THIS NOTICE DESCRIBES HOW INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS 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 health information to evaluate its staff performance, combine health information of multiple Hospice patients to evaluate how to more effectively serve all Hospice patients, disclose health information to Hospice staff and contracted personnel for training purposes, use your health information to contact patients as a reminder regarding a visit, or 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 those we have served including name, address, phone number and the dates care was provided by Hospice in order to contact patients or family members in order to raise money for Hospice. The funds raised support the programs and services provided all members of our community. Hospice will not sell, trade or share a patient’s or donor's personal information with anyone else, nor send donor mailings on behalf of other organizations. Hospice will only share personal information once the donor has given the charity specific permission to do so. If you do not want Hospice to contact you for fundraising purposes, notify the Director of Development, via whatever method suits you best, and indicate that you do not wish to be contacted.
THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH HEALTH INFORMATION MAY ALSO BE USED AND DISCLOSED.
When Legally Required. Hospice will disclose 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 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.
Conduct Health Oversight Activities. Hospice may disclose 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 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 the patient about the request or to obtain an order protecting the patient’s health information.
For Law Enforcement Purposes. Hospice may disclose 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 someone is the victim of a crime.
- To a law enforcement official if Hospice has a suspicion that a 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 health information to coroners and medical examiners for purposes of determining the cause of death or for other duties, as authorized by law.
To Funeral Directors. Hospice may disclose health information to funeral directors consistent with applicable law and if necessary, to carry out their duties with respect to funeral arrangements. If necessary to carry out their duties, Hospice may disclose health information prior to and in reasonable anticipation a death.
For Organ, Eye or Tissue Donation. Hospice may use or disclose 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 health information for research. Before Hospice discloses any of health information for such research purposes, the project will be subject to an extensive approval process. Hospice will ask permission if any researcher will be granted access to 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 health information if Hospice, in good faith, believes that such disclosure is necessary to prevent or lessen a serious and imminent threat to a patient’s health or safety or to the health and safety of the public.
For Specified Government Functions. In certain circumstances, the Federal regulations authorize Hospice to use or disclose 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 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 health information other than with appropriate written authorization. If Hospice is authorized to use or disclose health information, it may be revoked in writing at any time.
RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION
Patients have the following rights regarding health information that Hospice maintains:
1. Right to request restrictions. Patients have the right to request restrictions on certain uses and disclosures of health information is permitted. A patient has the right to request a limit on Hospice's disclosure of 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. Patients have the right to request that Hospice communicate with them in a certain way. For example, a patient may ask that Hospice only conduct communications pertaining to health information 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 provision of any reasons for the request and will attempt to honor all reasonable requests for confidential communications.
3. Right to inspect and copy health information. Patients have the right to inspect and copy health information, including billing records. A request to inspect and copy records containing health information may be made to Hospice’s Privacy Officer, at 845-634-4974. Hospice may charge a reasonable fee for copying and assembling costs associated with the request.
4. Right to amend health care information. If a patient or representative believes that health information records are incorrect or incomplete, a request to amend the records may be made to Hospice. 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 the health information records were not created by Hospice, if the records requested are not part of Hospice's records, if the health information a patient wishes to amend is not part of the health information that the patient or representative are permitted to inspect and copy, or if, in the opinion of Hospice, the records containing health information are not accurate and complete.
5. Right to an accounting. A patient or representative has the right to request an accounting of disclosures of health information made by 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 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.
6. Right to a paper copy of this notice. A patient or representative has a right to a separate paper copy of this Notice at any time even if he/she 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 health information and to provide to a patient or their legal representative notice of its duties and privacy practices. Hospice is required to abide by terms of the 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 patients or their legal representative. Patients and/or their representatives have the right to express complaints to Hospice and to the Secretary of Health and Human Services if there is a belief that 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. There will be no retaliation in any way for filing a complaint.
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