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
Houston Hospice 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. The Hospice 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. The Hospice 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
interdisciplinary team and other health care professionals who have agreed
to assist the Hospice in coordinating care. For example, physicians
involved in your care will need information about your symptoms in order
to prescribe appropriate medications. The Hospice also may 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. The Hospice may include your health
information in invoices to collect payment from third parties for the care
you receive from the Hospice. For example, the Hospice may be required by
your health insurer to provide information regarding your health care
status so that the insurer will reimburse you or the Hospice. The Hospice
also 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.
To Conduct Health Care Operations. The Hospice 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 Hospices patients. Health care operations 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.
Professional review and performance evaluation.
Contacting health care providers and patients with information about treatment alternatives and other
related functions that do not include treatment.- 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.
Fundraising for the benefit of the Hospice.
For example the Hospice may use your health information to evaluate
its 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 as part of general fundraising and community information
mailings (unless you tell us you do not want to be contacted).
The Hospice may disclose certain information about you including your
name, your general health status, your religious affiliation and where you
are in the Hospice's facility in a Hospice directory. The Hospice may
disclose this information to people who ask for you by name, facilitating
mail delivery and visitation. Please inform us if you wish to remain
anonymous and do not want to have your information released by contacting
our Director of Program Integrity @ 713-467-7423.
For Fundraising Activities. The Hospice may use information
about you including your name, address, phone number and the dates you
received care in order to contact you or your family to raise money for
the Hospice. If you do not want the Hospice to contact you or your family,
notify the Development Office at 713-677-7130 or
1-800-630-7894 and indicate that you do not wish to be contacted.
For Appointment Reminders. The Hospice may use and disclose
your health information to contact you as a reminder that you have an
appointment for a home visit.
For Treatment Alternatives. The Hospice may use and disclose
your health information to tell you about or recommend possible treatment
options or alternatives that may be of
interest to you.
The following is a summary of the circumstances under which and
purposes for which your health information may also be used and disclosed.
When Legally Required. The Hospice 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. The 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, investigations and interventions.
Report adverse events or product defects; enable product
recalls, tracking, repairs and replacements; and to conduct
post-marketing surveillance and compliance with requirements of the
Food and Drug Administration.
Notify a person who has been exposed to a communicable disease
or who may be at risk of contracting or spreading a disease.
Notify an employer about an individual who is a member of the
workforce as legally required.
To Report Abuse, Neglect Or Domestic Violence. The Hospice is
obligated to notify government authorities if the Hospice believes a
patient is the victim of abuse, neglect or domestic violence. The Hospice
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. The Hospice may
disclose your health information to a health oversight agency for
activities including audits; civil, administrative or criminal
investigations; inspections; licensure or disciplinary action.
In Connection With Judicial And Administrative Proceedings. The
Hospice 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.
As permitted or required by State law, the Hospice may disclose your
health information to a law enforcement official for certain law
enforcement purposes as follows:
As required by law for reporting of certain types of wounds or
other physical injuries.
pursuant to a 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, such as 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. The Hospice 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. The Hospice 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, the Hospice may
disclose your health information prior to and in reasonable anticipation
of your death.
For Organ, Eye Or Tissue Donation. The Hospice 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. The Hospice may, under very select
circumstances, use your health information for research. Before the
Hospice discloses any of your health information for such research
purposes, the project will be subject to an extensive approval process.
In the Event of A Serious Threat To Health Or Safety. The
Hospice may, consistent with applicable law and ethical standards of
conduct, disclose your health information if the Hospice, 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,
the Federal regulations authorize the Hospice 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 in law enforcement custody.
For Worker's Compensation. The Hospice may release your health
information for worker's compensation or similar programs.
Authorization to use or disclose health information
Other than is stated above, the Hospice will not disclose your health
information other than with 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
the Hospice 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 the Hospice"s disclosure of your health information to
someone who is involved in your care or the
payment of your care. However, the Hospice is not required to agree to
your request. If you wish to make a request
for restrictions, please contact the Director of Program
Integrity at 713-467-7423 or 1-800-824-2911
Right to receive confidential communications. You
have the right to request that the Hospice communicate with you in a
certain way. For example, you may ask that the Hospice only conduct
communications pertaining to your health information with you privately
with no other family members present. If you wish to receive
confidential communications, please contact the Director of
Program Integrity at 713-467-7423 or 1-800-824-2911. The Hospice
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 obtain a copy of your health information.
You have the right to inspect and copy your health information,
including billing records. A request to inspect and copy records
containing your health information may be made to the Medical
Records Manager at 713-467-7423 or 1-800-630-7894. If you
request a copy of your health information, the Hospice may charge a
reasonable fee for copying and assembling costs associated with your
request.
Right to amend health care information. You or your
representative have the right to request that the Hospice amend your
records, if you believe that your health information is incorrect or
incomplete. That request may be made as long as the information is
maintained by the Hospice. A request for an amendment of records must be
made in writing to the Medical Records Manager at 1905 Holcombe
Blvd. Houston, TX 77030. The Hospice may deny the request if it
is not in writing or does not include a reason for the amendment. The
request also may be denied if your health information records were not
created by the Hospice, if the records you are requesting are not part
of the Hospice"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 the Hospice, 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 the Hospice for certain reasons, including reasons
related to public purposes authorized by law and certain research. The
request for an accounting must be made in writing to Medical
Records Manager at 1905 Holcombe Blvd. Houston, TX 77030.
The request should specify the time period for the accounting starting
on or after April 14, 2003. Accounting requests may not be made for
periods of time in excess of six (6) years. The Hospice would 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.
Right to a paper copy of this notice. You or your
representative 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 the
Medical Records Manager at 713-467-7423 or 1-800-630-7894.
Duties of the hospice
The Hospice 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. The Hospice is required to abide by the
terms of this Notice as may be amended from time to time. The Hospice
reserves the right to change the terms of its Notice and to make the new
Notice provisions retroactive and effective for all health information
that it maintains. If the Hospice changes its Notice while you are on
service, the Hospice will provide a copy of the revised Notice to you or
your appointed representative. You or your personal representative has the
right to express complaints to the Hospice and to the Secretary of DHHS if
you or your representative believes that your privacy rights have been
violated. Any complaints to the Hospice should be made in writing to the Director
of Program Integrity at 1905 Holcombe Blvd.,
Houston, Texas 77030-4123 or
by calling 713-467-7423 or toll free at 1-800-824-2911. The
Hospice encourages you to express any concerns you may have regarding the
privacy of your information. You will not be retaliated against in any way
for filing a complaint. You may also contact the U.S. Department of Health
and Human Services (DHHS) 200 Independence Ave. S.W., Washington, D.C.
20201, or call toll free1-877-696-6775.
Contact person
The Hospice has designated the Director of Program Integrity
as its privacy officer for all issues regarding patient privacy and your
rights under the Federal privacy standards. You may contact this person at
1905 Holcombe Blvd., Houston, Texas 77030-4123, 713-467-7423,
1-800-824-2911.
Effective date
This Notice is effective April 14, 2003.
|
