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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
Compassionate Care Hospice may use your health information for the
purposes of providing you with treatment, obtaining payment for your
care and conducting health care operations. Your health information may
be used or disclosed only after Compassionate Care Hospice has obtained
your written consent. Compassionate Care 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 HEATLH INFORMATION MAY BE USED AND DISCLOSED AFTER YOU
HAVE PROVIDED YOUR WRITTEN CONSENT:
To Provide Treatment
Compassionate Care Hospice may use your health information to
coordinate care within Compassionate Care Hospice 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 Compassionate Care Hospice in coordinating care.
For example, physicians involved in your care will need information
about your symptoms in order to prescribe appropriate medications.
Compassionate Care Hospice may also disclose your health care
information to individuals outside of Compassionate Care Hospice
involved in your care including family members, clergy whom you have
designated, pharmacists, suppliers of medical equipment or other health
care professionals that Compassionate Care Hospice uses in order to
coordinate your care.
To Obtain Payment
Compassionate Care Hospice may include your health information in
invoices to collect payment from third parties for the care you may
receive from Compassionate Care Hospice. For example, Compassionate Care
Hospice may be required by your health insurer to provide information
regarding your health care status so that the insurer will provide
reimbursement for your care. Compassionate Care 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
Compassionate Care Hospice may use and disclose health care information
for its own operations in order to facilitate the function of
Compassionate Care Hospice as necessary to provide quality care to all
of its 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 planning related analyses
and formulary development
- Business management and general administrative activities of
Compassionate Care Hospice
- Certain marketing activities
For example, Compassionate Care 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
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 community information mailings (unless you tell
us you do not want to be contacted).
FOR COMPASSIONATE CARE HOSPICE PATIENTS IN THE INPATIENT FACILITY:
Compassionate Care Hospice may disclose certain information about you
including your name, your general health status, your religious
affiliation and where you are in the inpatient facility in a Hospice
directory while you are in Compassionate Care Hospice’s inpatient
facility. Compassionate Care Hospice may disclose this information to be
included in the directory.
Federal privacy rules allow Compassionate Care Hospice to use or
disclose your health information without your consent or authorization
for a number of reasons (check your State laws to ensure consistency
with State law requirements).
When Legally Required
Compassionate Care 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
Compassionate Care 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 an employer about an individual who is a member of the workforce as
legally required.
To Report Abuse, Neglect or Domestic Violence
Compassionate Care Hospice is allowed to notify government authorities
if the organization believes a patient is the victim of abuse, neglect
or domestic violence. The organization 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 organization may disclose your health information to a health
oversight agency for activities including audits, civil administrative
or criminal investigations, inspections, licensure or disciplinary
action. The organization, 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
Compassionate Care 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 organization makes reasonable efforts
to either notify you about the request or to obtain an order processing
your health information.
For Law Enforcement Purposes
Compassionate Care 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 organization has a suspicion that
your death was the result of criminal conduct including criminal
misconduct at the organization.
- In an emergency in order to report a crime.
To Coroners and Medical Examiners
Compassionate Care 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
Compassionate Care 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 organization may disclose your
health information prior to and in reasonable anticipation of your
death.
For Organ, Eye or Tissue Donation
Compassionate Care 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
Compassionate Care Hospice may, under very select circumstances, use
your health information for research. Before the organization discloses
any of your health information for such research purposes, the project
will be subject to an extensive approval process. The organization 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
Compassionate Care Hospice may, consistent with applicable law and
ethical standards of conduct, disclose your health information if the
organization, 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
Compassionate Care 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
Compassionate Care 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, Compassionate Care Hospice will not disclose
your health information other than with your written authorization. If
you or your representative authorizes Compassionate Care 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
Compassionate Care 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
organization’s disclosure of your health information to someone who is
involved in your care or the payment of your care. However, the
organization is not required to agree to your request. If you wish to
make a request for restrictions, please contact the Director of Clinical
Services.
Right to receive confidential communications.
You have the right to request that Compassionate Care Hospice
communicate with you in a certain way. For example, you may ask that
Compassionate Care 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 Director of Clinical Services. Compassionate Care 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 the Director of
Clinical Services. If you request a copy of your health information,
Compassionate Care 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 Compassionate
Care Hospice amend the records. That request may be made as long as the
information is maintained by Compassionate Care Hospice. A request for
an amendment of records must be made in writing to the Director of
Clinical Services. Compassionate Care Hospice may deny the request if it
is not in writing or does not include a reason for the amendment. The
request may also be denied if your health information records were not
created by the organization, if the records you are requesting are not
part of Compassionate Care 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 the organization, the records containing your health information are
accurate and complete.
Right to an accounting
You or your representative have the right to request an accounting
of disclosures of your health information made by the organization for
any reason other than for treatment, payment or health operations. The
request for an accounting must be made in writing to the Director of
Clinical Services. 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. Compassionate Care
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.
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 the
Director of Clinical Services. The patient or a representative may also
obtain a copy of the current version of the organization’s Notice of
privacy practices at its website, www.
DUTIES OF THE HOSPICE
Compassionate Care 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. Compassionate Care
Hospice is required to abide by terms of this Notice as may be amended
from time to time. Compassionate Care 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
organization changes its Notice, Compassionate Care 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 organization 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 organization should be made in writing
to the Director of Clinical Services. Compassionate Care 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
Compassionate Care Hospice’s contact person for all issues regarding
patient privacy and your rights under the Federal privacy standards is
the Director of Clinical Services.
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