THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION BY LAW MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS YOUR INFORMATION. PLEASE REVIEW IT CAREFULLY.
High Desert Hospice LLC (HDH) may use your Protected Health Information (PHI) as defined in the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) for purposes of providing you treatment, obtaining payment for your care and conducting health care operations. Other uses of your health information may be used or disclosed only after HDH has obtained your written consent. HDH has established a policy to guard against unnecessary disclosure of your Protected Health Information (PHI).
THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES AND PURPOSES FOR WHICH YOUR PHI MAY BE USED AND DISCLOSED.
To Provide Treatment:
HDH may use your medical information to coordinate care within and with others involved in your care; this can include your attending physician, members of HDH interdisciplinary team and other health care professionals who have agreed to assist HDH in coordinating your care. For example; physicians involved in your care will need information about your symptoms in order to prescribe appropriate medications. HDH also disclose your health care information to individuals outside of HDH involved in your care including authorized family members, caregivers, pharmacists, suppliers of medical equipment, other health care professionals that HDH uses in order to coordinate your care and clergy whom you have designated.
To Obtain Payment:
HDH may include your PHI in invoices to collect payment from third parties for the care you may receive from hospice, for example: HDH may be required by your health insurer to provide information regarding your health care status so that the insurer will reimburse you or HDH. HDH 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:
HDH may use and/or disclose your health information for its own operations in order to facilitate the function of the hospice as necessary to provide quality care to all of the hospice’s patients. Healthcare operations includes such activities as:
Quality assessment and improvement processes.
Process improvements designed to improve healthcare and/or reduce healthcare costs.
Protocol development, case management and care coordination.
Contacting health care individuals in regards to information concerning 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 healthcare learn under supervision.
Training of non-healthcare professionals.
Accreditation, certification, licensing or credentialing activities.
Review and auditing, including compliance reviews, legal services and compliance programs.
Business planning and development, including cost management and planning related to analysis and formulary development.
Business management and general administrative activities of HDH.
Fundraising for the benefit of HDH and certain marketing activities.
For example: HDH may use your PHI to evaluate its staffs performance, combined with your de-identified health information with other HDH patients in evaluating how to more effectively serve all hospice patients, disclose your PHI to hospice staff and contracted personnel for training purposes, use your PHI 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.
For Fundraising Activities:
HDH may use information about you including your name, address, phone number and the dates you received care at HDH in order to contact you or your family regarding fundraising activities and mailings to raise money for the High Desert Hospice Foundation. If you do not want you or your family to be contacted please notify the Administrative Director @ (541) 882-1636 and indicate you do not want to be contacted.
For Appointment Reminders:
HDH may use disclosed information to contact you as a reminder that you have an appointment for a home visit one or more of the interdisciplinary team members (nurse, hospice aide, spiritual counselor, volunteer and/or social worker).
For Treatment Alternatives:
HDH may disclose and/or use your health information to tell you about or recommend comfort treatment options or alternatives that may be of interest to you.
Federal privacy rules allow High Desert Hospice to use or disclose your Protected Health Information without your consent or authorization for a number of reasons:
When Legally Required:
HDH will disclose your PHI when it is required to do so by and Federal, State or Local law.
When There Are Risks to Public Health:
HDH may disclose your PHI for public activities and purposes in order to:
Prevention or control of a disease, injury or disability, reportable diseases, injury, sentinel events such as death and the conduct of public health surveillance, investigations and interventions.
Report adverse events, product defects, to track product recalls, repairs and replacements and compliance with requirements of the Food and Drug Administration.
Notification of a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease.
Notify an employer about an individual who is a member of the workforce as legally required.
To Reporting Abuse, Neglect or Domestic Violence:
HDH is allowed to notify government authorities if a hospice patient is believed to be a victim of abuse, neglect or domestic violence. HDH will disclose this only when specifically required or authorized by law or if the patient agrees to the disclosure.
To Conducting Health Oversight Activities:
HDH may disclose your PHI to a health oversight agency for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary actions. However HDH may not disclose information if you are being investigated and your health information is not directly related to your receipt of health care or public benefits.
In Connection With Judicial and Administrative Proceeding:
HDH may disclose your PHI in the course of any judicial or administrative proceeding in response to an order of the 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 HDH makes reasonable efforts to either notify you about the request or to obtain an order to protect your PHI.
For Law Enforcement Purposes:
As required by State and/or Federal law HDH may disclose your health information to a law enforcement official for certain 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 purposes 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 HDH has a suspicion that your death was the result of criminal conduct including criminal conduct at HDH.
In an emergency in order to report a crime.
To Coroners/Medical Examiners:
HDH may disclose your PHI to coroners and medical examiners for purposes of determining your cause of death or for other duties as authorized by law.
To Funeral Directors:
HDH may disclose your PHI to funeral directors consistent with applicable law and if necessary, to carry out their duties with respect to your funeral arrangements prior to and in reasonable anticipation of your death.
