Privacy Policy

HOME HOSPICE

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

Home Hospice (“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 implemented in 2003, and further defined in the HIPAA Final Rule 2010, and HIPAA/HITECH Omnibus Final Rule, for purposed 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: Home 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 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: Home Hospice may include your health information in invoices to collect payment from third parties for the care you receive from 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 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. Hospice will agree to restrict disclosure of health information to your health plan/insurer if you pay out of pocket in full for hospice services.

To Conduct Health Care Operations: Home 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 Hospice’s patients. Health care operations include such activities as:

Quality assessment and improvement activities.

Activities designed to improve 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. Fundraising for the benefit of the Hospice.

For example Home 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).

For Fundraising Activities: Home Hospice may use information about you including your name, address, and phone number in order to contact you and/or your family to raise money for Home Hospice. Individuals have the right to opt out of any or all fundraising communications from hospice. If you do not want Home Hospice to contact you and/or your family, notify the office at 903‐868‐9315, or write to: Home Hospice, 505 West Center Street, Sherman, TX 75090 and indicate that you do not wish to be contacted.

For Appointment Reminders: Home 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: Home 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: Home 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: Home 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, 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.

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: Home Hospice is allowed 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: Home 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. The Hospice, however, may not disclose your health information if you are the subject of the 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: Home 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 either to 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, Home Hospice may disclose your health information to law enforcement for 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: Home Hospice may disclose your health information to coroners and medical examiners for purposed of determining your cause of death or for other duties, as authorized by law.

To Funeral Directors: Home Hospice may disclose your health information to funeral directorsconsistent 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: Home Hospice may use or disclose your health information to organ procurement organizations or other entities engaged in the procurement, banking or transplantations of organs, eyes or tissue for the purpose of facilitating the donation and transplantation, if such organization was acting at your request.

For Research Purposes: Home Hospice may, under very select circumstances, use your healthinformation 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, including obtaining your consent for inclusion in the study.

In the event of a Serious Threat to Health or Safety: Home 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 Home 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 and law enforcement custody.

For Worker’s Compensation: Home Hospice may release your health information for worker’scompensation or similar programs.

AUTHORIZATIONS TO USE OR DISCLOSE HEALTH INFORMATION

Other than what is stated above, Home Hospice will not disclose your health information without your written authorization. Your health information will not be sold by Home Hospice, used in marketing of for any other purpose without your written authorization for each specific use. 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 Home Hospice maintains:

Right to request restrictions: You may request restrictions on certain uses and disclosures ofyour 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. We are not required to agree to your request if it is not feasible for us to ensure our compliance or believe it will negatively impact the care we may provide you. If Home Hospice desires to utilize your health information for fundraising purposes, you must authorize such use and have the right to deny such utilization. To request a restriction, you must make your request in writing to the Privacy Officer, Home Hospice, 505 West Center Street, Sherman, TX 75090. In your request, you must tell the Hospice what information you want to limit and to whom you want the limits to apply.

Right to receive confidential communications: You have the right to request that the Hospicecommunicate with you in a certain way. For example, you may ask that 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 Privacy Officer, Home Hospice, 505 West Center Street, Sherman, TX 75090. 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 yourhealth information, including health and billing records, both paper and electronic records. This does not include psychotherapy notes. You have the right to request your health records be sent to a third party named by you. Such request must be made in writing to the Privacy Officer, Home Hospice, 505 West Center Street, Sherman, TX 75090. If you request a copy of your health information, Home Hospice may charge a reasonable fee for copying and assembling cost associated with your request.

Right to amend health care information: You or your representative have the right to requestan 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 the Privacy Officer, Home Hospice, 505 West Center Street, Sherman, TX 75090. 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, including both paper and electronic records.

Right to an accounting: You or your representative have the right to request an accounting ofdisclosures 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 and accounting must be made in writing to the Privacy Officer, Home Hospice, 505 West Center Street, Sherman, TX 75090. 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 the Notice: Your or your representative have a right to a separatepaper copy of the Notice at any time even if you or your representative have received this Notice previously. To obtain a separate paper copy, please contact the Admissions Department at 903 868‐9315. You may also obtain a copy of the current version of the Hospice’s Notice of Privacy Practices at our website, www.homehospice.org.

DUTIES OF HOME HOSPICE

Home Hospice is required by law to maintain the privacy of your health information and to provide 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, and to notify you of any such amendments. 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 have the right to express complaints to the Hospice and to the Secretary of DHHS if you or your representative believe that your privacy rights have been violated. Any complaints to the Hospice should be made in writing to the Privacy Officer, Home Hospice, 505 West Center Street, Sherman, TX 75090. Home 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. Home Hospice is required to notify you of any breech event or activity that results in a breech in the protection or possible unwarranted disclosure of your health information.

EFFECTIVE DATE

This Notice is effective September 20, 2013.

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