|
-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.
USE AND DISCLOSURE OF HEALTH INFORMATION
Hospice Partners of the Central Coast may use your health information,
information that constitutes protected health information as defined
in the Privacy Rule of the Administrative Simplification provisions
of the Health Insurance Portability and Accountability Act of 1996,
for purposes of providing you treatment, obtaining payment for your
care and conducting health care operations. The Agency has established
policies to guard against unnecessary disclosure of your health
information.
THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH
AND PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED:
To Provide Treatment: The Hospice may use your health information
to coordinate care within the Agency and with others involved in
your care, such as your attending physician, members of the Hospice
Partners interdisciplinary team and other health care professionals
who have agreed to assist the Agency in coordinating care. For example,
physicians involved in your care will need information about your
symptoms in order to prescribe appropriate medications. The Hospice
also may disclose your health care 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 include your health information
in invoices to collect payment from third parties for the care you
may receive from the Agency. For example, the Agency may be required
by your health insurer to provide information regarding your health
care status so that the insurer will reimburse you or the Agency.
Hospice Partners 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: Hospice Partners may use and
disclose health care information for its own operations in order
to facilitate the function of the Hospice and as necessary to provide
quality care to all of the Agency’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 the
Hospice.
- Fundraising for the benefit of the Hospice and certain marketing
activities.
For example Hospice Partners may use your health information to
evaluate its staff performance, combine your health information
with other Agency patients in evaluating how to more effectively
serve all Agency patients, disclose your health information to Hospice
Partners 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 or your family as part of general fundraising
and community information mailings (unless you tell us you do not
want to be contacted).
For Fundraising Activities: Hospice Partners may use information
about you including your name, address, phone number and the dates
you received care at the Agency in order to contact you or your
family to raise money for Hospice Partners. The Agency may also
release this information to a related Agency foundation. If you
do not want Hospice Partners to contact you or your family, notify
the Administrator at 1-805-782-8608 and indicate that you do not
wish to be contacted or you may return fundraising material indicating
you wish to be removed from the mailing list.
For Appointment Reminders: Hospice Partners may use and disclose
your health information to contact you and/or your caregiver as
a reminder that you have an appointment for a home visit.
USES AND DISCLOSURES WHEN AN AUTHORIZATION IS NOT REQUIRED:
When Legally Required: Hospice Partners 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: Hospice Partners 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.
- To 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.
- To notify a person who has been exposed to a communicable disease
or who may be at risk of contracting or spreading a disease.
- To an employer about an individual who is or was a member of the
workforce as legally required to evaluate if the individual has
a work related illness or injury.
To Report Abuse, Neglect Or Domestic Violence: Hospice Partners
is allowed to notify government authorities if the Hospice believes
a patient is the victim of abuse, neglect or domestic violence.
The Agency 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: Hospice Partners may disclose
your health information to a health oversight agency for activities
including audits, civil administrative or criminal investigations,
inspections, licensure or disciplinary action. The Agency, 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: Hospice
Partners 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 the Hospice 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, Hospice Partners may disclose your health information to a
law enforcement official for 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 Agency has a suspicion that
your death was the result of criminal conduct including criminal
conduct at the Agency.
- In an emergency in order to report a crime.
To Coroners and Medical Examiners: Hospice Partners 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: Hospice Partners 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
Agency may disclose your health information prior to, and in reasonable
anticipation, of, your death.
For Organ, Eye, or Tissue Donation: Hospice Partners 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: Hospice Partners
may, consistent with applicable law and ethical standards of conduct,
disclose your health information if the Agency, 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 Agency 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: Hospice Partners may release your health
information for worker's compensation or similar programs.
AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION
Other than is stated above, Hospice Partners will not disclose your
health information without your written authorization. If you or
your representative authorizes the Agency to use or disclose your
health information, you may revoke that authorization in writing
at any time. Any information already used or disclosed prior to
the authorization revocation is not subject to that revocation.
For example, the authorization form would be required when the uses/disclosures
are made to a patient’s employer for disability, fitness for
duty or drug testing purposes.
YOUR RIGHTS
WITH RESPECT TO YOUR HEALTH INFORMATION
You have the following rights regarding your health information
that Hospice Partners 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 the Agency’s disclosure of
your health information to someone who is involved in your care
or the payment of your care. However, the Agency is not required
to agree to your request. If you wish to make a request for restrictions,
please contact the Health Information/Office Manager at 1-805-782-8608.
- Right to receive confidential communications: You have the right
to request that the Agency communicate with you in a certain way.
For example, you may ask that the Hospice 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 Director of Patient Care Services
at 1-805-782-8608. The Agency will not request that you provide
any reasons for your request and will attempt to honor your reasonable
requests for confidential communications.
- Right to inspect and copy your protected health information: You
have the right to request and obtain access to your Protected Health
Information, to the extent required by and consistent with the HIPAA
Privacy Rules. We reserve the right to deny access to Protected
Health Information that is not otherwise required to be given under
the HIPAA Privacy Rules or other applicable laws. 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 in writing to the Health Information/Office Manager
at 277 South Street Suite R, San Luis Obispo, CA 93401. If you request
a copy of your health information, Hospice Partners may charge a
reasonable fee for copying and assembling costs associated with
your request.
- Right to amend health care information: You or your representative
has the right to request that the Agency amend your records, if
you believe that your health information records are incorrect or
incomplete. That request may be made as long as the information
is maintained by the Hospice. A request for an amendment of records
must be made in writing to the Director of Patient Care Services,
277 South Street Suite R, San Luis Obispo, CA, 93401. 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 your
health information records were not created by the Hospice, if the
records you are requesting 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 Hospice Partners 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 Health
Information/Office Manager at 277 South Street Suite R, San Luis
Obispo, CA, 93401. The request should specify the time period for
the accounting starting on or after April 14, 2003. Accounting requests
may not be made for periods of time in excess of six (6) years.
The Agency would 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.
To obtain a separate paper copy, please contact the Health Information/Office
Manager at 1-805-782-8608. The current version of the Agency’s
Notice of Privacy Practices is also available at our website, www.hospicepartners.org
DUTIES OF THE HOSPICE
Hospice Partners 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. The Agency is required
to abide by terms of this Notice which may be amended from time
to time. The Agency 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 Hospice Partners changes its Notice
of Privacy Practices, the Agency will provide a copy of the revised
Notice to you or your appointed representative at the next date
of service and post it on the Agency’s website. You or your
personal representative have the right to express complaints to
Hospice Partners of the Central Coast and to the Secretary of Health
and Human Services if you or your representative believe that your
privacy rights have been violated. Any complaints to the Agency
should be made in writing to the Health Information/Office Manager,
277 South Street Suite R, San Luis Obispo, CA 93401. The Agency
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.
CONTACT PERSON
Hospice Partners of the Central Coast has designated the Health
Information/Office Manager as its Privacy Officer and contact person
for all issues regarding patient privacy and your rights under the
Federal privacy standards. You may contact this person at 277 South
Street Suite R, San Luis Obispo, CA 93401, 1-805-782-8608.
EFFECTIVE DATE
This Notice is effective April 14, 2003.
IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT:
Administrator
Hospice Partners of the Central Coast
277 South Street Suite R
San Luis Obispo CA 93401
Phone (805) 782-8608
Fax (805) 782-8614
Email: hpccinfo@wilshirefoundation.org
|
