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NOTICE OF COLUMBUS HOSPICE, INC.
USE AND
DISCLOSURE OF HEALTH INFORMATION Columbus Hospice 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. The
Hospice has established policies to guard against unnecessary disclosure of
your health information. THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH •
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 who you have designated, pharmacists, suppliers of medical equipment or
other health care professionals. •
Obtain Payment. The Hospice
may include your health information in invoices to collect payment from third
parties for the care you 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. • Conduct
Health Care Operations. The Hospice 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:
·
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. ·
Fund-raising for the benefit of the
Hospice. 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 as part of general fund-raising and community information mailings (unless you tell us you do not want to be contacted). The Hospice may
disclose certain information about you including your name, your general
health status, your religious affiliation and where you are in the Hospice's facility in a
Hospice directory while you are in the Hospice Inpatient facility. The Hospice 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 Fund-raising Activities. The Hospice 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. 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,
THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER
WHICH 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. ·
Report adverse events, product defects, to track products
or enable product recalls, repairs and replacements and to ·
Notify a person who has been exposed to a communicable
disease or who may be at risk of contracting or spreading a ·
Notify an employer about an individual who is a member of
the workforce as legally required. •
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. •
Conduct Health
Oversight Activities. The Hospice may disclose your health information to a
health oversight hospice for activities including audits, civil administrative
or criminal investigations, inspections, licensure 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. As permitted
or required by State law, the Hospice 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, ·
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. 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. 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. 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 Performance Nurse. ·
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
the Performance Improvement Nurse at 706-569-7992. 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
the Performance Improvement Nurse at 706-569-7992. 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. You or your representative have the right to request that the
Hospice 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 the Performance Improvement
Nurse at ·
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 certain reasons, including reasons related to public
purposes authorized by law and certain research. The request for an
accounting must be made in writing to the Performance
Improvement Nurse at ·
Right to 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 Performance Improvement Nurse. 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 the 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 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 Performance Improvement Nurse at This Notice is effective
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