HOSPICE OF WASHINGTON COUNTY, INC.
NOTICE OF 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.
Hospice of Washington County, Inc. takes the privacy of your health information seriously. The Hospice is required by law to maintain the privacy and to provide you with the Notice of Privacy Practices. This Notice is provided to tell you about our duties and practices with respect to your information. The Hospice is required to abide by the terms of this Notice as are currently in effect.
USE AND DISCLOSURE OF HEALTH INFORMATION
Hospice of Washington County, Inc. may use your health information, information that constitutes protected health information as defined in the Privacy Rule of the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996, for purposes of providing you treatment, obtaining payment for your care and conducting health care operations. Hospice of Washington County, Inc. has established policies 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. Hospice of Washington County, Inc. 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 Hospice of Washington County, Inc. in coordinating care. For example, physicians involved in your care will need information about your symptoms in order to prescribe appropriate medications. Hospice of Washington County, Inc. also may disclose your health care information to individuals outside of the Hospice involved in your care including family members, other relatives, close personal friends and clergy who you have designated, pharmacists, suppliers of medical equipment or other health care professionals.
To Obtain Payment. Hospice of Washington County, Inc. may disclose your health information to receive payment for the care you receive from the Hospice. For example, Hospice of Washington County, Inc. may be required by your health insurer to provide information regarding your health care status, your need for care and the care that the Hospice intends to provide so that the insurer will reimburse you or the Hospice.
To Conduct Health Care Operations. Hospice of Washington County, Inc. may use and disclose health 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 Hospice.
Fundraising for the benefit of Hospice.
For example, Hospice of Washington County, 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 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 as part of general fundraising and community information mailings (unless you tell us you do not want to be contacted).
For Fundraising Activities. Hospice of Washington County, Inc. may use information about you including your name, address, phone number and the dates you received care in order to contact you or your family to raise money for the Hospice. Hospice of Washington County, Inc. may also release this information to a related Hospice foundation. If you do not want the Hospice to contact you or your family, please call the Executive Director at (319) 653-7321.
For Appointment Reminders. Hospice of Washington County, Inc. may use and disclose your health information to contact you as a reminder that you have an appointment for a home visit.
For Treatment Alternatives. Hospice of Washington County, Inc. may use and disclose your health information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY ALSO BE USED AND DISCLOSED.
When Legally Required. Hospice of Washington County 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. Hospice of Washington County, 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.
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
Notify an employer about an individual who is a member of the workforce as legally required.
To Report Abuse, Neglect Or Domestic Violence. Hospice of Washington County, Inc. is allowed to notify government authorities if the Hospice believes a patient is the victim of abuse, neglect or domestic violence. Hospice of Washington County, 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. Hospice of Washington County, Inc. may disclose your health information to a health oversight hospice for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action. Hospice of Washington County, Inc., however, may not disclose your health information if your are the subject of an investigation and your health information in not directly related to your receipt of health care or public benefits.
Judicial and Administrative Proceedings. Hospice of Washington County, 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 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. As permitted or required by State law, Hospice of Washington County, Inc. may disclose your health information to a law enforcement official for certain 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. Hospice of Washington County, 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. Hospice of Washington County, 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, the Hospice may disclose your health information prior to and in reasonable anticipation of your death.
For Organ, Eye or Tissue Donation. Hospice of Washington County, 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.
Research Purposes. Hospice of Washington County, Inc. may, under certain circumstances, use and disclose your health information for research purposes. Before the Hospice discloses any of your health information for research purposes, the project will be subject to an extensive approval process. This process includes evaluating a proposed research project and its use of health information and trying to balance the research needs with your need for privacy. Before the Hospice uses or discloses health information for research, the project will have bee approved through this research approval process. Additionally, when it is necessary for research purposes and so long as the health information does not leave the Hospice, it may disclose your health information to researchers preparing to conduct a research project, for example, to help the researchers look for individuals with specific health needs. Lastly, if certain criteria are met, the Hospice may disclose your heal information to researchers after your death when it is necessary for research purposes.
Limited Data Set. Hospice of Washington County, Inc. may use or disclose a limited data set of your health information, that is, a subset of your health information for which all identifying information has been removed, for purposes of research, public health, or health care operations. Prior to our release, any recipient of that limited data set must agree to appropriately safeguard your health information.
In the Event of A Serious Threat to Health Or Safety. Hospice of Washington County, Inc. 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. Hospice of Washington County, 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, Hospice of Washington County, Inc. 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. If you revoke your authorization, the Hospice will no longer use or disclose health information about you for the reasons covered by your written authorization, except to the extent that the Hospice has taken action in reliance thereon. You understand that the Hospice is unable to take back any disclosures it has already made under the authorization, and that the Hospice is required to retain our records of the care that it has provided you.
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, Hospice of Washington County, Inc. is not required to agree to your request, unless your request is for a restriction on a disclosure to a health plan for purposes of payment or health care operations (and is not for purposes of treatment) and the medical information you are requesting to be restricted from disclosure pertains solely to a health care item or service for which you had paid out of pocket in full. If you wish to make a request for restrictions, please contact the Executive Director.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 Executive Director at (319) 653-7321.
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 Social Worker or the Executive Director at (319) 653-7321.If you request a copy of your health information, Hospice of Washington County, Inc. may charge a reasonable fee for copying and assembling costs associated with your request.You have the right to request that the Hospice provide you, and entity or a Designated individual with an electronic copy of your electronic health record containing your health information, if the Hospice uses or maintains electronic health records containing patient health information. The Hospice may require you to pay the labor costs incurred by the Hospice in responding to your request.
Right to amend health care information. You or your representative have the right to request that Hospice of Washington County, Inc. amend your records, if you believe that your health information is incorrect or incomplete. 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 at 948 E. 11th Street, Washington, Iowa, 52353. 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 Hospice of Washington County, Inc. for certain reasons, including reasons related to public purposes authorized by law. The request for an accounting must be made in writing to Executive Director at 948 E. 11th Street, Washington, Iowa 53253. 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 (6) years. Hospice of Washington County, Inc. would provide the first accounting your 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 Executive Director at (319) 653-7321.
DUTIES OF THE HOSPICE
Hospice of Washington County, 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. Hospice of Washington County, Inc. is required to abide by the terms of this Notice as may be amended from time to time. Hospice of Washington County, Inc. reserves the right to change their 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 your or your appointed representative.
COMPLAINTS You or your personal representative have the right to express complaints to the Hospice and to the Secretary of DHHS 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 at 948 E. 11th Street, Washington, Iowa, 52353. Hospice of Washington County, 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.
Hospice of Washington County has designated the Executive Director as its contact person for all issues regarding patient privacy and your rights under the Federal privacy standards. You may contact this person at 948 E. 11th Street, Washington, Iowa, 52353 or call (319) 653-7321.
This Notice is effective April 16, 2013.
IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT
948 E. 11th Street
Washington, Iowa 52353