HIPAA Notice



Hospice of Northwest Ohio has established policies to guard against unnecessary disclosure of your protected health information.  As defined in the HIPAA Final Rule, 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.  Business Associates who perform functions on behalf of Hospice using your protected health information are also required to comply with HIPAA privacy regulations.


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, your designated clergy, pharmacists, suppliers of medical equipment and other health care professionals.
  • All individuals providing your care need specific portions of your health information to provide their services for you.  For example, your physicians and nurses need to know your allergies in order to prescribe appropriate and safe medications.
  • Hospice shares your health information to coordinate your care when you transfer between your home, Hospice Inpatient Centers, contracted nursing facilities, contracted hospitals and other providers.

To Obtain Payment

  • Your health information may be included with billing to your insurance company, Medicare and/or Medicaid in order for Hospice to be reimbursed for our services provided to you.
  • Hospice may be required to obtain prior approval for your admission and to explain your need for hospicecare to your insurance company. 

To Conduct Health Care Operations

  • To provide the highest quality of care to you and all our patients, Hospice uses your protected healthinformation to conduct our internal operations, including:  staff training, quality improvement studies,accreditation surveys, certification, licensure audits and business planning.  For example, Hospice may use your medical record to evaluate staff documentation or to train new staff members.
  • 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 the annual Hospice Memorial Service and fundraising materials.  You and your family may remove your names from our mailing list for all or specific mailings by calling Hospice at 419-661-4001.  Mailings can be resumed at your request by calling the same number.
  • Hospice and our Business Associates will not sell your name or health information without your permission. 

When Legally Required by federal, state and/or local laws.

When There Are Risks to Public Health to prevent/control/report disease, injury, disability or death; to facilitate public health surveillance, investigations and interventions; to notify persons who have been exposed to a communicable disease; to notify an employer about a member of the workforce; and to report adverse reactions and product defects, as required by the Food and Drug Administration.

To Report Abuse, Neglect and Domestic Violence when the patient is the victim, as required by law, or when the patient agrees to the disclosure.

To Conduct Health Oversight Activities for audits, civil or criminal investigations, inspections, licensure or disciplinary action.  

In Connection with Judicial and Administrative Proceedings to respond to subpoenas, discovery requests or other lawful process.  Hospice will make a reasonable attempt 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 physical injuries as required by court order, warrant, subpoena or summons; to identify or locate a suspect, fugitive, material witness or missing person; to report a crime in an emergency; 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 Coroners and Medical Examiners to determine the cause of death or as authorized by law.

To Funeral Directors and Crematories to facilitate final arrangements.

For Organ, Eye or Tissue Donation to procurement organizations, to facilitate donation and transplant.

In the Event of a Serious Threat to Health and Safety, when Hospice believes disclosure is necessary to prevent or lessen an imminent threat to your health and safety, or to public health and safety, consistent with the law and ethical standards of conduct.

For Specific Government Functions related to the military, veterans, national security, intelligence activities, Presidential protection, medical suitability, inmates and law enforcement custody, to facilitate specific government functions, as authorized by federal regulations.

For Worker’s Compensation and Similar Programs.



  • For purposes other than those stated above, including:  to obtain HIV, psych, drug and alcohol treatment   records from a previous provider; to obtain records from the Veterans’ Administration (VA); to disclose copies of medical records from Hospice; to have FMLA, life insurance or long-term care insurance forms and absence letters completed by Hospice; to participate in research studies and product trials; to receive marketing materials; to permit the sale of your name or information; to film a Memory Gift Video.
  • You will be expected to sign the separate, specific written authorization permitting use/disclosure of your health information if you are able to do so; your legal representative may sign when you become unable.



Federal law guarantees specific rights regarding protected health information to all patients.  Please speak with your Hospice nurse or counselor to exercise the following rights:

Right to receive confidential communications.  You may ask Hospice staff to communicate with you in a certain way.  For example, you want Hospice to discuss your care with you and your spouse, without children present.  You do not need to give a reason for the request.  Hospice honors reasonable requests or works with you to find a mutually satisfactory alternative when necessary. 

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 you or your family may request a copy at any time.  The Notice is also posted in our Inpatient Centers.

Right to request restrictions on certain uses and disclosures of your protected health information.  For example, Hospice will update family members participating in your care on your condition unless you restrict us from doing so.  You may restrict the information we share and the persons with whom we share it.  Hospice honors your restrictions if possible, or reaches an alternative solution agreeable to both you and Hospice.

Right to restrict disclosures to your insurance company. Payers may request documentation containing protected health information unless you restrict it, such as when you pay for services in full out-of-pocket. 

Right to inspect and obtain copies of your protected health information.  You may request a meeting to view and discuss your Hospice health information. You may request copies of your Hospice record and the billing record.  The first copy of your records is free to you or your legal representative and a reasonable fee is charged for additional copies.  Electronic records may be requested in electronic format. If Hospice is unable to fulfill this request, copies will be provided in a format agreeable to you and to Hospice.

Right to amend health care information.  If you believe your Hospice record is incorrect or incomplete, you may request to amend it.  Make your request in writing and include the reason for the amendment.  Hospice may deny the request if these conditions are not met.

Right to an accounting of disclosures.  Reportable disclosures include those for public purposes authorized by law and those for purposes other than treatment, payment and internal operations.  Written requests are required, specifying the time period after 4/13/03, limited to a six-year timeframe.  The first accounting during any 12-month period is free of cost, with a reasonable fee charged for subsequent requests.

Right to express complaints about violations of your privacy rights.  Please inform Hospice in writing if you believe your protected health information was used or disclosed improperly.  Our Privacy Officer will promptly investigate your concerns.  You may also contact the Department of Health and Human Services to register a complaint.  Your hospice care will not be negatively affected in any way for filing a complaint.

Right to be notified when your health information is used or disclosed improperly.  If Hospice discovers that your protected health information was not properly secured and was used or disclosed inappropriately, you will be immediately notified in writing. 



Hospice of Northwest Ohio is required by federal law to maintain the privacy of your protected health information and to abide by the terms of this Notice.  Hospice maintains the privacy of your protected health information for 50 years after death/discharge.  The Notice may be changed by federal law and Hospice policies.  Active patients will receive a revised copy identifying all changes whenever revisions are made.



Please address your questions and privacy concerns to the Hospice Privacy Officer, Hospice of Northwest Ohio, 30000 East River Rd., Perrysburg, OH 43551, phone 419-661-4001.





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