NOTICE OF HOSPICE OF THE PANHANDLE
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
Hospice of the Panhandle 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
of the Panhandle 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
Hospice of the Panhandle may use your health information
to coordinate care within 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 of
the Panhandle 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 the Hospice uses in order to coordinate your care.
To Obtain Payment
Hospice of the Panhandle may include your health information
in invoices to collect payment from third parties for the
care 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.
To Conduct Health Care Operations
Hospice of the Panhandle 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
include such activities as:
- Quality assessment and improvement activities.
- 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, practitioners and non-health care
professionals can learn under supervision
- 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 of the Panhandle.
- In reference to fundraising activities,
Hospice of the Panhandle may use information about you
including your name, address, phone number and the dates
you received care at hospice in order to contact you or
your family. If you do not want hospice to contact you
or your family, notify the Privacy Officer and indicate
that you do not wish to be contacted.
For example, Hospice of the Panhandle
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 Hospice of the Panhandle to use
or disclose your health information without your consent or
authorization for a number of reasons.
When Legally Required
Hospice of the Panhandle 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 of the Panhandle 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.
- Report to an employer about an individual
who is a member of the workforce as legally required.
To Report Abuse, Neglect Or
Domestic Violence
Hospice of the Panhandle is allowed to notify government
authorities if the 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.
To Conduct Health Oversight Activities
Hospice of the Panhandle 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 of the Panhandle 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 Hospice of the Panhandle makes reasonable efforts to
either notify you about the request or to obtain an order
protecting your health information.
For Law Enforcement Purposes
Hospice of the Panhandle 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
of the Panhandle 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
Hospice of the Panhandle 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 of the Panhandle 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,
Hospice may disclose your health information prior to and
in reasonable anticipation of your death.
For Organ, Eye Or Tissue Donation
Hospice of the Panhandle 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 of the Panhandle 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. Hospice of the Panhandle 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 of the Panhandle 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
Hospice of the Panhandle 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 of the Panhandle 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 of the Panhandle will
not disclose your health information without your written
authorization. If you or your representative authorizes Hospice
of the Panhandle 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 of the Panhandle 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 Hospice’s disclosure of your health information
to someone who is involved in your care or the payment
of your care. However, Hospice of the Panhandle is not
required to agree to your request. If you wish to make
a request for restrictions, please contact the Privacy
Officer at Hospice of the Panhandle, 122 Waverly Court,
Martinsburg, WV 25401. Telephone number is 304-264-0406
or 800-345-6538.
- Right to receive confidential communications
You have the right to request that Hospice of the
Panhandle 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 the Privacy Officer at
Hospice of the Panhandle. 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 obtain a copy of
your health information
You have the right to inspect and obtain a copy of your
health information, including billing records. A request
to inspect and/or to obtain a copy of your records containing
your health information may be made to the Privacy Officer
at Hospice of the Panhandle at a cost of $10.00.
- 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 of the Panhandle amend the records.
That request may be made as long as the information is
maintained by Hospice. A request for an amendment of records
must be made in writing to the Privacy Officer. Hospice
of the Panhandle 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 of the Panhandle
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.
- Right to an accounting
You or your representative has the right to request an
accounting of disclosures of your health information made
by Hospice of the Panhandle for any reason other than
for treatment, payment or health operations. The request
for an accounting must be made in writing to the Privacy
Officer. 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 of the Panhandle 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 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 Privacy Officer at Hospice
of the Panhandle.
DUTIES OF HOSPICE OF THE PANHANDLE
Hospice of the Panhandle is required by law to maintain
the privacy of your health information and to provide you
and your representative this Notice of its duties and privacy
practices. Hospice of the Panhandle is required to abide by
terms of this Notice as may be amended from time to time.
Hospice of the Panhandle 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 notice is changed, Hospice of the Panhandle 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 of the Panhandle and to the Secretary
of Health and Human Services if you or your representative
believes that your privacy rights have been violated. Hospice
of the Panhandle 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 AT HOSPICE OF THE PANHANDLE
The Hospice’s contact person for all issues regarding
patient privacy and your rights under the Federal privacy
standards is the Privacy Officer, Hospice of the Panhandle,
122 Waverly Court, Martinsburg, WV 25403. The telephone number
is 304-264-0406 or 800-345-6538.
EFFECTIVE DATE
This Notice is effective April 14, 2003.
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