NOTICE OF HOSPICE PRIVACY PRACTICES

USE AND DISCLOSURE OF HEALTH INFORMATION

Hospice of the West may use your health information, information that constitutes protected health information as defined in the Privacy Rule of the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996, for purposes of providing you treatment, obtaining payment for your care and conducting health care operations.  Hospice of the West has established policies 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:

To Provide Treatment  Hospice of the West may use your health information to coordinate care within the hospice and with others involved in your care, such as your attending physician, members of the Hospice of the West interdisciplinary team and other health care professionals who have agreed to assist Hospice of the West in coordinating your care.  Hospice of the West may also disclose your health care information to individuals outside of the hospice involved in your care including family members, clergy who you have designated, pharmacists, suppliers of medical equipment or other health care professionals.

To Obtain Payment  Hospice of the West may include your health information in invoices to collect payment from third parties for the care you receive from our hospice.  Hospice of the West may also 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 Operations  Hospice of the West may use and disclose health 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.  A health care operation 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 analyses and formulary development.
  • Business management and general administrative activities of the hospice.
  • Release of  information to a foundation for special funding.

To Report Abuse, Neglect or Domestic Violence  Hospice of the West is allowed to notify government authorities if the hospice believes a patient is the victim of abuse, neglect or domestic violence.  Hospice of the West 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 West may disclose your health information to a health oversight hospice for activities including oversight care, audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action.  Hospice of the West, however, may not disclose your health information if you are the subject of an investigation and your health information is not directly related to the investigation.

In Connection with Judicial and Administrative Proceedings  Hospice of the West 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  Hospice of the West will disclose your health information when it is required to do so by any Federal, State or local law for certain 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 a 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  Hospice of the West 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 West 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.  If  necessary to carry out their duties, Hospice of the West may disclose your health information prior to and in reasonable anticipation of your death.

AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION

Other than what is stated above, Hospice of the West will not disclose your health information without 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 Hospice of the West maintains:

  • Right to Receive Confidential Communications.  You have the right to request that the hospice communicate pertaining to your health information with you privately and with no other family members present.  Hospice of the West 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 copy your health information, including billing records.

Duties of the Hospice

Hospice of the West 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.  Hospice of the West is required to abide by the terms of this Notice as may be amended from time to time.  Hospice of the West 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 Hospice of the West changes its Notice, the hospice will provide a copy of the revised Notice to you or your appointed representative.  You or your personal representatives have the right to express complaints to Hospice of the West if you or your representatives believe that your privacy rights have been violated.

CONTACT PERSON

Hospice of the West has designated the Administrator as its contact person for all issues regarding patient privacy and your rights under the Federal privacy standards.  You may contact the Administrator at Hospice of the West, 21410 N 19th Ave, Suite 100, Phoenix, AZ 85027 or by phone at 602-343-6422.

EFFECTIVE DATE

This notice is effective August 1, 2010.