Under federal law, your health information is protected and confidential. Your health information includes information about your symptoms, test results, diagnosis, treatment and related medical information. Your health information also includes payment, billing and insurance information. This privacy notice applies to Alive Hospice ("the Hospice"), including its employees, staff, volunteers and third-party business associates.

HOW WE USE AND DISCLOSE YOUR PATIENT HEALTH INFORMATION
We may use or disclose your health information as described below. We are required to comply with any state laws that impose stricter standards than the uses and disclosures described in this notice.

To Provide Treatment. We 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 your care. For example, physicians involved in your care will need information about your symptoms in order to prescribe appropriate medications.
To Obtain Payment. We may use or disclose your health information in invoices to receive payment from third parties for the care you receive from us. For example, we may provide information to your health insurance company regarding your healthcare status so that the insurer will reimburse you or the Hospice. We also may need to obtain prior approval from your insurer for hospice care.
To Conduct Health Care Operations. We may use and disclose health information in order to facilitate our internal operations and, as necessary, to provide quality care to all of our patients, including proper administration of records, evaluation of our quality of treatment, assessing the care and outcome of your case and others like it and arranging for legal services.
For Fundraising Activities. While it is not our standard practice, we 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 the Hospice. We will only use specific information about a patient (for example in videos, brochures, and testimonials) in fundraising solicitations if we receive written authorization to do so. If you do not want the Hospice to contact you or your family, notify our Vice President for Community Development and indicate that you do not wish to be contacted.
For Appointment Reminders. The Hospice may use and disclose your health information to contact you as a reminder that you have an appointment such as a home visit.
For Treatment Alternatives. We 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.
For the Hospice Directory. Unless you object, we may disclose certain information about you including your name, your general health status and where you are in our facility in a Hospice directory while you are in the Residence. We may disclose this information to people who ask for you by name and to clergy. Please inform us if you do not want your information to be included in the directory.
When Legally Required. We will disclose your health information when required to do so by any Federal, State or local law.
For Public Health Activities. As required by law, we may disclose vital statistics (including reports of death), disease information, information related to recalls of dangerous products and similar information to public health authorities.
To Report Abuse, Neglect or Domestic Violence. As authorized by law, we may notify government authorities if we believe a patient is the victim of abuse, neglect or domestic violence and certain conditions are met.
To Conduct Health Oversight Activities. We may disclose your health information to a health oversight agency for activities, including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action and similar activities.
In Connection With Judicial and Administrative Proceedings. We may disclose your health information in response to an order of a court or administrative tribunal. We may also disclose your health information in response to a subpoena, discovery request or other lawful process, but only when reasonable efforts have been made to notify you about the request or to obtain an order protecting your health information.
For Law Enforcement Purposes. As required by law, we may disclose your health information to a law enforcement official for certain law enforcement purposes.
To Coroners, Medical Examiners and Funeral Directors. We may disclose your health information to coroners, medical examiners and funeral directors as authorized by law, prior to, and in reasonable anticipation of, your death.
For Organ, Eye or Tissue Donation. We 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. We may, under very select circumstances, use or disclose your health information for research.
In the Event of a Serious Threat To Health or Safety. We may, consistent with applicable law, disclose your health information if we, in good faith, believe 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 or another person.
For Specified Government Functions. In certain circumstances, we may 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. We may release your health information for worker's compensation or similar programs.
Communication with Family/Disaster Notification. Unless you object, we may disclose to your family members or others involved in your care, information relevant to their involvement in your care or payment for your care or information necessary to inform them of your location and condition. We may also release information to disaster relief agencies so they may assist in notifying those involved in your care of your location and general condition.

AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION
Other than as stated above, we will not use or disclose your health information other than with your written authorization. If you or your representative authorize us to use or disclose your health information, you may revoke that authorization in writing at any time to stop future uses or disclosures.

YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION
You have the following rights regarding your health information that we maintain. Please contact the person named below to obtain the appropriate form to exercise these rights.

Right to request restrictions. You may request restrictions on certain uses and disclosures of your health information. However, we are not required to agree to your request, but if we agree to restrictions, we must abide by those restrictions.
Right to receive confidential communications. You have the right to request that we communicate with you confidentially. You may make this request at any time during the course of your care to the admissions staff or to any direct care staff. We will not request that you provide any reasons for your request and will attempt to honor your reasonable requests.
Right to inspect and copy your health information. You have the right to inspect a copy your health information that is used to make a decision about you, including billing records, by making a request in writing. If you request a copy of your health information, we may charge a reasonable fee for copying and assembling costs associated with your request.
Right to amend healthcare information. You have the right to request in writing that we amend your records, if you believe that your health information is incorrect or incomplete. We may deny the request if it is not in writing or does not include a reason for the amendment. We may deny the request for certain other reasons, including that the records are accurate and complete.
Right to an Accounting. You have the right to request a list of disclosures of your health information made by us for certain reasons, including reasons related to public purposes authorized by law and certain research. The list will not include disclosures made for reasons of treatment, payment or healthcare operations, disclosures you authorize, certain other disclosures, or disclosures made prior to April 14, 2003. We will 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 have a right to request a paper copy of this Notice at any time even if you have received this notice previously or electronically. You may also obtain a copy of the current version of our Notice of Privacy Practices at our website, www.alivehospice.org.

DUTIES OF THE HOSPICE
We are required by law to maintain the privacy of your health information and to provide to you this Notice of our duties and privacy practices. We are required to abide by the terms of this Notice as may be revised from time to time. We reserve the right to change the terms of this Notice and to make the new Notice provisions effective for all health information that we maintain. If we change our Notice, we will provide a copy of the revised Notice to you or your appointed representative upon request. You have the right to complain to us and to the Secretary of Department of Health and Human Services (DHHS) if you believe that your privacy rights have been violated. Any complaints to us should be made in writing to the contact person listed below. You will not be retaliated against in any way for filing a complaint.

CONTACT PERSON
We have designated the Privacy Officer as our contact person for all issues regarding patient privacy and exercising your rights under the Federal privacy standards. You may contact this person at: Privacy Officer, Alive Hospice, 1718 Patterson Street, Nashville, TN 37203, (615) 963-4715.