Spruce Pine NC 28777
Hospice and Palliative Care of the Blue Ridge is very concerned about our patient's privacy. Below are the practices followed.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT.
USE AND DISCLOSURE OF HEALTH INFORMATION
Hospice of the Blue Ridge may use your health information, information that constitutes protected health information as defined in the Privacy Rule of the Administration Simplification provisions of the Health Insurance Portability and Accountability Act of 1996, for the purposes of providing you treatment, obtaining payment for your care and conducting health care operations. Hospice has established policies to guard against unnecessary disclosures of your health information.
In addition to information about your health, protected health information includes your billing records as well as your name, address, social security number and nay other information that can identify you.
THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES THAT DESCRIBE HOW YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED:
To provide treatment. Hospice may use your health information to coordinate care within 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 hospice in coordinating care. For example, physicians involved in your care will need information about your symptoms in order to prescribe appropriate medications. Hospice may also disclose your health care information to individuals outside of the hospice interdisciplinary team who are involved in your care including a hospital or nursing home if you are admitted for care, family members, clergy who you have designated, pharmacist, suppliers of medical equipment or other health care professionals.
To obtain payment. Hospice may include information in invoices to collect payment from third parties for the care your receive from Hospice. For example, 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. Hospice may also need to obtain prior approval for 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 may use and disclose health information for its own operations in order to facilitate the function of the hospice program and as necessary to provide quality care to all of the hospice patients. Health care operations includes such activities as:
1. Quality assessment and improvement activities;
2. Activities designed to improve health or reduce health care costs;
3. Protocol development, case management and care costs;
4. Contacting health care providers and patients with information about treatment alternatives and other related functions that do not include treatment;'
5. Professional review and performance evaluation;
6. Training programs including those in which students; trainees or practitioners in health care learn under supervision:
7. Training of non-health care professionals;
8. Accreditation, certification, licensing or credentialing activities;
9. Review and auditing, including compliance reviews, medical reviews, legal services and compliance programs;
10. Business planning and development including cost management and planning related analyses and formulary development;
11. Business management and general administrative activities of the hospice; and
12. Fundraising for the benefit of hospice.
For example, hospice many 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 mailing (unless you tell us you do not want to be contacted.
For fundraising activities. 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 hospice. If you do not want hospice to contact you or your family for fundraising purposes (such as a newsletter), notify the Hospice Business Office Manager at 828-765-5677 and indicate that you do not wish to be contacted.
For appointment reminders. Hospice may use and disclose your health information to contact you as a reminder that you have an appointment or to schedule a home visit.
For treatment alternatives. 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. Hospice will disclose your health information when it is required to do so by any federal, state or local law, or other judicial or administrative proceeding.
When there are risks to public health. Hospice may disclose your health information if you have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition.
To report abuse, neglect or domestic violence. Hospice is required to notify government authorities if hospice staff believes a patient is the victim of abuse, neglect or domestic violence.
In connection with judicial and administrative proceedings. Hospice may disclose your health information in the course of any judicial or administrative proceeding in response to an order of a court.
To cooperate with health oversight activities. Hospice may disclose your health information to a state or federal health oversight agency that is authorized by law to oversee our operations.
For law enforcement purposes. As permitted or required by state law, hospice may disclose your health information to a law enforcement official for certain law enforcement purposes as follows:
1. As required by law for reporting of certain types of wounds or or other physical injuries pursuant to the court order, warrant, subpoena or summons or similar process;
2. For the purpose of identifying or locating a suspect, fugitive, material witness or missing person;
3. Under certain limited circumstances, when you are the victim of a crime;
4. To a law enforcement official if the hospice has a suspicion that your death was the result of criminal conduct including criminal conduct by hospice staff;
5. In an emergency in order to report a crime.
To coroners and medical examiners. 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, hospice may disclose your health information prior to and in reasonable anticipation of your death.
For organ, eye or tissue donation. 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 medical research purposes. Hospice may, under very select circumstances, use your health information for research. Before 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. Hospice may, consistent with applicable law and ethical standards of conduct, disclose your health information if 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 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 Workers compensation. 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, Hospice of the Blue Ridge will not disclose your health information, other than with your written authorization. If you or your representative authorizes 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 CARE INFORMATION
You have the rights regarding your health information that Hospice of the Blue Ridge maintains:
1. 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 hospice's disclosure of your health information to someone who is involved in your care or the payment of your care. However, Hospice is not required to agree to your request. If you wish to make a request for restrictions. Please contact the Business Office Manager at Hospice of the Blue Ridge. The phone number is 828-765-5677.
2. Right to receive confidential communications. You have the right to request that hospice staff communicate 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 Office Manager at 828-765-5677.
3. Right to inspect and copy you health information. You have the right to inspect and copy your health information, including billing records. A request in inspect and copy records containing your health information may be made to Hospice of the Blue Ridge at 828-765-5677. If you request a copy of your health information, hospice will charge a reasonable fee for copying and assembling costs associated with your request.
4. Right to amend health care information. You or your representative have the right to request that hospice amend your records, if you believe that your health information is incorrect or incomplete. That request may be made as long as Hospice of the Blue Ridge maintains the information. A request for an amendment of records must be made in writing to Hospice and Palliative care of the Blue Ridge, Office Manager at 236 Hospital Drive, Spruce PIne, N.C. 28777. 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 Hospice. 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 contain your health information are accurate and complete.
5. Right to an accounting. You or your representative have the right to request an accounting of disclosures of your health information made by hospice for certain reasons, including reasons related by public purposes authorized by law and certain research. The request for and accounting must be made in writing to Hospice and Palliative Care of the Blue Ridge, Office Manager at 236 Hospital Drive, Spruce Pine N.C. 28777. The request should specify the time period for the periods of time in excess of six (6) years. Hospice will provide the first accounting you request during any 12 month period without charge. Subsequent accounting requests may be subject to a reasonable cost-bases fee.
6. Right to object to the release of your health information to the NC Department of Health and Human Services (DHHS) for the purpose of health care oversight. Hospice is licensed by DHHS and patient health information is used in oversight activities of DHHS to determine hospice compliance with federal and state regulations. You may object to DHHS access to your health care infomation. You objection may be made in writing at the time of admission by mailing your request to: Hospice and Palliative Care of the Blue Ridge, Office Manager at 236 Hospital Dr. Spruce Pine, N.C. 28777.
7. 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 copy, please contact. Hospice and Palliative Care of the Blue Ridge. Office Manager at 828-765-5677.
DUTIES OF: HOSPICE AND PALLIATIVE CARE OF THE BLUE RIDGE
Hospice and Palliative Care of the Blue Ridge is required by law to maintain the privacy of your health information and to provide to you and your representative this Notice of this duties and privacy practices. Hospice is required to abide by the terms of this Notice as may be amended from time to time. 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 hospice changes its Notice, 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 hospice and the Secretary of DHHS if you or your representative believe that your privacy rights have been violated. Any complaints to hospice should be made in writing to: Hospice and Palliative Care of the Blue Ridge, Office Manager, 236 Hospital Drive, Spruce Pine, N.C. 28777. Hospice encourages you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in anyway.
Hospice and Palliative Care of the Blue Ridge has designated the following position as its contact person for all issues regarding patient privacy and your rights under the federal privacy standards.
236 Hospital Drive
Spruce Pine, N.C. 28777
Effective Date: April 14, 2003
IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE WRITE TO: HOSPICE AND PALLIATIVE CARE OF THE BLUE RIDGE OR CALL.