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 Northwest Ohio has established a policy to guard against unnecessary disclosure of your health information. As defined in the Privacy Rule of the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996, Hospice may use your health information for the purposes explained below, including providing your treatment, obtaining payment for your care and conducting its health care operations.
HOSPICE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION
To Provide Treatment
- Hospice coordinates the care and treatment you receive from all providers: hospice and other physicians, nurses, aides, social workers, volunteers, family members, clergy whom you have designated, pharmacists, suppliers of medical equipment and other health care professionals.
- All individuals providing your care need to know and use specific portions of your health information to perform their services for you. For example, your physicians need to know your symptoms in order to prescribe appropriate medications.
- Hospice shares your health information as necessary to coordinate your care if you are transferred to/from your home, contracted nursing homes, hospital hospice beds and the Hospice inpatient unit.
To Obtain Payment
- Your health information may be included in invoices to collect payment for your Hospice care from insurance companies, Medicare, Medicaid and other third parties.
- Hospice may be required to obtain prior approval for admission and explain your need for hospice care to your insurance company.
- For example, your health insurance company may require Hospice to provide information regarding your health care status before paying the bill. To Conduct Health Care Operations
- To provide quality care to you and all Hospice patients, Hospice uses your health information for its own operations including: studies to improve quality of services, research studies using your record, training and evaluation programs, accreditation surveys, certification, licensure, audits and business planning.
- For example, Hospice may use your health information to evaluate its staff performance, to determine how to serve patients more effectively and to train staff members and contracted personnel.
- Hospice uses only names, addresses and dates of care to send you and/or your family:
- Hospice newsletters
- Satisfaction surveys
- Bereavement information
- Acknowledgments of memorial donations
- Invitations to annual Hospice memorial service
To decline specific mailings from Hospice of Northwest Ohio, please call 419-661-4001.
- INPATIENT UNIT ONLY: Hospice maintains a current listing of patients, their room numbers and telephone extensions in the Hospice inpatient facility, and may disclose this information to people who ask for you by name. If you do not want this basic information disclosed, you may request restrictions.
For Fundraising Activities
- Hospice may use your name, address, phone number and the dates you received care to contact you and your family as part of any fundraising activities on behalf of Hospice. If you do not want to be contacted, you may request restriction
When Legally Required by federal, state and/or local laws
When There Are Risks to Public Health
- To prevent or control disease, injury or disability
- To report disease, injury and deaths
- To facilitate public health surveillance, investigations and interventions
- To report adverse reactions and product defects, as required by the Food and Drug Administration
- To notify persons who have been exposed to a communicable disease or who may be at risk of contracting or spreading a disease
- To notify an employer about a person who is a member of the workforce, as legally required.
To Report Abuse, Neglect and Domestic Violence
- When the patient is the victim, as required or authorized by law, or when the patient agrees to the disclosure.
To Conduct Health Oversight Activities
- To health oversight agencies for audits, civil or criminal investigations, inspections, licensure or disciplinary action.
In Connection with Judicial and Administrative Proceedings
- To respond to a subpoena, discovery request or other lawful process.
- Hospice will make reasonable efforts to notify you about the request or obtain an order protecting your health information.
For Law Enforcement Purposes
- To report certain types of wounds or other physical injuries as required by court order, warrant, subpoena or summons.
- To identify or locate a suspect, fugitive, material witness or missing person.
- Under limited circumstances, when you are the victim of a crime.
- To report a death suspected to be the result of a criminal act, including criminal conduct at Hospice.
- To report a crime in an emergency
To Coroners and Medical Examiners
- To determine cause of death or for other duties as authorized by law.
To Funeral Directors
- To facilitate funeral arrangements.
For Organ, Eye or Tissue Donation
- To organ procurement organizations and entities, to facilitate donation and transplantation.
For Research Purposes
- Under very select circumstances only after extensive approval process.
In the Event of a Serious Threat to Health or Safety
- Consistent with law and ethical standards of conduct, when Hospice believes that disclosure is necessary to prevent or lessen an imminent threat to your health and safety, or to the health and safety of the public.
For Specified Government Functions
- In certain circumstances, Federal regulations authorize Hospice to use and disclose patient health information to facilitate specified government functions related to the military, veterans, national security, intelligence activities, protection of the President, medical suitability determinations, and inmates and law enforcement custody.
For Workers Compensation or Similar Programs
SEPARATE WRITTEN AUTHORIZATION REQUIRED
- For purposes other than those stated above, you or your representative must sign a separate, specific authorization permitting the use or disclosure of your health information.
- You or your representative may revoke this authorization in writing at any time.
- For example, written authorization is required before Hospice can disclose patient-specific information to an employer for a family member’s leave of absence request, and when you choose to have our volunteers create a memory gift video for your family
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
You have specific rights regarding your health information maintained by Hospice of Northwest Ohio. If you wish to exercise the following rights, please speak with your Hospice nurse:
- Right to receive confidential communications, requesting Hospice to communicate with you in a certain way. For example, you want Hospice to discuss your health information with you alone, without family members present. Hospice will not require that you provide any reasons for your request and will attempt to honor all reasonable requests.
- Right to a paper copy of this notice at any time. Every patient is given a copy of this notice at the initial Hospice visit, and may request a copy at any time. You may also view and print a copy of Hospice's Notice of Privacy Practices online at www.hospicenwo.org.
If you wish to exercise the rights below, please contact the Hospice Privacy Officer:
- Right to request restrictions on certain uses and disclosures of your health information, such as the amount of your health information disclosed to persons involved in your care or for payment of your care. Hospice is not required to honor such restrictions.
- Right to inspect and obtain copies of your health information, including billing records. Hospice may charge a reasonable fee for copying costs.
- Right to amend health care information if you believe that your records are incorrect or incomplete. Requests must include the reason for the amendment and must be made in writing. Hospice may deny the request if: it is not in writing; includes no reason; the disputed records were not created by Hospice; the records are not part of the information you are permitted to inspect and copy; or if Hospice believes the health information is accurate.
- Right to an accounting of disclosures made by Hospice for reasons other than treatment, payment or health operations. Reportable disclosures include public purposes authorized by law and certain research purposes. Requests must be made in writing, specifying the time period after the effective date of 04/13/03, limited to a six-year time span. The first accounting during any 12-month period is provided without cost, with a reasonable fee charged for subsequent requests.
- Right to express complaints about violations of your privacy rights to Hospice and to the Secretary of the Department of Health and Human Services, if you believe your health information was used or disclosed improperly. Hospice encourages you to express any concerns you may have in writing, by contacting our Privacy Officer. Your Hospice care will not be negatively affected in any way for filing a complaint.
DUTIES OF THE HOSPICE
Hospice of Northwest Ohio is required by law to:
- Maintain the privacy of your health information
- Provide you and your representative a copy of this Notice of our duties and privacy practices
- Abide by the terms of this Notice. Hospice reserves the right to change the terms of this Notice. If Hospice changes its Notice while you are an active patient, Hospice will provide you or your legal representative a copy of the revised Notice of Privacy Practices identifying the changes made.
CONTACT PERSON
If you have questions or wish to exercise your rights as explained in this Notice of Privacy Practices, please contact:
Privacy Officer
Hospice of Northwest Ohio
30000 East River Rd.
Perrysburg, OH 43551
419-661-4001
EFFECTIVE DATE APRIL 14, 2003