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.
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 Hospice of the Panhandle 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 your family, a relative, a close
friend, or any other person you identify, 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
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:
and performance improvement activities.
development, case management and care coordination.
care providers and patients with information about treatment alternatives and
other related functions that do not include treatment.
review and performance evaluation.
including those in which students, trainees, practitioners and non-health care
professionals can learn under supervision
certification, licensing or credentialing activities.
auditing, including compliance reviews, medical reviews, legal services and
and development including cost management and planning related analyses and
management and general administrative activities of Hospice of the Panhandle.
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
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.
of the Panhandle will disclose your health information when it is required to
do so by any Federal, State or local law.
There Are Risks to Public Health
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
·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
of the Panhandle may disclose Health Information to our business associates
that perform functions on our behalf or provide us with services if the
information is necessary for such functions or services. For example, we may
use another company to perform billing services on our behalf. All of our
business associates are obligated to protect the privacy of your information
and are not allowed to use or disclose any information other than as specified
in our contract.
Report Abuse, Neglect or Domestic Violence
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
Conduct Health Oversight Activities
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
Connection With Judicial and Administrative Proceedings
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.
Law Enforcement Purposes
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
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
·In an emergency in
order to report a crime.
Coroners and Medical Examiners
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.
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.
Organ, Eye or Tissue Donation
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.
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.
the Event of a Serious Threat to Health or Safety
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
Specified Government Functions
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.
of the Panhandle may release your health information for worker’s compensation
or similar programs.
USES and DISCLOSURES
THAT REQUIRE US TO GIVE YOU AN OPPORTUNITY TO OBJECT AND OPT OUT
1.Unless you object,
we may disclose to a member of your family, relative, a close friend or any
other person you identify, your Protected Health Information that directly
relates to treat person’s involvement in your health care. If you are unable to
agree or object to such a disclosure, we may disclose such information as necessary
if we determine that it is in your best interest based on our professional judgment.
2.We may disclose
your Protected Health Information to disaster relief organizations that seek
your Protected Health Information to coordinate your care, or notify family and
friends of your location or condition in a disaster. We will provide you with
an opportunity to agree or object to such disclosure whenever we practically
can do so.
AUTHORIZATION TO USE OR DISCLOSE HEALTH
The following uses and disclosures
of your Protected Health Information will be made only with your written
disclosures of Protected Health Information for marketing purposes; and
constitute a sale of your Protected Health Information
than what 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
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. If you wish to make a
request for restrictions, please contact the Privacy Officer at Hospice of the
Panhandle, 122 Waverly Court, Martinsburg, WV 25403.
Telephone number is 304-264-0406 or 800-345-6538. However, Hospice of
the Panhandle is not required to agree to your request unless you are asking us
to restrict the use and disclosure of your Protected Health Information to a
health plan for payment or health care operation purposes and such information
you wish to restrict pertains solely to a health care item or service for which
you have paid us "out-of-pocket” in full. We will comply with your request
unless the information is needed to provide you with emergency treatment.
receive confidential communications
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.
inspect and obtain a copy of your health information
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.
will be a charge at $10.00 to receive a written summary of the requested
information or $.50 per page to have the requested information copied and
mailed to the patient or representative.
·Right to Get
Notice of a Breach
You have the right to be notified upon a breach of
any of your unsecured Protected Health Information
amend health care information
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
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 or after
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
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.
·Right to opt out of Fundraising
use certain information (name, address, telephone number or e-mail information,
age, date of birth, gender, health insurance status, dates of service,
department of service information, treating physician information or outcome
information) to contact you for the purpose of raising money. You will have the
right to opt out of receiving such communications with each solicitation. The
money raised will be used to expand and improve the services and programs we
provide the community. You are free to opt out of fundraising
solicitation, and your decision will have no impact on your treatment or
payment for services at Hospice. If you do not want to receive future fundraising requests you can call
our telephone number 304-264-0406 or 1-800-345-6538 and leave a message
identifying yourself and stating that you do not want to receive fundraising
requests. There is no requirement that you agree to accept fundraising
communication from us, and we will honor your request not to receive any
communications from us after the date we receive your decision.
DUTIES OF HOSPICE OF
Hospice of the Panhandle is
required by law to maintain the privacy of your health information and to
provide you or 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 post a copy of our current notice at our office. 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, 330 Hospice
Lane, Kearneysville, WV 25430. The telephone number is 304-264-0406 or
This Notice is effective March