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.
We have summarized our responsibilities and your rights on this first page. For a complete description of our privacy practices, please review this entire notice.
Cypress Hospice is required to:
- Maintain the privacy of your health information.
- Provide you with this notice of our legal duties and privacy practices with respect to information we collect and maintain about you.
- Abide by the terms of this notice.
- Notify you following a breach of unsecured protected health information.
As a client of our hospice, you have several rights with regard to your health information, including the following:
- The right to request that we not use or disclose your health information in certain ways.
- The right to request to receive communications in an alternative manner or location.
- The right to access and obtain a copy of your health information.
- The right to request an amendment to your health information.
- The right to an accounting of disclosures of your health information.
We reserve the right to change our privacy practices and to make the new provisions effective for all health information we maintain. A copy of the revised notice will be available after the effective date of the changes upon request.
We will not use or disclose your health information without your authorization, except as described in this notice. Thus, for example, we will require your authorization before we would use or disclose your protected health information for marketing purposes, and, if applicable, for most uses of psychotherapy notes. In addition, we will not sell your health information without a specific authorization from you.
Understanding Your Health Record/Information
Beginning at the time of admission, we are documenting your care and treatment in your patient record. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a:
- basis for planning your care and treatment;
- means of communication among the many health professionals who contribute to your care;
- legal document describing the care you received;
- means by which you or a third-party payer can verify that services billed were actually provided;
- a tool in educating health professionals;
- a source of data for medical research;
- a source of information for public health officials who oversee the delivery of health care in the United States;
- a source of data for hospice planning and marketing; and
- a tool with which we can assess and continually work to improve the care we render and the outcomes we achieve.
Understanding what is in your record and how your health information is used helps you to: ensure its accuracy, better understand who, what, when, where, and why others may access your health information, and make more informed decisions when authorizing disclosure to others.
How We Will Use or Disclose Your Health Information
- Treatment. The Hospice may use your health information to coordinate care within the hospice team 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 care/services. For example, information about your symptoms will need to be reported to the physician in order to obtain appropriate prescriptions for symptom management. The Hospice may also disclose your health care information to individuals outside the hospice team in an effort to coordinate your care. This may include family members, clergy whom you have designated, pharmacists, suppliers of durable medical equipment and/or other health care professionals that the hospice uses in order to coordinate your care.
The hospice will send out weekly appointment reminders to contract nursing homes to notify them of scheduled staff visits to see their hospice patients.
Information may be disclosed to community social service agencies in an effort to provide linkage for care resources desired by the patient or representative.
- Payment. The hospice may include your health information in invoices to collect payment from third parties for the care you receive from the hospice. For example, the hospice may be required by your health insurer to provide information regarding your health care status so that the insurer will reimburse the hospice for services rendered.
- Health care operations. The hospice may use and disclose health care information for its own operations in order to facilitate the function of the hospice and as necessary to provide quality care to all of the hospice’s patients. Health care operations include 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.
- Volunteer training.
- Memorial services for hospice families.
- 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 the Hospice.
- Fundraising for the benefit of the Hospice and certain marketing activities.
For example, the hospice may 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 or your family as part of general fundraising and community information mailings (unless you tell us you do not want to be contacted).
- For Fundraising Activities. The hospice may use information about you including your name, address, phone number and the dates your received care at the Hospice in order to contact you or your family to raise money for the Hospice. The Hospice many also release this information to a related Hospice foundation. If you do not want the hospice to contact you or your family, please notify the Executive Director/Privacy Official and indicate that you do not wish to be contacted.
- When legally required. The 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. The 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.
- To report adverse events, product defects, to track products or enable product recalls, repairs and replacements of the food and drug administration.
- To notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease.
- To an employer about an individual who is a member of the workforce as legally required.
- To Report Abuse, Neglect or Domestic Violence. The hospice is allowed to notify government authorities if the hospice believes a patient is the victim of abuse, neglect or domestic violence. The 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. The 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. The 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. The hospice may disclose your health information in the course of any judicial or administrative proceedings 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 the Hospice makes reasonable efforts to either notify you about the request or to obtain an order protecting your health information.
- For Law Enforcement Purposes. The hospice may disclose your health information to a law enforcement official for 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 the purpose of identifying or locating a suspect, fugitive, material witness or missing person.
- Under certain limited circumstances, when you are the victim of a crime or the hospice believes that disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or the safety of the public.
- To a law enforcement official if the Hospice has a suspicion that your death was the result of criminal conduct including criminal conduct on the part of the Hospice.
- In an emergency in order to report a crime.
- To Coroners and Medical Examiners. The hospice may disclose your health information to coroners and medical examiners for purposes of determining your cause of death or for the other duties, as authorized by law.
- To Funeral Directors. The hospice may disclose your health information to funeral directors consistent with applicable law and is necessary, to carry out their duties with respect to your funeral arrangements. If necessary to carry out their duties, the hospice may disclose your health information prior to and in reasonable anticipation, of your death.
- For Organ, Eye, or Tissue Donation. The 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 according to your specific wishes.
- For Research Purposes. The hospice may, under very select circumstances, use your health information for research. Before the hospice discloses any of your health information for such research purposes, the project will be subject to an extensive approval process. The hospice will ask your permission if any researcher will be granted access to your individually identifiable health information.
- In the Event of a Serious Threat to Health or Safety. The hospice may, consistent with applicable law and ethical standards of conduct, disclose your health information if the 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 the 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. The 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, the hospice will not disclose your health information other than with your written authorization. If you or your representative authorizes the hospice to use or disclose your health information, you may revoke that authorization in writing at any time.
The hospice will not sell your information without your prior written authorization or as otherwise allowed by law.
YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION
You have the following rights regarding your health information that the Hospice 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 the hospice’s disclosure of your health information to someone who is involved in your care or the payment of your care. 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 Executive Director/Privacy Official.
- Right to receive confidential communications. You have the right to request that the hospice communicate with you in a certain way. For example, you may ask that the 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 Executive Director. The 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. A request to inspect and copy records containing health information may be made to the Executive Director/Privacy Official. If you request a copy of your health information, the hospice may charge a reasonable fee for copying and assembling costs associated with your request.
- Right to amend health care information. If you or your representative believes that your health information records are incorrect or incomplete, you may request that the hospice amend the records. That request may be made as long as the information is maintained by the hospice. A request for an amendment of records must be made in writing to the Executive Director/Privacy Official. The hospice may deny the request if not in writing or does not include a reason for amendment. The hospice may deny the request if your health information records were not created by us, if the records you are requesting are not part of our 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 the 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 the hospice for any reason other than for treatment, payment or health operations. The request for an accounting must be made in writing to the Executive Director/Privacy Official. The request should specify the time period for the requested accounting. Accounting requests may not be made for periods of time in excess of six years. The 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 Executive Director/Privacy Official.
C/O Cypress Hospice
2 Berea Commons, Suite #1
Berea, OH 44017
For More Information or to Report a Problem
If have questions and would like additional information, you may contact our facility’s Privacy Official who is also the Director. You may also contact the Privacy Officer at firstname.lastname@example.org or at 440-243-5668 x236.
If you believe that your privacy rights have been violated, you may file a complaint with us. These complaints must be filed in writing on a form provided by our facility. The complaint form may be obtained from the Director, and when completed should be returned to the Director.
You may also file a complaint with the secretary of the federal Department of Health and Human Services or the Office for Civil Rights. There will be no retaliation for filing a complaint.
Celeste Davis, Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
233 N. Michigan Ave., Suite 240
Chicago, IL 60601
Voice Phone (800) 368-1019
FAX (312) 886-1807
TDD (800) 537-7697