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Disclosure of Information Policy
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
Caring Hospice Services 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 the Hospice
has obtained your written consent. The 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:
To Provide Treatment. The Hospice may use your health information to
coordinate care within the 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 the Hospice in coordinating care. For example,
physicians involved in your care will need information about your
symptoms in order to prescribe appropriate medications. The Hospice
also may disclose your health care information to individuals
outside of the 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. The Hospice may include your health information in
invoices to collect payment from third parties for the care you may
receive from the Hospice. For example, the Hospice may be required
by your health insurer to provide information regarding your health
care status so that the insurer will reimburse you or the Hospice.
The 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. The Hospice 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 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 cost
management and planning related analyses and formulary
development.
- Business management and general administrative
activities of the Hospice.
- Fundraising for the benefit of the Hospice and
certain marketing activities.
For example the 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. The Hospice may use
information about you including your name, address, phone number and the dates you
received care at the Hospice in order to contact you or your family
to raise money for the Hospice. The Hospice may also release this
information to a related Hospice foundation. If you do not want the
Hospice to contact you or your family, e-mail us at cvisco@caringhospice.com or
contact the Privacy Officer at 800-390-2998 and indicate that you do
not wish to be contacted.
Federal privacy rules allow the Hospice to use or
disclose your health information without your consent or
authorization for a number of reasons.
When Legally Required. The 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. The 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. The Hospice is allowed to
notify government authorities if the Hospice believes a patient is
the victim of abuse, neglect or domestic violence. The 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. The 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. The 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. The 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. The 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 Hospice 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. The 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. The 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. The 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. The Hospice 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. The 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. The Hospice 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 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. The 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, the Hospice will not
disclose your health information other than with your written
authorization. If you or your representative authorizes the 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 the 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
Hospice's disclosure of your health information to someone who is
involved in your care or the payment of your care. However, the
Hospice is not required to agree to your request. If you wish to
make a request for restrictions, please contact the Privacy Officer
for Caring Hospice Services at 800-390-2998.
- Right to receive confidential
communications. You have the right to request that the
Hospice communicate with you in a certain way. For example, you may
ask that the 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 Privacy Officer for Caring Hospice Services at
800-390-2998.
The 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
Privacy Officer for Caring Hospice at 800-390-2998.
If you request a copy of your health information,
the 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 the 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 the Privacy Officer for Caring Hospice
Services at 400 Commerce Drive, Suite C, Fort Washington, PA
19034.
The 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 the Hospice, if the records you are requesting are not
part of the 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 Hospice, 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 Hospice 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 for Caring Hospice Services at 400 Commerce Drive, Suite C,
Fort Washington, PA 19034.
The request should specify the time period for the
accounting starting on April 14, 2003. Accounting requests may not
be made for periods in excess of six years. The 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.
- 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 for
Caring Hospice Services at 400 Commerce Drive, Suite C, Fort
Washington, PA 19034.
DUTIES OF THE HOSPICE
The 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. The
Hospice is required to abide by terms of this Notice as may be
amended from time to time. The 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
Hospice changes its Notice, the 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 the
Hospice 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 Hospice should be made in writing to
the Privacy Officer for Caring Hospice Services at 400 Commerce
Drive, Suite C, Fort Washington, PA 19034. The 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
The Hospice's contact person for all issues
regarding patient privacy and your rights under the Federal privacy
standards is Privacy Officer for Caring Hospice Services at
800-390-2998.
EFFECTIVE DATE
This Notice is effective April 14, 2003.
IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE,
PLEASE CONTACT
Privacy Officer
Caring Hospice Services
800-390-2998
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