Privacy Statement
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.
Stein Hospice 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 and hospital hospice beds
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 Stein Hospice, please call 419-625-5269.)
For Fundraising Activites (as a non-profit charitable organization, Stein Hospice has a statutory obligation to obtain public support).
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 restrictions.
When Legally Required by federal, state and/or local laws
When There Are Risks to Public Health
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.
You have specific rights regarding your health information maintained by Stein Hospice. 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 inspect and obtain copies of your health information, including billing records. Hospice may charge a reasonable fee for copying costs.
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
Stein Hospice 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
Stein Hospice
1200 Sycamore Line
Sandusky, OH 44870
419-625-5269
EFFECTIVE DATE APRIL 14, 2003