KLAMATH HOSPICE, INC.
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
Klamath Hospice, Inc. (Hospice) takes the privacy of your health information seriously. Hospice is required by law to maintain your privacy and to provide you with this Notice of Privacy Practices. This Notice is provided to describe Hospice’s legal duties and your rights with respect to your protected health information. Hospice is required to abide by the terms of this Notice that are currently in effect and to notify you in the event of a breach of your unsecured health information.
Hospice may use your health information, which is protected health information, for purposes of providing you treatment, obtaining payment for your care and conducting health care operations. Hospice has established policies to guard against unnecessary disclosure of your health information. The following categories describe ways that Hospice uses and discloses your health information. For each category, an explanation of the category is provided, in some cases with examples. Not every use of disclosure in a category will be listed. However, all of the ways Hospice is permitted to use and disclose your health information will fall into one of these categories.
THE FOLLOWING DESCRIBES THE CIRCUMSTANCES UNDER WHICH AND PURPOSES
FOR WHICH YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED
To Provide Treatment: Hospice may use and disclose 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 also may disclose your health care information to individuals outside of Hospice involved in your care such as pharmacists, suppliers of medical equipment or other health care professionals.
To Obtain Payment: Hospice may use and disclose your health information so that Hospice or others may bill and receive payment for the care you receive from Hospice. For example, Hospice may be required by your health insurer to provide information regarding your health care status, your need for care and the care that Hospice intends to provide to you, so that the insurer will reimburse you or Hospice for services provided and received. 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: Hospice may use and disclose health information for its own operations in order to facilitate the functioning of Hospice and as necessary to provide quality care to all of Hospice’s patients. Health care operations includes 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 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 Hospice.
For example Hospice may use your health information to evaluate its performance, combine your health information with other patients in evaluating how to more effectively serve all hospice patients, or disclose your health information to members of Hospice’s workforce for training purposes.
ADDITIONAL PERMITTED USES AND DISCLOSURES OF HEALTH INFORMATION
When Legally Required: 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: 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 employer’s workforce in certain limited situations, as authorized by law.
To Report Abuse, Neglect Or Domestic Violence: Hospice 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: 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. 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 health care or public benefits.
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 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, Hospice may disclose your health information to a law enforcement official for certain law enforcement 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 purposes 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 Hospice has a suspicion that your death was the result of criminal conduct including criminal conduct at Hospice.
• In an emergency in order to report a crime.
To Coroners And Medical Examiners: Hospice 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: 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. Hospice may disclose your health information prior to and in reasonable anticipation of your death, if necessary, for Funeral Directors to carry out those duties.
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 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. This process includes evaluating a proposed research project and its use of health information and trying to balance the research needs with your need for privacy. Before Hospice uses or discloses health information for research, the project will have been approved through this research approval process. Additionally, when it is necessary for research purposes, and so long as the health information does not leave Hospice, it may disclose your health information to researchers preparing to conduct a research project, for example, to help the researchers look for individuals with specific health needs. Lastly, if certain criteria are met, Hospice may disclose your health information to researchers after your death when it is necessary to research purposes.
Limited Data Set: Hospice may use or disclose a limited data set of your health information, that is, a subset of your health information for which all identifying information has been removed, for purposes of research, public health, or health care operations. Prior to Hospice’s release, any recipient of that limited data set must agree to appropriately safeguard your health information.
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 Worker’s Compensation: Hospice may release your health information for worker’s compensation or similar programs.
OTHER USES AND DISCLOSURES OF YOUR HEALTH INFORMATION TO WHICH YOU MAY AGREE OR OBJECT
To Persons Involved in Your Care: When appropriate, Hospice may share your health information with a family member, or other relative or any other person you identify if that person is involved in your care and the information is relevant to your care or the payment of your care. Hospice also may notify your family about your location or general condition or disclose such information to an entity in a disaster relief effort.
You may ask Hospice at any time not to disclose your health information to any person(s) involved in your care. Hospice will agree to your request unless circumstances constitute an emergency or if the patient is a minor.
For Fundraising Activities: Hospice, or Hospice’s business associate may use information about you including your name, address, telephone number and the dates you received care, in order to contact you or your family regarding fundraising purposes. You have the right to opt-out of receiving these communications from Hospice. If you do not want Hospice to contact you or your family, notify the HIPAA Privacy & Security Officer at 541-882-2902 or 877-882-2902 and indicate that you do not wish to receive fundraising communications.
AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION
Except as otherwise permitted or required by this Notice of Privacy Practices, Hospice will not use or disclose your health information unless you or your personal representative provide written authorization. If you or your representative authorizes Hospice to use or disclose your health information, you may cancel that authorization, in writing, at any time. If you cancel your authorization, Hospice will no longer use or disclose health information about you for the reasons covered by your written authorization, except to the extent that Hospice has taken action in reliance thereon. You understand that Hospice is unable to take back any disclosures it has already made under the authorization, and that Hospice is required to retain its records of the care that it has provided you.
The following uses and disclosures of your health information will only be made with your signed authorization:
1. Uses and disclosures for marketing purposes;
2. Uses and disclosures that constitute a sale of health information;
3. Most uses and disclosures of psychotherapy notes, if Hospice maintains psychotherapy notes; and,
4. Any other uses and disclosures not described in this Notice.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
Right to request restrictions: You have the right to request restrictions on uses and disclosures of your health information for treatment, payment and health care operations. You have the right to request a limit on the 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, unless your request is for a restriction on a disclosure to a health plan for purposes of payment or health care operations (and is not for purposes of treatment) and the medical information you are requesting to be restricted from disclosure pertains solely to a health care item or service for which you have paid out of pocket in full. If you wish to make a request for restrictions, please contact the HIPAA Privacy & Security Officer at 541-882-2902 or 877-882-2902.
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 HIPAA Privacy & Security Officer at 541-882-2902 or 877-882-2902. Hospice will not request that you provide any reasons for your request and will attempt to honor any 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 HIPAA Privacy & Security Officer at 541-882-2902 or 877-882-2902. If you request a copy of your health information, Hospice may charge a reasonable fee for copying and assembling costs associated with your request. You have the right to request that Hospice provide you, an entity or a designated individual with an electronic copy of your electronic health record containing your health information. Hospice may require you to pay the labor costs incurred by Hospice in responding to your request.
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 the information is maintained by Hospice. A request for an amendment of records must be made in writing to Klamath Hospice, Inc. 4745 South 6th Street, Klamath Falls, OR, 97603, Attn: HIPAA Privacy & Security Officer. 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 an accounting: You or your representative have the right to request an accounting of disclosures of your health information made by Hospice for the previous six (6) years. The accounting will not include disclosures made for treatment, payment or health care operations unless Hospice maintains your health information in an Electronic Record (EHR). The request for an accounting must be made in writing to Klamath Hospice, Inc. 4745 South 6th Street, Klamath Falls, OR, 97603, Attn: HIPAA Privacy & Security Officer. 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 opt-out of fundraising: You or your representative have the right to opt-out of receiving fundraising communications. Instructions for how to opt-out are included in each fundraising solicitation you receive.
Right to receive notification of a breach: You or your representative have the right to receive notification of a breach of your unsecured health information. If you have questions regarding what constitutes a breach of your rights with respect to breach notification, please contact the HIPAA Privacy & Security Officer at 541-882-2902 or 877-882-2902.
Right to a complete 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 HIPAA Privacy & Security Officer at 541-882-2902 or 877-882-2902. You may also obtain a copy of the current version of Hospice’s Notice of Privacy Practices at its website, www.klamathhospice.org.
CHANGES TO THIS NOTICE
Hospice reserves the right to change the terms of its Notice. Hospice reserves the right to make the revised Notice effective for health information we already have about you, as well as any health information we receive in the future. Hospice will post a copy of the current Notice in a clear and prominent location to which you have access. The Notice also is available to you upon request. The Notice contains, at the end of this document, the effective date. If Hospice changes its Notice, Hospice will provide a copy of the revised Notice to you or your appointed representative.
IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE
Hospice has designated the HIPAA Privacy and Security 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 4745 South 6th Street, Klamath Falls, OR, 97603 or 541-882-2902 or 877-882-2902.
COMPLAINTS OR QUESTIONS REGARDING THIS NOTICE
You or your personal representative have the right to express complaints to Hospice and to the Secretary of the Department of Health and Human Services (DHHS) if you or your representative believe that your privacy rights have been violated. Any complaints to Hospice should be made in writing to the HIPAA Privacy & Security Officer at Klamath Hospice, Inc., 4745 South 6th Street, Klamath Falls, OR, 97603. Hospice encourages you to express any concerns you may have regarding the privacy of your information. You will not be penalized in any way for filing a complaint. Oregon residents may file a complaint with the Department of Human Services at Public Health Division, 800 NE Oregon St., Suite 305, Portland, Oregon 97232 (971-673-1222). California residents may file a complaint with the Chico District Office of the Department of Health Services at 1367 E. Lassen Avenue, #B-1, Chico, CA 95973. California residents may also call the Sacramento District Office – South at 800-554-0354.
EFFECTIVE DATE: This Notice is effective 10/01/13