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
Under Federal law, your identifiable health information (known as “protected 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 (“Notice”) applies to Alive Hospice (“the Hospice”) including its employees, staff, and volunteers. Your health information may be stored electronically and is subject to electronic disclosure.
How we use and disclose your patient health information
We may use and 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 and disclose 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 are involved in 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 and disclose your health information to receive payment for the care you receive. For example, we may provide information to your health insurance company so that the insurer will reimburse you or the Hospice, we may need to obtain prior approval from your insurer for hospice care, and we may use or disclose your health information to determine whether you are eligible for health benefits.
To Conduct Health Care Operations. We may use and disclose health information in order to facilitate our internal operations and to provide quality care to all of our patients, including proper administration of records, evaluation of quality of treatment, assessing the care and outcome of your case and others like it, arranging for legal services and providing appointment reminders.
For Fundraising Activities. We may use and disclose information about you including your name, address, telephone number and the dates you received care in order to contact you or your family to raise money for the Hospice. We will only include 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 wish to receive fundraising communications, you may notify our Vice President for Community Development at (615) 327-1085 and indicate that you do not wish to be contacted. The Hospice will not condition your treatment on your choice with respect to receiving fundraising communications.
For a Facility Directory. We may use and 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 Hospice residence. We may disclose this information to people who ask for you by name, and we may disclose this information plus your religions affiliation 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 authorized 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 authorized by law, we may disclose your health information to law enforcement officials 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 select circumstances, use or disclose your health information for research.
To Business Associates. We may disclose your health information to third parties known as “Business Associates” that perform various activities (e.g. legal services, delivery of goods) for us and that agree to protect the privacy of your health information.
In The Event of a Serious Threat to Health or safety. We may 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 facilities specified government functions relating to military and veterans, national security and intelligence activities, protective services for the President and others, medial suitability determinations and inmates and law enforcement custody.
For Workers Compensation. We may release your health information for workers’ 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 or payment for 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. Subject to compliance with limited exceptions, we will not use or disclose psychotherapy notes, use or disclose your health information for marketing purposes or sell your health information unless you have signed an 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. However, your decision to revoke the authorization will not affect or undo any use or disclosure of your health information that occurred before you notified us of your decision to revoke your authorization.
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 disclosure of your health information. However, we are not required to agree to your request, except for requests to restrict disclosures to a health plan when you have paid in full out-of-pocket for your care and when the disclosures are not required by law. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
Right to receive confidential communications. You have the right to request that we communicate with you through alternative means or locations. We will not request that you provide any reasons for your request and will accommodate your reasonable requests. We may require you to provide information on how payment will be handled and an address or other method to reach you. Requests must be made in writing.
Right to inspect and copy your health information. You have the right to inspect and 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 our labor and supply costs for creating the copy and postage, if applicable. If your information is stored electronically and you request an electronic copy, we will provide it to you in a readable electronic form and format.
Right to amend healthcare information. You have the right to request that we amend our 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. Requests must be made in writing.
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 that we are not required to record such as disclosures you authorize. We will provide the first accounting you request during any 12-month period without charge. Additional accounting requests made during the same 12-month period 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 the Notice at any time even if you have received this Notice previously 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 long as it is in effect. We reserve the right to change the terms of the 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 your or your appointed representative upon request. We will also post a copy of the current Notice in the Hospice residence and on our website, www.alivehospice.org. We are required by law to notify affected individuals following a breach unsecured protected health information.
You have the right to complain to us and to the Secretary of Department of Health and Human Services 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.
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) 327-1085.
This notice is effective May 10, 2013.