospice,
Inc., however, may not disclose your health information if you are the subject
of an investigation and your health information is not directly related to your
receipt of health care or public benefits.
In
Connection With Judicial And Administrative Proceedings. Hope Hospice, Inc. 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 or in response to a subpoena, discovery request or
other lawful process, but only when Hope Hospice, Inc. makes reasonable efforts
to either notify you about the request or to obtain an order protecting your
health information.
For
Law Enforcement Purposes. As
permitted or required by State law, Hope Hospice, Inc. 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 Hope Hospice, Inc. has a suspicion that your death was the result
of criminal conduct including criminal conduct at Hope Hospice, Inc.
· In an emergency in
order to report a crime
To
Coroners And Medical Examiners.
Hope Hospice, Inc. 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. Hope Hospice,
Inc. 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, Hope Hospice,
Inc. may disclose your health information prior to and in reasonable
anticipation of your death.
If
You Have Previously Elected To Donate Organ, Eye Or Tissue. Hope Hospice, Inc. 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.
In
The Event Of A Serious Threat To Health Or Safety. Hope Hospice, Inc. may, consistent with applicable
law and ethical standards of conduct, disclose your health information if Hope
Hospice, Inc., 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 Hope Hospice, Inc.
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 and law enforcement custody.
For
Worker's Compensation. Hope
Hospice, Inc. may release your health information for worker's compensation or
similar programs.
YOUR
RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION
You
have the following rights regarding your health information that Hope Hospice,
Inc. maintains:
· Right to
request restrictions. You may
request restrictions on certain uses and disclosures of your health
information. You have the right to request a limit on Hope Hospice, Inc.'s
disclosure of your health information to someone who is involved in your care
or the payment of your care. However, Hope Hospice, Inc. is not required to
agree to your request. If you wish to make a request for restrictions, please contact
the Fiscal Services Director.
· Right to
receive confidential communications.
You have the right to request that Hope Hospice, Inc. communicate with you in a
certain way. For example, you may ask that Hope Hospice, Inc. only conduct
communications pertaining to your health information with you privately with no
other family members present. If you wish to receive confidential
communications, please contact the Fiscal Services Director at
· Right to
inspect and copy your health information.
You have the right to inspect and copy your health information, including
billing records. A request to inspect and copy records containing your health
information may be made to the Fiscal Services Director at
· Right to amend
health care information. You or
your representative has the right to request that Hope Hospice, Inc. amend your
records, if you believe that your health information is incorrect or incomplete.
That request may be made as long as the information is maintained by Hope
Hospice, Inc. A request for an amendment of records must be made in writing to
the Fiscal Services Director at
· Right to an
accounting. You or your
representative have the right to request an accounting of disclosures of your
health information made by Hope Hospice, Inc. for certain reasons, including
reasons related to public purposes authorized by law and certain research. The
request for an accounting must be made in writing to the Fiscal Services
Director at
· Right to a
paper copy of this notice. You or
your representative has a right to a separate paper copy of this Notice at any
time even if you or your representative has received this Notice previously. To
obtain a separate paper copy, please contact the Fiscal Services Director at
DUTIES
OF HOPE HOSPICE
Hope
Hospice, Inc. is required by law to maintain the privacy of your health
information and to provide to you and your representative this Notice of its duties
and privacy practices. Hope Hospice, Inc. is required to abide by the terms of
this as may be amended from time to time. Hope Hospice, Inc. reserves the right
to change the terms of its Notice and to make the new Notice provisions
effective for all health information that it maintains. If Hope Hospice, Inc.
changes its Notice, Hope Hospice, Inc. will provide a copy of the revised
Notice to you or your appointed representative. You or your personal
representative has the right to express complaints to Hope Hospice, Inc. and to
the Secretary of Department of Health and Human Services if you or your
representative believes that your privacy rights have been violated. Any
complaints to Hope Hospice, Inc. should be made in writing to the Fiscal
Services Director at
CONTACT
PERSON
Hope
Hospice, Inc. has designated the Fiscal Services Director as its contact person
for all issues regarding patient privacy and your rights under the Federal
privacy standards. You may contact this person at
EFFECTIVE
DATE
This
Notice is effective
IF
YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT THE FISCAL
SERVICES DIRECTOR,
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