|
Notice
of THIS
NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE READ AND REVIEW IT CAREFULLY. Use
and Disclosure of Health Information Hospice
Circle of Love Association may use your health information for purposes
of providing you treatment obtaining payment for your care and
conducting health care operations. 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.
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 included such activities as:
-
Quality assessment and improvement activities. -
Activities designed to improve health or reduce
health care cost. -
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
contacted 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, notify Executive
Director 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 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 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 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
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 Notice of Privacy Practices. Your
are given a notice of -
Right
to request restrictions on further disclosures.
You
may request restrictions on certain uses and disclosures or 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
Patient Care Coordinator. -
Right
to receive confidential communications in an alternative manner or
location.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 Patient Care
Coordinator. 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
of access to protected health information.
You have the right to inspect and obtain a copy of your health
information, including billing records.
A request to inspect and copy records containing your health
information may be made to Secretary.
If you request a copy of your health information, the Hospice may
charge $.25 per sheet 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
Executive Director. 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 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 a part of the health information you or your representative are
permitted to inspect and copy, of if, in the opinion of the Hospice, the
records containing your health information are accurate and complete. -
Right
to an accounting of disclosures. You
and 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
Executive Director. The
request should specify the time period for the accounting starting on -
Right
to complain to the Agency or HHS regarding privacy related matters.
You and your representative
have the right to express complaints to the Hospice and to the Secretary
of Health and Human Services (HHS) 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
Executive Director. The
Hospice encourages you to express any concern you may have regarding the
privacy of your information. You
will not be retaliated against in any way for filing a complaint. 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. CONTACT
PERSON
The Hospice’s contact person for all issues regarding patient
privacy and your rights under the Federal privacy standards is Privacy
Officer, 314 S. Third, Enid OK 73701
OR CALL AT: 580-234-2273. EFFECTIVE
DATE
This Notice is effective April 14, 2003. IF
YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT
THE
EXECUTIVE
DIRECTOR. |