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USE AND DISCLOSURE OF HEALTH INFORMATION Hospice By The Bay may use your health information for purposes of providing you treatment, obtaining payment for your care and conducting health care operations. Your health information may be used or disclosed only after Hospice By The Bay has obtained your written consent. Hospice By The Bay has established a policy 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 AFTER YOU HAVE PROVIDED YOUR WRITTEN CONSENT:
To Provide Treatment Hospice By The Bay may use your health information to coordinate care within Hospice By The Bay and with others involved in your care, such as your attending physician, members of Hospice By The Bay interdisciplinary team and other health care professionals who have agreed to assist Hospice By The Bay in coordinating care. For example, physicians involved in your care will need information about your symptoms in order to prescribe appropriate medications. Hospice By The Bay also may disclose your health care information to individuals outside of Hospice By The Bay involved in your care including family members, clergy whom you have designated, pharmacists, suppliers of medical equipment or other health care professionals that Hospice By The Bay uses in order to coordinate your care.
To Obtain Payment Hospice By The Bay may include your health information in invoices to collect payment from third parties for the care you may receive from Hospice By The Bay. For example, Hospice By The Bay may be required by your health insurer to provide information regarding your health care status so that the insurer will reimburse you or Hospice By The Bay. Hospice By The Bay 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 By The Bay may use and disclose health care information for its own operations in order to facilitate the function of Hospice By The Bay and as necessary to provide quality care to all of Hospice By The Bay'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.
- 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 By The Bay.
- Fundraising for the benefit of Hospice By The Bay and some marketing activities. For example Hospice By The Bay 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 As a patient, Hospice By The Bay may share some general information about you and your family with its parent Foundation. This information may be used to notify you or your family members about gifts received in your honor or memory, provide tribute opportunities, request charitable support for ongoing programs and services, and extend personal invitations to educational seminars and other hospice events. If you do not wish Hospice By The Bay Foundation to communicate with you or your family, please contact the Foundation office directly at (415) 526-5500.
Federal privacy rules allow Hospice By The Bay to use or disclose your health information without your consent or authorization for a number of reasons:
When Legally Required Hospice By The Bay 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 By The Bay 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.
To an employer about an individual who is a member of the workforce as legally required.
To Report Abuse, Neglect Or Domestic Violence Hospice By The Bay is allowed to notify government authorities if Hospice By The Bay believes a patient is the victim of abuse, neglect or domestic violence. Hospice By The Bay 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 By The Bay 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 By The Bay, 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 By The Bay may disclose your health information in the course of any judicial or administrative proceeding in response to a court order 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 By The Bay makes reasonable efforts to either notify you about the request or to obtain an order protecting your health information.
For Law Enforcement Purposes Hospice By The Bay 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.
- To a law enforcement official if Hospice By The Bay has a suspicion that your death was the result of criminal conduct including criminal conduct at Hospice By The Bay
- In an emergency in order to report a crime.
To Coroners And Medical Examiners Hospice By The Bay 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 By The Bay 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 By The Bay may disclose your health information prior to and in reasonable anticipation of your death.
For Organ, Eye Or Tissue Donation Hospice By The Bay 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 By The Bay may, under very select circumstances, use your health information for research. Before Hospice By The Bay discloses any of your health information for such research purposes, the project will be subject to an extensive approval process. Hospice By The Bay 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 Hospice By The Bay may, consistent with applicable law and ethical standards of conduct, disclose your health information if Hospice By The Bay, 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 By The Bay 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 By The Bay may release your health information for worker's compensation or similar programs.
AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION Other than is stated above, Hospice By The Bay will not disclose your health information other than with your written authorization. If you or your representative authorizes Hospice By The Bay 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 Hospice By The Bay 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 By The Bay's disclosure of your health information to someone who is involved in your care or the payment of your care. However, Hospice By The Bay is not required to agree to your request. If you wish to make a request for restrictions, please contact the Privacy Practices Officer directly at (415) 927-2273.
RIGHT TO RECEIVE CONFIDENTIAL COMMUNICATIONS You have the right to request that Hospice By The Bay communicate with you in a certain way. For example, you may ask that Hospice By The Bay 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 Practices Officer at (415) 927-2273. Hospice By The Bay 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 your health information may be made to the Hospice By The Bay Privacy Practices Officer. If you request a copy of your health information, Hospice By The Bay may charge a reasonable fee for copying and assembling costs associated with your request.
RIGHT TO AMEND HEALTHCARE INFORMATION If you or your representative believes that your health information records are incorrect or incomplete, you may request that Hospice By The Bay amend the records. That request may be made as long as the information is maintained by Hospice By The Bay. A request for an amendment of records must be made in writing to the Privacy Practices Officer. Hospice By The Bay 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 By The Bay, if the records you are requesting are not part of Hospice By The Bay'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 By The Bay, 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 By The Bay for any reason other than for treatment, payment or health operations. The request for an accounting must be made in writing to the Privacy Practices Officer. The request should specify the time period for the accounting starting on April 14, 2003. Accounting requests may not be made for periods of time in excess of six years. Hospice By The Bay 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 representatives 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
Practices Officer. Hospice By The Bay patients or a representative
may also obtain a copy of the current version of Hospice By The Bay's Notice of Privacy Practices at its website, www.hospiceofmarin.org.
DUTIES OF HOSPICE BY THE BAY Hospice By The Bay 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 By The Bay is required to abide by terms of this Notice as may be amended from time to time. Hospice By The Bay 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 By The Bay changes its Notice, Hospice By The Bay 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 By The Bay and to the Secretary of Health and Human Services if you or your representative believes that your privacy rights have been violated. Any complaints to Hospice By The Bay should be made in writing to the Privacy Practices Officer. Hospice By The Bay 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 By The Bay's contact person for all issues regarding patient privacy and your rights under the Federal privacy standards is Rhonda Fisher-Borwn, Privacy Offier, Hospice By The Bay, 17 E. Sir Francis Drake Blvd., Larkspur, California 94939, (415) 927-2273.
EFFECTIVE DATE This Notice is effective April 14, 2003.
IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT: Rhonda Fisher-Brown, Privacy Officer, at (415) 927-2273.
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