THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. THIS INFORMATION IS PROVIDED AGAIN AT THE TIME OF ADMISSION AND SHOULD BE REVIEWED CAREFULLY.
Use and Disclosure of Health Information
Chautauqua Hospice & Palliative Care 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 healthcare operations. Chautauqua Hospice & Palliative Care 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
Chautauqua Hospice & Palliative Care 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 to prescribe appropriate medications. Hospice also may disclose your healthcare information to individuals outside of Hospice involved in your care including family members, clergy who you have designated, pharmacists, suppliers of medical equipment, or other healthcare professionals.
To Obtain Payment
Chautauqua Hospice & Palliative Care may include your health information in invoices to collect payment from third parties for the care you receive from Hospice. For example, Hospice may be required by your health insurer to provide information regarding your healthcare status so that the insurer will reimburse you or Hospice. 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. Chautauqua Hospice & Palliative Care agrees to restrict disclosure to a health plan if the individual pays out of pocket, in full, for healthcare services.
To Conduct Healthcare Operations
Chautauqua Hospice & Palliative Care may use and disclose health information for its own operations to facilitate the function of Hospice and as necessary to provide quality care to all of Hospice’s patients. Healthcare operations include such activities as:
For Evaluation and Training
Chautauqua Hospice & Palliative Care may use your health information for the following purposes:
For Fundraising Activities
Chautauqua Hospice & Palliative Care may use information about you including your name, address, phone number and the dates you received care from Hospice to raise money through fundraising activities for Hospice. If you do not want Hospice to contact you or your family, you have the choice to opt out and elect not to receive communication. If you decide that you do not wish to be contacted, please notify the Privacy Official at 716-338-0033.
For Appointment Reminders
Chautauqua Hospice & Palliative Care 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
Chautauqua Hospice & Palliative Care 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
Chautauqua Hospice & Palliative Care 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
Chautauqua Hospice & Palliative Care may disclose your health information for public activities and purposes to:
To Report Abuse, Neglect or Domestic Violence
Chautauqua Hospice & Palliative Care is allowed to notify government authorities if Hospice believes a patient is the victim of abuse, neglect or domestic violence. 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
Chautauqua Hospice & Palliative Care may disclose your health information to a health oversight agency for activities including audits, civil, administrative, or criminal investigations, inspections, licensure, or disciplinary action. Hospice, however, may not disclose your health information if you are the subject of an investigation and your health information is not directly related to your receipt of healthcare or public benefits.
In Connection with Judicial and Administrative Proceedings
Chautauqua Hospice & Palliative Care 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 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, Chautauqua Hospice & Palliative Care may disclose your health information to a law enforcement official for certain law enforcement purposes as follows:
To Coroners and Medical Examiners
Chautauqua Hospice & Palliative Care 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
Chautauqua Hospice & Palliative Care 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
Chautauqua Hospice & Palliative Care 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
Chautauqua Hospice & Palliative Care may, under very select circumstances, use your health information for research. Before Hospice discloses any of your health information for such research purposes, an authorization will be obtained in writing. All information will be kept confidential and shall be used solely for the purpose of medical or scientific research or the improvement of the quality of medical care.
In the Event of a Serious Threat to Health or Safety
Chautauqua Hospice & Palliative Care may, consistent with applicable law and ethical standards of conduct, disclose your health information if Hospice 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, Federal regulations authorize Chautauqua Hospice & Palliative Care 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 other, medical suitability determinations and inmates and law enforcement custody.
For Worker’s Compensation
Chautauqua Hospice & Palliative Care may release your health information for worker’s compensation or similar programs.
Authorization to Use or Disclose Health Information
Other than is stated above, Chautauqua Hospice & Palliative Care will not disclose your health information other than with your written consent. This includes mental health notes. 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 INFORMATION
You have the following rights regarding your health information that Chautauqua Hospice & Palliative Care 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 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 Director of Nursing at 716-338-0033.
Right to Receive Confidential Communications
You have the right to request that Hospice 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 Privacy Official at 716-338-0033. 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. You may request to receive your health information in any of the following ways:
This request to inspect and/or copy records containing your health information may be made to the Privacy Official at 716-338-0033. 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 Chautauqua Hospice & Palliative Care 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 Hospice. A request for an amendment of records must be made in writing to the Director of Nursing at 20 W. Fairmount Ave., Lakewood, NY 14750. 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 records you are requesting are not part of 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 Hospice, the records containing your health information are accurate and complete.
Right to be Informed of a Breach of Your Private Health Information
You or your representative will be informed by mail as soon as reasonable (but no later than 60 calendar days) of a breach in you Private Health Information. If deemed urgent you will be contacted via telephone.
Right to Restrict Certain Disclosures to Health Plans
You may restrict disclosures to your health plan if you have paid for the service out of pocket, in full.
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 to public purposes authorized by law and certain research. The request for an accounting must be made in writing to the Privacy Official at 20 W. Fairmount Ave., Lakewood, NY 14750. 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. 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 Privacy Official at 716-338-0033. The patient or the patient’s representative also may obtain a copy of the current version of Chautauqua Hospice & Palliative Care Notice of Privacy Practices at www.hospicechautco.org.
Duties of Chautauqua Hospice & Palliative Care
Chautauqua Hospice & Palliative Care 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. 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 to the Secretary of Health and Human Services if you or your representative believe that your privacy rights have been violated. Any complaints to Hospice should be made in writing to the VP of Clinical Services or designee at 20 W. Fairmount Ave., Lakewood, NY 14750. 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.
Contact person
Hospice has designated the Privacy Official as its contact person for all issues regarding patient privacy and your rights under the Federal privacy standards. You may contact the Privacy Official by phone at 716-338-0033 or by writing to us at Chautauqua Hospice & Palliative Care, 20 W. Fairmount Ave., Lakewood, NY 14750
Effective date
This Notice is effective September 2016.
