USE AND DISCLOSURE OF HEALTH INFORMATION
Mountain Valley Hospice
may use your health information for purposes of providing you treatment,
obtaining payment for your care and conducting health care operations.
Your health information may be used or disclosed only after the Hospice
has obtained your written consent. The Hospice has established a policy
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 AFTER YOU HAVE PROVIDED YOUR WRITTEN CONSENT:
To Provide
Treatment. Hospice may use your health information to coordinate
care within the Hospice and with others involved in your care, such as you
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 whom you’ve designated, pharmacists, suppliers of
medical equipment or other health care professionals that the Hospice uses
in order to coordinate your care.
To Obtain Payment.
The Hospice may include your health information in invoices to collect
payment from third parties for the care you may 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.
To Conduct Health
Care Options. The Hospice 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’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 analysis and formulary development.
- Business management and general administrative activities of the
Hospice.
- Fundraising for
the benefit of the Hospice and certain marketing activities.
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.
The hospice may use information about you including your name, address,
phone number and the dates you received care at the Hospice 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 notify
Mountain Valley Hospice and indicate that you do not wish to be contacted.
Federal privacy rules allow the Hospice to use or
disclose your health information without your consent or authorization for
a number of reasons:
- 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:
a
Prevent or control disease, injury or disability, report
disease, injury, vial events such as birth or death and the conduct of
public health surveillance, investigations and interventions.
a
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.
a
To notify a person who has been exposed to a communicable
disease or who may be at risk of contracting or spreading a disease.
a
To an employer about an individual who is a member of the
workforce as legally required.
To 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.
To Conduct Health Oversight Activities.
The Hospice may disclose your health information to a health oversight
agency for activities including audits, civil administrative or criminal
investigation, inspections, licensure or disciplinary action. The
Hospice, however, may not disclose your health information in 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. The
Hospice 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 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 the 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 as
consistent with your wishes.
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. The Hospice 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. 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 you or
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
determination and inmates and law enforcement custody.
For
Worker’s Compensation.
The Hospice may release your health information for worker’s compensation
or similar programs.
AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION
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.
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 the Hospice is not required
to agree to your request. If you wish to make a request for
restrictions, please contact Mountain Valley Hospice.
- 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 communication please contact
Mountain Valley Hospice. The Hospice will not request that you provide any
reasons for your request and will attempt to honor your reasonable
request 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 Mountain Valley Hospice. If you request a copy of your health information, the
Hospice may charge at a reasonable fee for copying and assembling costs
associated with your request.
- 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 any reason other than
for treatment, payment or health operations. The request for an
accounting must be made in writing to Mountain Valley Hospice. 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. The Hospice 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 has 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
Mountain Valley Hospice.
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
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 Health and Human Services if you or your
representative believe that your privacy rights have been violated. Any
complaints to the Hospice should be made in writing to Mountain Valley Hospice.
The Hospice 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.
CONTACT PERSON
The Hospice’s contact person for all issues regarding
patient privacy and your rights under the Federal privacy standard is
Mountain Valley Hospice – 108 Steele Avenue, Gloversville, NY 12078 – (518)
725-4545.
IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE
PLEASE CONTACT Mountain Valley Hospice. |