For Organ/Eye/Tissue Donation:
HDH may use or disclose your PHI to organ procurement organizations or other entities engaged in the procurement, banking or transportation of organs, eyes, or tissue for the purpose of facilitating the donation and transplantation.
For Research Purposes:
HDH may, under very select circumstances, use your PHI for research. Before HDH discloses any of your PHI for such research purposes, the project will be subject to an extensive approval process. HDH will ask your permission if any researcher will be granted access to your PHI information.
In the Event of a Serious Threat to Health or Safety:
HDH may, consistent with applicable law and ethical standards of conduct, disclose your PHI if HDH , in good faith, believe that such disclosure is necessary to prevent or lessen a serious and/or imminent threat to your health, safety or to the health and safety of the public.
For Specified Government Functions:
In certain circumstances Federal regulations authorized HDH to use or disclose your PHI to facilitate specified government functions relating to military, veterans, national security, intelligence activities and protective services for the President and others, medical suitability determinations, inmates and law enforcement custody.
For Workers Compensation:
HDH may release your PHI for worker’s compensations or similar programs.
AUTHORIZATION TO USE OR DISCLOSE PROTECTED HEALTH INFORMATION
Other than is stated above, HDH will not disclose your health information other than with your written authorization. If you or your representative authorizes HDH to use and/or disclose PHI, you may revoke that authorization in writing any time.
YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
You have the following rights regarding your PHI that HDH maintains:
The Right to Request Restrictions:
You may request restrictions and limits on certain uses and disclosures of your PHI. You have the right to request a limit on HDH’s disclosure of your PHI to someone who is involved in your care and/or the payment of your care. However, HDH is not required to agree to your request. If you wish to make a request for restrictions, please contact Jan Florez, HDH’s Privacy Officer @ (541) 882-1636.
The Right to Receive Confidential Communications:
You have the right to request that HDH communicate with you in a certain way. For example; you may ask that HDH only conduct communications pertaining to your PHI with you privately with no other family members present. If you wish to receive confidential communications, please contact Jan Florez, Privacy Officer @ (541) 882-1636. HDH will not request that you provide any reasons for your request and will attempt to honor your reasonable requests for confidential communications.
The Right to Inspect and Copy Your PHI:
You have the right to inspect and copy your PHI, including billing records. A request to inspect and copy records containing your health information may be made to Jan Florez, Privacy Officer. If your request a copy of your PHI HDH may charge a reasonable fee for copying and assembling costs associated with your request.
The Right to Amend Your PHI:
If you and/or believe that your medical records are incorrect or incomplete, you may request that HDH amend the records. That request may be made as long as the information is maintained and was created by HDH. A request for an amendment of your records must be made in writing to Jan Florez, Privacy Officer @ (541) 882-1636. HDH may deny the request if it is not in writing or does not include a reason for the amendments. The request also may be denied if your medical records were not created by HDH, if the records you are requesting are not part of HDH records, if the PHI you wish to amend is not part of the medical record you and/or your representative are permitted to inspect and copy, or if in the opinion of HDH, the records containing your PHI are accurate and complete.
The Right to an Accounting:
You and/or your representative have the right to request an accounting of disclosures of your PHI made by HDH for any reason other than for treatment, payment or healthcare operations. The request for an accounting must be made in writing to Jan Florez, Privacy Officer. The request should specify the time period for the accounting starting after February 7, 2005. Accounting requests may not be made for periods of time in excess of six (6) years. HDH will provide the first accounting to you during any Twelve Mont Period (Contact the Administrative Director @ 2894 Greensprings Dr. Klamath Falls, Oregon 97601. The request will need to be in writing with the) month period without charge. Subsequent accounting requests may be subject to a reasonable cost-based fee.
The right to Revoke Use and Disclosure of Your PHI:
You and/or your representative have the right to revoke at any time in writing previously granted use and disclosure of PHI to specific persons. You may contact our Privacy Officer, Jan Florez @ (541) 882-1636.
The Right to a Paper Copy of This Notice:
You and/or your representative have a right to a separate paper copy of this Notice of Privacy Practices at any time even if you and/or your representative have received this Notice previously. To obtain a separate paper copy please contact Jan Florez, Privacy Officer @ (541) 882-1636.
DUTIES OF HIGH DESERT HOSPICE LLC
HDH is required by law to protect and maintain the privacy of your PHI and to provide you and/or your representative this Notice explaining its duties and privacy practices. HDH is required to abide by the terms of this Notice and may amend from time to time. If HDH amends this Notice you and/or your representative will be provided with the new Notice.
You and/or your appointed representative have the right to express concerns to HDH and to the Secretary of Department of Human and Health Services (DHHS) if you believe your rights have been violated. HDH does request you present your concerns/complaints in writing so records can be kept regarding these issues. HDH forbids retaliation against anyone who files such complaints.
The HDH contact person for all issues regarding patient privacy and your right under the Federal Standard for HIPAA (Healthcare Information Portability and Accountability Act) is:
Our New Address:
High Desert Hospice
The U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Toll Free: 1-877-696-6775