HIPAA 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.
USE AND DISCLOSURE OF HEALTH INFORMATION
Harmony Life Hospice of Shreveport, LA may use your health information for purposes of providing treatment, obtaining payment for your care and conducting health care operations, and any other use required by law.
Treatment: We may use your health information to coordinate care within the Hospice and with others involved with your care, such as attending physician, other professionals who have agreed to assist the Hospice in coordinating care, pharmacists, and suppliers of medical supplies, family members /others whom you have designated. For example, we may discuss your health information to physicians involved in your care who may need information to prescribe the appropriate medications.
Payment: Your health information may be used, as needed, to obtain payment for your health care services, for example, obtaining approval for coverage and services, providing information to your insurer regarding your health care status.
Health Care Operations: 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 its patients. Such activities include:
- Quality Assessment and improvement activities
- Protocol development, case management and care coordination
- Contacting health care providers about alternative treatment options
- Professional review and performance evaluations
- Training/Orientation programs whereby students/interns learn under supervision
- Training of non-health care professionals
- Accreditation, certification, licensing or credentialing
- Review and auditing, compliance reviews, medical reviews, legal services
- Business management and administrative functions of the Hospice
Hospice may disclose certain information about you in a Hospice directory while you are in an inpatient facility. Please inform us if you do not want to be included in the directory.
When Legally Required: Hospice will disclose your health information when it is required to do so by Federal, State or local law.
When There Are Risks to Public Health: 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, investigation and interventions
- 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
- To notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease
- To an employer about an individual who is a member of the workforce as legally required
To Report Abuse, Neglect or Domestic Violence: Hospice is allowed to notify government authorities if the Hospice believes a patient is a victim of abuse, neglect or domestic violence. Hospice will make the disclosure only when specifically required or authorized by law or when the patient agrees to the disclosure.
We may use or disclose your health information in the following situations: as required by law, Health Oversight, Food and Drug Administration requirements, Legal Proceedings, Law Enforcement, Coroners, Funeral Directors, Organ Donation, Research, Criminal Activity, Military Activity and National Security, Worker’s Compensation, Inmates Required Uses and Disclosures. Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500.
Other Permitted and Required Uses and Disclosures: Will be made only with your consent, Authorization, or Opportunity to object required by law.
You May Revoke This Authorization: You may revoke at any time, in writing, except to the extent that Hospice has taken a reliance on the use or disclosure indicated in the authorization.
Right to inspect and copy your protected health information: Hospice may charge a reasonable fee for copying and assembling associated with your request.
Right to request restrictions: You may request restrictions on certain uses and disclosures of your health information. However, Hospice is not required to agree to your request for restrictions.
Right to receive confidential communication: You may request that Hospice communicate with you in a certain way, such as when no other family members are around.
Right to amend health care information: You have a right to ask Hospice to amend records if you feel that your health information is incorrect or incomplete. Hospice may deny the request if it does not include a reason for the amendment. The request may be denied if your health information records were not created by the Hospice, are not part of the Hospice’s records, if the health information you are requesting to amend is not part of the health information you are permitted to inspect a copy, or if, the Hospice feels the records containing your health information is accurate and complete. You then have the opportunity to file a statement of disagreement with the Hospice.
Right to an accounting: You have a right to request an accounting of disclosures of your health care information by Hospice for any reason other than treatment, payment or health operations.
We have the right to change the terms of this notice and will inform you of any changes. You then have the right to object or withdraw as provided in this notice.
Complaint: You may complain to us or the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our privacy contact of your complaints. We will not retaliate against you for filing a complaint.
We are required by law to maintain the privacy of, and provide individuals with, this notice of our legal duties and privacy practices with respect to protected health information. If you have any objections to this form, please ask to speak with our HIPAA Compliance Officer.
The following information has been added as of September 23, 2013 to the HIPPA Notice of Privacy Practices:
(Page 1 of 2) When Legally Required: We are also allowed to share your information in other ways-usually in ways that contribute to the public good. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html
(Page 2 of 2)Your Rights: Right to inspect and copy your protected health information: Hospice will provide a copy of your health information usually within 30 days of your request.
Right to request restrictions: If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
Right to amend health care information: If Hospice denies your request to amend records, we will tell you why in writing within 60 days.
Right to accounting: We will provide one accounting a year for free, but will charge a reasonable cost-based fee if you ask for another one within 12 months.
Right to choose someone to act for you: If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health care information. We will make sure this person has this authority and can act for you before we take any action.
Right to receive a copy of the privacy notice: You can ask for a paper copy of this notice anytime, even if you have agreed to receive this notice electronically. We will promptly provide you with a paper copy.
Right and choice to tell us to: Share information with your family, close friends or others involved in your care.
Right and choice to tell us to: Share information in a disaster relief situation.
Right and choice to tell us to: Include your information in a Hospice directory while you are in an inpatient facility.
We never share your information for marketing purposes or fundraising efforts and we do not sale your information.
Complaint: You may complain to Lisa Carson, R.N. email@example.com Phone:318-798-5775 or you may file a complaint with the U.S. Department of Health and Human Resources Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775 or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
Our Responsibilities: We are required by law to maintain the privacy and security of your protected health information. We will let you know promptly when a breach occurs that may have compromised the privacy or security of your information. We must follow the duties and privacy practices described in this notice and give you a copy of it. We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. For more information see: www.hhs.gov/privacy/hipaa/understanding/consumers/noticepp.html
Changes to the Terms of this Notice: We can change the terms of this notice and the changes will apply to all information we have about you. This new notice will be available upon request, in our office, and on our website.