HOSPICE OF MEDINA COUNTY
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 Medina County is legally required to protect the privacy of your health information. We call this information “protected health information” or “PHI” for short. Hospice of Medina County may use your health information for purposes of providing you treatment, obtaining payment for your care, conducting health care operations. Hospice of Medina County has established a policy to guard against unnecessary disclosure of your health information. We are required to abide by the terms of this notice. However, we reserve the right to change the terms and our privacy policies at any time.
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 Medina County may use your health information to coordinate care within Hospice of Medina County and with others involved in your care, such as your attending physician, members of Hospice of Medina County interdisciplinary team and other health care professionals who have agreed to assist Hospice of Medina County in coordinating care. For example, physicians involved in your care will need information about your symptoms in order to prescribe appropriate medications. Hospice of Medina County also may disclose your health care information to individuals outside of Hospice of Medina County involved in your case including family members, clergy whom you have designated, pharmacists, suppliers of medical equipment or other health care professionals that Hospice of Medina County uses in order to coordinate your care.
To Obtain Payment for Treatment. We may use and disclose your PHI in order to bill and collect payment for the treatment and services provided to you. For example, we may provide portions of your PHI to our billing department and your health plan to get paid for the health care services we provided to you. We may also provide your PHI to our business associates, such as billing companies, claims processing companies and others that process our health care claims.
To Conduct Health Care Operations. We may use and disclose health care information for our own operations in order to facilitate the function of Hospice of Medina County and as necessary to provide quality care to all of the Hospice’s patients. Health care operations include 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.
• 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 of Medina County.
For example, Hospice of Medina County may use your health information to evaluate its staff performance.
For Appointment Reminders. Hospice of Medina County 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 Medina County 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.
For Research Purposes. In certain circumstances, we may provide PHI in order to conduct medical research.
Fundraising Activities. We may use PHI to raise funds. The money raised through these activities is used to expand and support the health care services and educational programs we provide to the community.
Hospice of Medina County 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. Hospice of Medina County 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.
THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY ALSO BE USED AND DISCLOSED.
1. Public Health Activities. Hospice of Medina County may disclose your health information in order to prevent and control disease, vital events such as birth or death, to report adverse events, to track products.
2. For Specific Government Functions. We may disclose PHI of military personnel and veterans in certain situations and we may disclose PHI for national security purposes, such as protecting the President of the United States or conducting intelligence operations.
3. In the Event of a Serious Threat to Health or Safety. Hospice of Medina County may disclose your health information if Hospice of Medina County, 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.
4. For Workers’ Compensation. Hospice of Medina County may provide health information in order to comply with workers’ compensation laws.
5. To Report Abuse, Neglect, or Domestic Violence. Hospice of Medina County is required to notify government authorities if Hospice of Medina County believes a patient is the victim of abuse, neglect, or domestic violence. Hospice of Medina County will make this disclosure only when specifically required or authorized by law.
6. To Conduct Health Oversight Activities. Hospice of Medina County may disclose your health information to a health oversight agency for activities including audits civil administrative or criminal investigations, inspections, licensure, or disciplinary action. Hospice of Medina County, 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.
7. In Connection with Judicial and Administrative Proceedings. Hospice of Medina County 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 Hospice of Medina County makes reasonable efforts to either notify you about the request or to obtain protecting your health information.
8. For Law Enforcement Purposes. As permitted or required by State law, Hospice of Medina County 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 Hospice of Medina County has a suspicion that your death was the result of criminal conduct including criminal conduct of Hospice of Medina County.
• In an emergency in order to report a crime.
9. To Coroners and Medical Examiners. Hospice of Medina County may disclose your health information and medical examiners for purposes of determining your cause of death or for other duties, such as authorized by law.
10. To Funeral Directors. Hospice of Medina County may disclose your health information to 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, Hospice of Medina County may disclose your health information prior to and in reasonable anticipation of your death.
11. For Organ, Eye, or Tissue Donation. Hospice of Medina County 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 transportation.
You have the following rights regarding your health information that Hospice of Medina County maintains:
1. Right to Request Restrictions. You have the right to ask that we limit how we use and disclose your PHI. We will consider your request but are not legally required to accept it. If we accept your request, we will put any limits in writing and abide by them except in emergency situations. You may not limit the uses and disclosures that we are legally required or allowed to make. You may request a restriction by contacting our privacy officer.
2. 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 obtained by contacting our privacy officer. If you request a copy of your health information, Hospice of Medina County may charge a reasonable fee for copying and assembling costs associated with your request. We will respond to you within 30 days after receiving your written request. In certain situations, we may deny your request. If we do, we will tell you, in writing, our reasons for the denial and explain your right to have the denial reviewed.
3. Right to Get a List of the Disclosures We have Made. You have the right to get a list of the instances in which we have disclosed your PHI. The list will not include uses or disclosures that you have already consented to, such as those made for treatment, payment, or health care operations, directly to you, to your family, or in our facility directory. The list also won’t include uses and disclosures made for national security purposes, to corrections or law enforcement personnel, or before April 14, 2003. The request for an accounting must be made in writing to the privacy officer. The list will include the date of the disclosure, to whom PHI was disclosed (including their address, if known), a description of the information disclosed, and the reason for the disclosure. Accounting requests may not be made for periods of time in excess of six (6) years. Hospice of Medina County will provide the first accounting to you request during any 12-month period without charge. Subsequent accounting requests may be subject to a reasonable cost-based fee.
4. Right to Receive Confidential Communications. You have the right to request that Hospice of Medina County communicate with you in a certain way. For example, we may ask that Hospice of Medina County only conducts 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 privacy officer. Hospice of Medina County will not request that you provide any reasons for your request and will attempt to honor your reasonable request for confidential communications.
5. Right to Amend Health Care Information. You or your representative have the right to request that Hospice of Medina County amends 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 Hospice of Medina County. A request for an amendment of records must be made in writing to the privacy officer. Hospice of Medina County may deny the request if it is not in writing or does not include a reason for the amendment. The request may also be denied if your health information records were not created by Hospice of Medina County, if the records you are requesting are not part of Hospice of Medina County’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 or copy, or if, in the opinion of Hospice of Medina County, the records containing your health information are accurate and complete.
6. Right to Paper Copy of this Notice. You or your representative have a right to 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 privacy officer. The patient or a patient’s representative may also obtain a copy of the current version of Hospice of Medina County’s Notice of Privacy Practices at it’s website, www.hospiceofmedina.org
You may complain to us or to the Secretary of Health and Human Services if you believe your rights have been violated by us. You may file a complaint with us by notifying our privacy contact. We will not retaliate against you for filing a complaint.
CONTACT PERSON
Hospice of Medina County has designated the privacy officer as its contact person for all issues regarding patient privacy and your rights under the Federal privacy standards.
You may contact our Privacy Officer, Kathy Schmidt, at 330-722-4771 or kschmidt@hospiceofmedina.org for further information about the complaint process.
This notice effective April 14, 2003.
