Hospicare and Palliative Care Services of Tompkins County

Hospicare and Palliative Care Services of Tompkins County

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. It is divided into the seven sections. Please review it carefully.

USE AND DISCLOSURE OF HEALTH INFORMATION

Hospicare and Palliative Care Services of Tompkins County (HPCSTC) may use your health information, information that constitutes protected health information as defined in the Privacy Rule of the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996, for purposes of providing you treatment, obtaining payment for your care and conducting health care operations. HPCSTC has established policies to guard against unnecessary disclosure of your health information.

Examples of protected health information include but are not limited to health information that is associated with personally identifiable data, such as: names; residential addresses and residential zip codes; and social security numbers.

SECTION

1. Permitted Uses and Disclosures of Health Information

2. Other Permitted Uses and Disclosures of Health Information

relating to public policy or legal circumstances.

3. Authorization to use or disclose health information

4. Your rights with respect to your health information

5. Duties of Hospicare and Palliative Care Services

6. Contact Person

7. Effective Date

8. You or Your Personal Representative’s Acknowledgement

of Provision of HPCSTC’s Notice of Privacy Practices

1. THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED:

To Provide Treatment. HPCSTC may use your health information to coordinate care within HPCSTC and with others involved in your care, such as your attending physician, members of HPCSTC interdisciplinary team and other health care professionals who have agreed to assist HPCSTC in coordinating care. For example, physicians involved in your care will need information about your symptoms in order to prescribe appropriate medications. HPCSTC also may disclose your health care information to individuals outside of HPCSTC involved in your care including family members, clergy who you have designated, pharmacists, suppliers of medical equipment or other health care professionals.

To Obtain Payment. Upon your written request as required by NYS Privacy Rules on the release of information HPCSTC may include your health information in invoices to collect payment from third parties for the care you receive from HPCSTC. For example, HPCSTC may be required by your health insurer to provide information regarding your health care status so that the insurer will reimburse you or HPCSTC. HPCSTC 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. HPCSTC may use and disclose health information for its own operations in order to facilitate the function of HPCSTC and as necessary to provide quality care to all of HPCSTC 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 HPCSTC.

For example HPCSTC may use your health information to evaluate its staff performance, combine your health information with other HPCSTC patients in evaluating how to more effectively serve all HPCSTC patients, disclose your health information to HPCSTC 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 as part of general fundraising and community information mailings (unless you tell us you do not want to be contacted).

For Fundraising Activities. HPCSTC relies on the generous financial support of the community to enable it to continue to provide quality services. On occasion, HPCSTC may use your information to contact you or your family for fundraising. Rarely, HPCSTC may also release your name and address to its foundation. If you do not want HPCSTC to contact you or your family, please notify the Development Associate in the front office at (607) 272-0212 ext. 129.

For Appointment Reminders. HPCSTC may use and disclose your health information to contact you as a reminder that you have an appointment for a home visit.

For Treatment Alternatives. HPCSTC 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.

2. OTHER PERMITTED USES AND DISCLOSURES OF HEALTH INFORMATION RELATING TO PUBLIC POLICY OR LEGAL CIRCUMSTANCES FOR WHICH YOUR HEALTH INFORMATION MAY ALSO BE USED AND DISCLOSED

When Legally Required. HPCSTC 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. HPCSTC 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 as legally required.

To Report Abuse, Neglect Or Domestic Violence. HPCSTC is allowed to notify government authorities if HPCSTC believes a patient is the victim of abuse, neglect or domestic violence. HPCSTC 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. HPCSTC may disclose your health information to a health oversight hospice for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action. HPCSTC, 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. HPCSTC 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 HPCSTC 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, HPCSTC may disclose your health information to a law enforcement official for certain law enforcement purposes as follows:

As required by law for reporting 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 HPCSTC has a suspicion that your death was the result of criminal conduct including criminal conduct at the Hospice.



In an emergency in order to report a crime.

To Coroners And Medical Examiners. HPCSTC may disclose your health information to coroners and medical examiners for purposes of determining your cause of death or for other duties, if required by law.

To Funeral Directors. HPCSTC 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, HPCSTC may disclose your health information prior to and in reasonable anticipation of your death.

For Organ, Eye Or Tissue Donation. HPCSTC 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. HPCSTC may, under very select circumstances, use your health information for research. Before HPCSTC discloses any of your health information for such research purposes, the project will be subject to an extensive approval process.

In the Event of A Serious Threat To Health Or Safety. HPCSTC may, consistent with applicable law and ethical standards of conduct, disclose your health information if HPCSTC, 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 HPCSTC 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. HPCSTC may release your health information for worker's compensation or similar programs.

3. AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION

Other than for the reasons stated above, HPCSTC will not disclose your health information without your written authorization. If you or your representative authorizes HPCSTC to use or disclose your health information, you may revoke that authorization in writing at any time.

4. YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION

You have the following rights regarding your health information that HPCSTC 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 HPCSTC disclosure of your health information to someone who is involved in your care or the payment of your care. However, HPCSTC is not required to agree to your request. If you wish to make a request for restrictions, please contact the Privacy Officer at (607) 272-0212.

Right to receive confidential communications. You have the right to request that HPCSTC communicate with you in a certain way. For example, you may ask that HPCSTC 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 Officer at (607) 272-0212. HPCSTC 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 Privacy Officer at (607) 272-0212. If you request a copy of your health information, HPCSTC may charge a reasonable fee for copying and assembling costs associated with your request.

Right to amend health care information. You or your representative has the right to request that HPCSTC 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 HPCSTC. A request for an amendment of records must be made in writing to the Privacy Officer 172 East King Road, Ithaca, New York 14850. HPCSTC 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 HPCSTC, if the records you are requesting are not part of HPCSTC 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 HPCSTC, the records containing your health information are accurate and complete.

Right to an accounting. You or your representative has the right to request an accounting of disclosures of your health information made by HPCSTC for certain reasons, including reasons related to public purposes authorized by law and certain research. The request for an accounting must be made in writing to the Privacy Officer at 172 East King Road, Ithaca, New York 14850. 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. HPCSTC 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 has the right to a separate paper copy of this Notice at any time even if you or your representative has received this Notice previously. To obtain a separate paper copy, please contact the Privacy Officer at (607) 272-0212.

Right to Lodge a Complaint. You or your personal representative has the right to lodge a complaint to HPCSTC and to the Office of Civil Rights in the Department of Health and Human Services (DHHS) if you or your representative believes that your privacy rights have been violated. Complaints, in writing, to HPCSTC should be made to:

Privacy Officer
Hospicare and Palliative Care Services of Tompkins County
172 East King Road, Ithaca
New York 14850.

Complaints, in writing or by telephone, to DHHS should be made to:

Region II, Office for Civil Rights
U.S. Department of Health and Human Services
Jacob Javits Federal Building
26 Federal Plaza--Suite 3312,
New York, New York, 10278.
Voice Phone (212) 264-3313. FAX (212) 264-3039

HPCSTC 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.

5. DUTIES OF HPCSTC

HPCSTC 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. HPCSTC is required to abide by the terms of this Notice as may be amended from time to time. HPCSTC 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 HPCSTC changes its Notice, HPCSTC will provide a copy of the revised Notice to you or your appointed representative.

6. CONTACT PERSON

HPCSTC has designated the Privacy Officer as its contact person for all issues and questions regarding patient privacy and your rights under New York State or Federal privacy standards. You may contact this person at (607) 272-0212 or by writing to the Privacy Officer, 172 East King Road, Ithaca, New York 14850.

7. EFFECTIVE DATE. This Notice is effective April 14, 2003.