Our Privacy Policy
United Hospice of Rockland, Inc.
Notice of Privacy Practices
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
United Hospice of Rockland, Inc.,
[hereafter
referred to as "Hospice"]
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 Hospice has
obtained your written consent. 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:
Provide Treatment.
Hospice may use your health information to coordinate care
within the organization and with others involved in your
care, such as your attending physician, members of the
Hospice interdisciplinary team 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. Hospice also may
disclose your health care information to individuals outside
of Hospice involved in your care including family members,
clergy whom you have designated, pharmacists, suppliers of
medical equipment or other health care professionals that
Hospice uses in order to coordinate your care.
Obtain Payment.
Hospice may include your health information in invoices to
collect payment from third parties for the care that you may
receive from Hospice. For example, Hospice may be
required by your health insurer to provide information
regarding your health care status so that the insurer will
reimburse you or Hospice. 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.
Conduct Health Care Operations.
Hospice may use and
disclose health care information for its own operations in
order to facilitate the function of Hospice and as necessary
to provide quality care to all of Hospice's patients.
Health care operations include the following activities:
-
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 Hospice.
-
Fundraising for the benefit of Hospice and
certain marketing activities.
For example, 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).
For Fundraising Activities.
Hospice may use information about you including your name,
address, phone number and the dates you received care from
Hospice in order to contact you or your family to raise
money for Hospice. The funds raised support the programs
and services provided to you, your family and the community.
If you do not want Hospice to contact you, notify the
Director of Development, in writing, and indicate that you
do not wish to be contacted.
THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH
AND PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY ALSO BE
USED AND DISCLOSED.
When Legally Required.
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.
Examples under which Hospice may disclose your health
information for public activities and purposes are 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.
Report Abuse, Neglect Or Domestic Violence.
Hospice is allowed to notify government authorities if
Hospice believes a patient is the victim of abuse, neglect
or domestic violence. Hospice will make this
disclosure only when specifically required or authorized by
law or when the patient agrees to the disclosure.
Conduct Health Oversight Activities.
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. Hospice, 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 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.
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 Hospice has a
suspicion that your death was the result of
criminal conduct including criminal conduct at
Hospice.
-
In
an emergency in order to report a crime.
To Coroners And Medical Examiners.
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.
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.
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.
Hospice may, under very select circumstances, use your
health information for research. Before Hospice
discloses any of your health information for such research
purposes, the project will be subject to an extensive
approval process. Hospice will ask your permission if any
researcher will be granted access to your individually
identifiable health information.
In the Event of A Serious Threat To Health Or Safety.
Hospice may, consistent
with applicable law and ethical standards of conduct,
disclose your health information if 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.
Hospice 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 will not disclose your
health information other than with your written
authorization. If you or your representative
authorizes Hospice to use or disclose your health
information, you may revoke that authorization in writing at
any time.
YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION
You have the following rights regarding your health
information that Hospice maintains:
1.
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 Hospice's disclosure of your health
information to someone who is involved in your care or the
payment of your care. However, Hospice is not required
to agree to your request. If you wish to make a
request for restrictions, please contact Hospice's Privacy
Officer, at 845-634-4974.
2.
Right to receive confidential communications.
You have the right to request that Hospice communicate with
you in a certain way. For example, you may ask that
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 Hospice’s Privacy Officer
at 845-634-4974. Hospice will not request that you
provide any reasons for your request and will attempt to
honor your reasonable requests for confidential
communications.
3.
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 Hospice’s Privacy Officer, at 845-634-4974.
If you request a copy of your health information, Hospice
may charge a reasonable fee for copying and assembling costs
associated with your request.
4.
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 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 Hospice’s Privacy Officer,
United Hospice of Rockland, 11 Stokum Lane, New City NY
10956. 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 Hospice, if the records you are requesting
are not part of 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 Hospice, the records containing your
health information are accurate and complete.
5.
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 Hospice’s Privacy Officer,
United Hospice of Rockland, 11 Stokum Lane, New City NY
10956. The request should specify the time period for
the accounting starting on April 14, 2003. Accounting
requests may not be made for periods of time in excess of
six years. 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.
6.
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 Hospice’s
Privacy Officer at 845-634-4974. Hospice patients or their
representatives may also obtain a copy of the current
version of Hospice's Notice of Privacy Practices at its
website,
www.hospiceofrockland.org
DUTIES OF HOSPICE
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. Hospice is required to abide by terms of this
Notice as may be amended from time to time. 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 Hospice changes its
Notice, Hospice 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 Hospice and to the Secretary of Health and Human Services
if you or your representatives believe that your privacy
rights have been violated. Any complaints to Hospice
should be made in writing to Hospice’s Privacy Officer,
United Hospice of Rockland, 11 Stokum Lane, New City NY
10956. 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.
CONTACT PERSON
Hospice's contact person for all issues regarding patient
privacy and your rights under the Federal privacy standards
is
Hospice's Privacy Officer, United Hospice of Rockland,
11 Stokum Lane, New City NY 10956. Telephone: (845)
634-4974.
EFFECTIVE DATE: This
Notice is effective April 14, 2003.
IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE,
PLEASE CONTACT HOSPICE’S PRIVACY OFFICER
United
Hospice of Rockland
Website Privacy Policy
United Hospice of Rockland respects
the privacy of our visitors and does not collect any
personal information.
We do not attempt to track individuals
in any manner and we do not link the web information to link
to any other databases with the purpose of identifying
individual website users. We do not track IP addresses or
deposit any “cookies” in an attempt to gain information
about website users.
When visiting links to other sites, we
encourage you to review the privacy policies and statements
of each site you visit.
Any questions and comments regarding
the United Hospice of Rockland Website Privacy Policy should
be directed to:
Lanie Etkind, Director of Development,
UHR, 11 Stokum Lane, New City, NY 10956
phone: 845 634 4974 email:
letkind@hospiceofrockland.org
 |
