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
Compassionate Care Western North Carolina. (the “Hospice”) may use your health information, which is 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 medical 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, 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 received 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 care 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. Health care operations include 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 evaluations.
- 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, Hospice may use your health information to evaluate it’s 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 or 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).
For Fundraising Activities: The Hospice may use information about you including your name, address, phone number and the dates you received care at the Hospice in order to contact you or your family to raise money for the Hospice. The Hospice may also release this information to a related Hospice foundation. If you do not want the Hospice to contact you or your family, or to use your information in fundraising activities, notify the Privacy Compliance Officer and indicate that you do not wish to be contacted or your information shared.
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 THE PURPOSES FOR WHICH, YOUR HEALTH INFORMATION MAY ALSO BE USED AND DISCLOSED
- When Legally Required
- When There are Risks to Public Health
- To Report Abuse, Neglect or Domestic Violence
- To Conduct Health Oversight Activities
- In Connection with Judicial and Administrative Proceedings
- For Law Enforcement Purposes
- To Coroners and Medical Examiners
- To Funeral Directors
- For Organ, Eye or Tissue Donation
- For Research Purposes
- In the Event of a Serious Threat to Health or Safety
- For Specified Government Functions
- For Worker’s Compensation
Please contact the Hospice office for additional examples of Federal Privacy Rule allowances.
AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION
Other than previously stated, the Hospice will not disclose or sale your health information for marketing or any other purpose without obtaining 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 restriction. 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. The Hospice will restrict disclosure of your health information to any health plan in which you pay out of-pocket in full for your healthcare services. If you wish to make a request for restrictions, please contact the Hospice Privacy Compliance Officer.
- Right to receive confidential communication. 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 Hospice Privacy Compliance Officer at 828.682.9675. 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 copy 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 Hospice Privacy Compliance Officer at 828.682.9675. 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. If you or your representative believes that your health information records are incorrect or incomplete you may request that the Hospice amend the records. 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 Compassionate Care Western North Carolina, Privacy Compliance Officer, 856 Georges Fork Road, Burnsville, NC, 28714. 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 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 has 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 Hospice of Compassionate Care Western North Carolina, Privacy Compliance Officer, 856 Georges Fork Road, Burnsville, NC 28714. The request should specify the time period for the accounting starting on April 14, 2003. Accounting requests may not be made for periods of time in excess of six 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 has 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 Hospice Privacy Compliance Officer at 828.682.9675. The Hospice patient or a representative may also obtain a copy of the current version of the Hospice’s Notice of Privacy Practices at our website: www.compassionatecarewnc.org.
- Right to receive breach notification. Hospice will notify you in the event of the discovery of any breach of your protected health information without reasonable delay and in no case later than 60 days. Hospice will provide individual notice in written form by first-class mail or by e-mail if the affected individual has agreed to receive such notices electronically.
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 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 effective for all health information that it maintains. If the Hospice changes its Notice, 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 Health and Human Services if you or your representative believes that your privacy rights have been violated. Any complaints to the Hospice should be made in writing to Compassionate Care Western North Carolina, Privacy Compliance Officer, 856 Georges Fork Road, Burnsville, NC 28714. 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.
The Hospice has designated the Privacy Compliance Officer as its contact person for all issues regarding patient privacy and your rights under the Federal privacy standards. You may contact this person at:
Compassionate Care Western North Carolina
Privacy Compliance Officer
856 Georges Fork Road
Burnsville, NC 28714
This notice is revised in accordance with the Department of Health and Human Services Office for Civil Rights Final Rule, September 19, 2013.
IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE PLEASE CONTACT:
COMPASSIONATE CARE WESTERN NORTH CAROLINA
Privacy Compliance Officer
856 Georges Fork Road
Burnsville, NC 28714