.
Hospice of the Prairie may use your health information to coordinate
care and treatment within Hospice of the Prairie and with others
involved in your care and treatment activities, such as: your
attending physician, members of Hospice of the Prairie
Interdisciplinary Team consisting of hospice physicians, social
workers, chaplains, nurses, home health aides, volunteers, or other
health care professionals who have agreed to assist Hospice of the
Prairie in coordinating your care. One example is physicians involved
in your care will need information about you to prescribe appropriate
medications. Hospice of the Prairie may disclose your health care
information to individuals outside of Hospice of the Prairie involved
in your care and treatment activities including family members,
designated clergy, pharmacists, suppliers of medical equipment, or
other health care professionals that Hospice of the Prairie uses to
coordinate your care.
To Obtain
Payment. Hospice of the Prairie may disclose your health
information to collect payment from third parties for the care you
receive from Hospice of the Prairie. For example, Hospice of the
Prairie may be required by your health insurer to provide invoices or
information regarding your health care status so that the insurer will
reimburse you or Hospice of the Prairie. Hospice of the Prairie 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. Hospice of the Prairie may also disclose
your health information to a health care provider outside of Hospice
of the Prairie for that health care provider’s payment activities.
To Conduct
Health Care Operations. Hospice of the Prairie may use and
disclose your health care information for its own operations in order
to facilitate the function of Hospice of the Prairie and as necessary
to provide quality care to all of Hospice of the Prairie patients.
Health care operations include activities such 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,
planning-related analyses, and formulary development.
- Business
management and general administrative activities of Hospice of the
Prairie.
- Fundraising
for the benefit of Hospice of the Prairie and certain marketing
activities.
Hospice of the
Prairie may disclose your health information to another health care
provider for the health care operations of that health care provider
if Hospice of the Prairie and that health care provider has or had a
relationship with you. The information disclosed will relate to that
relationship and is for very limited purposes as permitted by law.
Hospice of the
Prairie may use your health information to evaluate 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, or contact you or
your family as part of general fundraising and community information
mailings. Please inform us if you do not want to be contacted.
For Hospice of
the Prairie Directory Purposes and to Family and Friends. Hospice
of the Prairie may disclose certain information to people inquiring
about you by name, including your name, your general health status,
your location in our facility or your location while you are under our
care, or your religious affiliation. Your religious affiliation will
only be provided to members of clergy and clergy do not have to ask
for you by name. This information will be maintained in the Hospice of
the Prairie directory. Please inform us if you do not want your
information to be given to others.
For
Fundraising Activities. Hospice of the Prairie may use information
about you including your name, address, phone number, and the dates
you received care at Hospice of the Prairie in order to contact you or
your family to raise money for Hospice of the Prairie. Hospice of the
Prairie may also release this information to a related Hospice
foundation. If you do not want Hospice of the Prairie to contact you
or your family, notify the contact person identified at the end of
this document and indicate that you do not wish to be contacted.
USE AND
DISCLOSURE OF YOUR PROTECTED HEALTH INFORMATION WITHOUT YOUR
PERMISSION:
Federal
privacy rules allow Hospice of the Prairie to use or disclose your
health information without your permission or authorization for the
following reasons:
When Legally
Required. Hospice of the Prairie 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. Hospice of the Prairie may disclose your
health information for public activities and purposes in order to:
- Prevent,
control, or report disease, injury, or disability, vital events such
as birth or death, and the conduct of public health surveillance,
investigations, 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 of the Prairie is
allowed to notify government authorities if Hospice of the Prairie
believes a patient is the victim of abuse, neglect, or domestic
violence. Hospice of the Prairie 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. Hospice of the Prairie 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 the
Prairie, 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.
In Connection
With Judicial and Administrative Proceedings. Hospice of the
Prairie 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 the Prairie makes reasonable
efforts to either notify you about the request or to obtain an order
protecting your health information or as permitted by law.
