Privacy Notice:
General Inpatient Care
NOTICE OF COMMUNITY HOSPICE, INC. 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.
Understanding Your Health Record/Information
Each time you visit a hospital, physician, or other healthcare provider, they make a record of your visit. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment and a plan for future care or treatment. This information, your health or medical record, serves as a basis for planning your care and treatment, is a way to communicate with the many health professionals who contribute to your care, is a legal document describing the care you received, allows you a third party to verify that a service billed was provided, can be a tool in educating health professionals and a source of data for medical research, a source of information for public health officials charged with improving the health of a nation, a source of data for facility planning and marketing, and can be a tool to help us assess and continually improve the care we render and the outcomes we achieve.
Understanding what is in your record and how your health information is used helps you to ensure its accuracy, helps you better understand who, what, when, where and why others may access your health information, and can help you decide when to authorize disclosure to others.
Your Health Information Rights
Although your health record is the physical property of the healthcare practitioner or facility that compiled it, the information belongs to you. You have the right to request a restriction on certain uses and disclosures of your information, receive a paper copy of the notice of information practices upon admission, inspect and obtain a copy of your health record, amend your health record as provided in 45 CFR 164.528, obtain an accounting of disclosures of your health information, request communications of your health information by alternative means or at alternative locations, and revoke your authorization to use or disclose your health information except to the extent that action has already been taken. Community Hospice will provide you with access to an electronic form of your protected health information in a timely manner upon your request for such information.
Our Responsibilities
Community Hospice is required to maintain the privacy of your health information, give you a notice of our legal duties and privacy practices about information we collect and maintain about you, abide by the terms of this notice, let you know if we are unable to agree to a requested restriction, and satisfy reasonable requests you make to send health information another way or to alternate locations. Community Hospice is required to notify affected individuals following a breach of unsecured protected health information.
We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will give current patients the revised notice. We will not use or share your health information without your authorization, except as described in this notice.
For More Information or to Report a Problem
If you believe your privacy rights have been violated, you can file a complaint with Community Hospice and with the Secretary of Health and Human Services. No retaliation will be made for filing a complaint.
Sandy Zerkle, RN, Chief Quality & Compliance Officer
Community Hospice, Inc.
1480 Carter Avenue
Ashland, KY 41101
Phone: 606-329-1890 or 800-926-6184
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. Community Hospice, Inc. may use your health information to coordinate care within Community Hospice, Inc. and with others involved in your care, such as your attending physician, members of the Community Hospice interdisciplinary team and other health care professionals who have agreed to assist Community Hospice in coordinating care. For example, physicians involved in your care will need information about your symptoms in order to prescribe appropriate medications. Community Hospice, Inc. also may disclose your health care information to individuals outside of Community Hospice, Inc. 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. Community Hospice, Inc. may include your health information in invoices to collect payment from third parties for the care you may receive from Community Hospice, Inc. For example, Community Hospice, Inc. may be required by your health insurer to provide information regarding your health care status so that the insurer will reimburse you or Community Hospice, Inc. Community Hospice, Inc. 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. We must agree to your request to restrict disclosure of protected health information to a health plan if the information pertains solely to a healthcare item or service for which you have paid Community Hospice in full
To Conduct Health Care Operations. Community Hospice, Inc. 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 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.
- Bereavement activities and services.
For example, Community Hospice, Inc. 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 Community 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).
Community Hospice, Inc. may disclose certain information about you including your name, your general health status, your religious affiliation and where you are in the Hospice facility in a Hospice directory while you are in the Hospice Inpatient Facility. Community Hospice, Inc. may disclose this information to people who ask for you by name. Please inform us if you do not want your information to be included in the directory.
For Fundraising Activities. Community Hospice, Inc. may use information about you including your name, in order to send mailings, such as newsletters, event notifications and fundraising activities to raise money for Community Hospice, Inc. You have the right to opt out of receiving such communications. Community Hospice will not disclose your protected health information in exchange for remuneration without your authorization. Your information will not be released to a third party that intends to market products or services to you.
Federal privacy rules allow Community Hospice, Inc. to use or disclose your health information without your consent or authorization for a number of reasons:
When Legally Required. Community Hospice, Inc. 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. Community Hospice, Inc. 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. Community Hospice, Inc. is allowed to notify government authorities if the Hospice believes a patient is the victim of abuse, neglect or domestic violence. Community Hospice, Inc. 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. Community Hospice, Inc. may disclose your health information to a health oversight agency for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action. Community Hospice, Inc., 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. Community Hospice, Inc. 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 Community Hospice, Inc. makes reasonable efforts to either notify you about the request or to obtain an order protecting your health information.
For Law Enforcement Purposes. Community Hospice, Inc. 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 Community Hospice, Inc. 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. Community Hospice, Inc. 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. Community Hospice, Inc. 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, Community Hospice, Inc. may disclose your health information prior to and in reasonable anticipation, of your death.
For Organ, Eye Or Tissue Donation. Community Hospice, Inc. 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. Community Hospice, Inc. may, under very select circumstances, use your health information for research. Before Community Hospice, Inc. discloses any of your health information for such research purposes, the project will be subject to an extensive approval process. Community Hospice, Inc. 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. Community Hospice, Inc. may, consistent with applicable law and ethical standards of conduct, disclose your health information if Community Hospice, Inc., 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 Community Hospice, Inc. 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. Community Hospice, Inc. may release your health information for worker's compensation or similar programs.
AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION
Other than is stated above, Community Hospice, Inc. will not disclose your health information other than with your written authorization. If you or your representative authorizes Community Hospice, Inc. 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 Community Hospice, Inc. 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 Community Hospice, Inc.'s disclosure of your health information to someone who is involved in your care or the payment of your care. However, Community Hospice, Inc. is not required to agree to your request. If you wish to make a request for restrictions, please contact Community Hospice, Inc.
Right to receive confidential communications. You have the right to request that Community Hospice, Inc. communicate with you in a certain way. For example, you may ask that Community Hospice, Inc. 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 Community Hospice, Inc. Community Hospice, Inc. 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 Community Hospice, Inc. If you request a copy of your health information, Community Hospice, Inc. 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 Community Hospice, Inc. amend the records. That request may be made as long as the information is maintained by the Community Hospice, Inc. A request for an amendment of records must be made in writing to Community Hospice, Inc. Community Hospice, Inc. 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 Community Hospice, Inc., if the records you are requesting are not part of Community Hospice, Inc.'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 Community Hospice, Inc., 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 Community Hospice, Inc. for any reason other than for treatment, payment or health operations. The request for an accounting must be made in writing to Community Hospice, Inc. 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. Community Hospice, Inc. 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 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 Community Hospice, Inc.
DUTIES OF COMMUNITY HOSPICE, INC.
Community Hospice, Inc. 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. Community Hospice, Inc. is required to abide by terms of this Notice as may be amended from time to time. Community Hospice, Inc. 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 Community Hospice, Inc. changes its Notice, Community Hospice, Inc. 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 Community Hospice, Inc. 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 Community Hospice, Inc. should be made in writing to Community Hospice, Inc. Community Hospice, Inc. 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.
More Information
Any uses and disclosures other than those permitted in this notice will be made only with your written authorization. Community Hospice is not required to agree to a requested restriction; however, once your request has been process, it will remain in effect until you request a change. If you wish to exercise any of your rights about personal health information, please contact:
Sandy Zerkle, RN, Chief Quality & Compliance Officer
Community Hospice, Inc.
1480 Carter Avenue
Ashland, KY 41101
Phone: 606-329-1890 or 800-926-6184
EFFECTIVE DATE
This Notice is effective August 21, 2013.
