| Use
and disclosure of health information |
Community Hospice
& Palliative Care may use your health information for purposes of
providing you treatment, obtaining payment for your care and conducting
health care operations. Your health information may be used or disclosed
only after the Hospice has obtained your written consent. The Hospice
has established a policy 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 AFTER YOU HAVE PROVIDED YOUR
WRITTEN CONSENT:
To Provide
Treatment. The Hospice may use your health information to coordinate
care within the Hospice and with others involved in your care, such as
your attending physician, members of the Hospice interdisciplinary team,
volunteers and other health care professionals who have agreed to assist
the Hospice 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 and/or clergy whom you have designated, pharmacists,
suppliers of medical equipment or other health care professionals that
the Hospice uses in order to coordinate your care.
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 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 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
Hospice's patients. Health care operations includes 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.
- Bereavement Services
For example the
Hospice 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 or your family as part of general fundraising and
community information mailings (unless you tell us you do not want to
be contacted).
Federal privacy
rules allow the Hospice to use or disclose your health information without
your consent or authorization for a number of reasons.
When Legally
Required. The Hospice 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. 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 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 inform an employer regarding
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 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 the patient agrees
to the disclosure.
To Conduct
Health Oversight Activities. The Hospice may disclose your health
information to a health oversight agency for activities including audits,
civil administrative or criminal investigations, inspections, licensure
or disciplinary action.
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 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. The Hospice 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 Hospice has a suspicion that your death was the result of criminal
conduct including criminal conduct 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 if you
request it.
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. The Hospice will ask your permission
prior to any researcher being granted access to your individually identifiable
health information.
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 and law enforcement
custody.
For Worker's
Compensation. The Hospice may release your health information for
worker's compensation or similar programs.
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Other than is stated above,
the Hospice will not disclose your health information other than with
your written authorization. If you or your representative authorizes the
Hospice to use or disclose your health information, you may revoke that
authorization in writing at any time.
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You have the following rights
regarding your health information that the Hospice 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 Hospice's
disclosure of your health information to someone who is involved in
your care or the payment of your care. However, the Hospice is not required
to agree to your request. If you wish to make a request for restrictions,
please contact Brenda Smart.
- Right to receive confidential
communications. You have the right to request that the Hospice 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 your Hospice Social Worker.
The Hospice 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 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 Brenda Smart. If you request a copy of your health information, the
Hospice may charge a reasonable fee for copying and assembling costs
associated with your request.
- Right to amend health
care information. If you or your representative believes that your
health information records are incorrect or incomplete, you may request
that the Hospice amend the records. 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 Brenda Smart. The Hospice may
deny the request if it is not in writing or does not include a reason
for the amendment.
- 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 any reason
other than for treatment, payment or health operations. The request
for an accounting must be made in writing to Brenda Smart. The request
should specify the time period for the accounting starting October 1,
2002. Accounting requests may not be made for periods of time in excess
of six years. The Hospice 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 Brenda Smart.
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The Hospice 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 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 its Notice and to make the new Notice provisions effective
for all health information that it maintains. If the Hospice changes its
Notice, the Hospice will provide a copy of the revised Notice to you or
your appointed representative. You or your personal representative have
the right to express complaints to the Hospice 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 Hospice should
be made in writing to Mary Clawson at 734-522-4244. 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.
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The Hospice's
contact person for all issues regarding patient privacy and your rights
under the Federal privacy standards is Brenda Smart.
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This Notice is
effective October 1, 2002
IF YOU HAVE ANY
QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT BRENDA SMART.
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