For Law
Enforcement Purposes. Hospice of the Prairie may disclose your
health information to an official of the law for law enforcement
purposes as follows:
- As required
by law for reporting certain types of wounds or other physical
injuries pursuant to the court order, warrant, subpoena, 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.
- If Hospice of
the Prairie has a suspicion that your death was the result of
criminal conduct, including criminal conduct at Hospice of the
Prairie.
- In an
emergency to report a crime.
To Coroners
and Medical Examiners. Hospice of the Prairie 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. Hospice of the Prairie may disclose your health
information to funeral directors consistent with applicable law and,
if necessary, to carry out their duties with respect to your funeral
arrangements.
Hospice of the
Prairie may disclose your health information prior to and in
reasonable anticipation of your death.
For Organ,
Eye, or Tissue Donation. Hospice of the Prairie 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.
For Research
Purposes. Hospice of the Prairie may, under very select
circumstances, use your health information for research. Hospice of
the Prairie 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. Hospice of the Prairie
may, consistent with applicable law and ethical standards of conduct,
disclose your health information if Hospice of the Prairie, 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.
For Specified
Government Functions. In certain circumstances, Federal
regulations authorize Hospice of the Prairie 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 determinations, and inmates and law enforcement custody.
For Worker’s
Compensation. Hospice of the Prairie may release your health
information for worker’s compensation or similar programs.
AUTHORIZATION
TO USE OR DISCLOSE HEALTH INFORMATION
Other than
what is stated above, Hospice of the Prairie will not disclose your
health information without your written authorization. If you, or your
representative, authorize Hospice of the Prairie 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 Hospice of the
Prairie 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 disclosures of your health
information to those who are involved in your care or the payment of
your care. However, Hospice of the Prairie is not required to agree
to your request. If you do not want certain information shared with
others, you must make a request for a restriction. If you wish to
make a request for restrictions, please contact the person listed at
the end of this document.
- Right to Receive Confidential Communications by Alternative
Means or Location. You have the right to request that Hospice of
the Prairie communicate with you confidentially. For example, you
may ask that Hospice of the Prairie only conduct communications
pertaining to your health information with you privately, with no
other family members present. If you wish to receive confidential
communications, notify the contact person listed at the end of this
document. Hospice of the Prairie will not request that you
provide any reasons for your request, and will attempt to honor your
reasonable requests for confidential communications.
- Right to Inspect and Copy Your Health Information. You have
the right to inspect and obtain a copy of your health information,
including billing records, maintained in your designated record set.
A request to inspect and copy records containing your health
information may be made to the contact person listed at the end of
this document. If you request a copy of your health information,
Hospice of the Prairie may charge a reasonable fee for copying and
assembling your health records. In certain circumstances, we may
deny your request to inspect and obtain a copy of your records.
- Right to Amend Health Care Information. If you, or your
representative, believe that your health information records are
incorrect or incomplete, you may request that Hospice of the Prairie
amend the records. That request may be made as long as the
information is maintained by Hospice of the Prairie. A request for
an amendment of records must be made in writing to the contact
person listed at the end of this document. Hospice of the Prairie
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 the
Prairie, if the records you are requesting are not part of Hospice
of the Prairie’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 and copy, or if, in the
opinion of Hospice of the Prairie, the records containing your
health information are accurate and complete.
- Right to An Accounting. You, or your representative, have
the right to request an accounting of disclosures of your health
information made by Hospice of the Prairie for any reason other than
for treatment, payment, or health operations. The request for an
accounting must be made in writing to the contact person listed at
the end of this document. The request should specify the time period
for the accounting but may not include any periods prior to April
14, 2003. Accounting requests may not be made for periods of time in
excess of six years. Hospice of the Prairie will 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. This accounting will contain only the information as
required by law.
- Right to a Paper Copy of This Notice. You, or your
representative will be provided with a copy of this notice upon
admission to Hospice of the Prairie, and also have 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 our contact person listed at the
end of this document.
You or a representative may also obtain a copy of the current
version of the Hospice of the Prairie Notice of Privacy Practices at
our website,
