Our notice of privacy practices describes how medical information about you may be used and disclosed and how you can get access to this information. Download it here.
Please Review this carefully:
Hospicare & Palliative Care Services (HPCS) are required by law to protect the privacy of your health information. HPCS is required to provide you with this Notice of Privacy Practices to describe HPCS legal duties and your rights with respect to your protected health information. HPCS is also required to abide by the terms of this Notice which is currently in effect, and to notify you in the event of a breach of your unsecured health information. HPCS 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.
How HPCS may use and disclose your health information
The following describes the ways HPCS may use and disclose your health information for treatment, payment and health care operations.
To Provide Treatment
HPCS may use and disclose your health information to coordinate care within HPCS and with others involved in your care, such as your attending physician, members of the HPCS interdisciplinary team and other health care professionals who have agreed to assist HPCS in coordinating your care. For example, HPCS may disclose your health information to a physician involved in your care who needs information about your symptoms to prescribe appropriate medications.
To Obtain Payment
HPCS may use and disclose your health information so that HPCS or others may bill and receive payment for the care you receive from HPCS. For example, HPCS may be required by your health insurer to provide information regarding your health care status, your need for care and the care that HPCS intends to provide to you so that the insurer will reimburse you or HPCS for services provided and received.
To Conduct Health Care Operations
HPCS may use and disclose health information for its own operations to facilitate the functioning of HPCS and as necessary to provide quality care to all HPCS patients. Health care operations may 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 HPCS.
For example HPCS may use your health information to evaluate its performance, combine your health information with other HPCS patients in evaluating how to more effectively serve all HPCS patients, or disclose your health information to members of the HPCS workforce for training purposes.
Additional Permitted Uses and Disclosures of Health
As Required by Law: HPCS will disclose your health information when it is required to do so by any Federal, State or local law.
Public Health Risks: HPCS 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 about an individual who is a member of the employer’s workforce in certain limited situations, as authorized by law. To Report Abuse, Neglect Or Domestic Violence: HPCS is allowed to notify government authorities if HPCS believes a patient is the victim of abuse, neglect or domestic violence. HPCS 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
HPCS may disclose your health information to a health oversight agency for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action. However, HPCS 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
HPCS 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 HPCS 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, HPCS may disclose your health information to a law enforcement official for certain 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 HPCS has a suspicion that your death was the result of criminal conduct, including criminal conduct at HPCS.
- In an emergency in order to report a crime.
To Coroners And Medical Examiners
HPCS 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
HPCS 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, HPCS may disclose your health information prior to and in reasonable anticipation of your death.
For Organ, Eye Or Tissue Donation
HPCS 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
HPCS may, under certain circumstances, use and disclose your health information for research purposes. Before HPCS discloses any of your health information for research purposes, the project will be subject to an extensive approval process. This process includes evaluating a proposed research project and its use of health information and trying to balance the research needs with your need for privacy. Before HPCS uses or discloses health information for research, the project will have been approved through this research approval process. Additionally, when it is necessary for research purposes and so long as the health information does not leave our organization, HPCS may disclose your health information to researchers preparing to conduct a research project, for example, to help the researchers look for individuals with specific health needs. Lastly, if certain criteria are met, HPCS may disclose your health information to researchers after your death when it is necessary for research purposes.
For A Limited Data Set
HPCS may use or disclose a limited data set of your health information, that is, a subset of your health information for which all identifying information has been removed, for purposes of research, public health, or health care operations. Prior to our release, any recipient of that limited data set must agree to appropriately safeguard your health information.
In the Event of A Serious Threat To Health Or Safety
HPCS may, consistent with applicable law and ethical standards of conduct, disclose your health information if, in good faith, HPCS 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 HPCS 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
HPCS may release your health information for worker’s compensation or similar programs.
Other Uses and Disclosures of Your Health Information to Which You May Agree or Object
Persons Involved in Your Care
When appropriate, HPCS may share your health information with a family member, other relative or any other person you identify if that person is involved in your care and the information is relevant to your care or the payment of your care. HPCS also may notify your family about your location or general condition or disclose such information to an entity assisting in a disaster relief effort. You may ask HPCS at any time not to disclose your health information to any person(s) involved in your care. HPCS will agree to your request unless circumstances constitute an emergency or if the patient is a minor.
Fundraising Activities HPCS, our hospice foundation, or a HPCS business associate may use information about you, including your name, address, telephone number and the dates you received care, in order to contact you for fundraising purposes. You have the right to opt-out of receiving these communications from HPCS. If you do not want HPCS to contact you for fundraising purposes, notify the Development Associate at (607) 272-0212 and indicate that you do not wish to receive fundraising communications.
Authorization to use or Disclose Health Information
Other than the permitted uses and disclosures described above, HPCS will not use or disclose your health information without an authorization signed by you or your personal representative. If you or your representative signs a written authorization allowing HPCS to use or disclose your health information, you may cancel the authorization (in writing) at any time. If you cancel your authorization, HPCS will follow your instructions except to the extent that we have already relied upon your authorization and taken action. The following uses and disclosures for your health information will only be made with your signed authorization:
- Uses and disclosures for marketing purposes;
- Uses and disclosures that constitute a sale of health information;
- Most uses and disclosures of psychotherapy notes, if HPCS maintains psychotherapy notes; and
- Any other uses and disclosures not described in this Notice
Your Rights Regarding Your Health Information
You have the following rights regarding your health information that HPCS maintains:
Right to request restrictions
You have the right to request restrictions on uses and disclosures of your health information for treatment, payment and health care operations. You have the right to request a limit on the disclosure of your health information to someone who is involved in your care or the payment of your care. HPCS 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 Privacy Officer at (607) 272-0212.
Right to receive confidential communications
You have the right to request that HPCS communicates with you in a certain way. For example, you may ask that HPCS only conducts 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. HPCS will not request that you provide any reasons for your request and will attempt to honor any reasonable requests for confidential communications.
Right of access 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, HPCS may charge a reasonable fee for copying and assembling costs associated with your request. You have the right to request that HPCS provides you, an entity or a designated individual with an electronic copy of your electronic health record containing your health information, if HPCS uses or maintains electronic health records containing patient health information. HPCS may require you to pay the labor costs incurred in responding to your request.
Right to amend health care information
You or your representative have the right to request that HPCS amends 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 HPCS. A request for an amendment of records must be made in writing to the Privacy Officer at 172 East King Road, Ithaca, New York, 14850. HPCS 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 HPCS, if the records you are requesting are not part of HPCS 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 HPCS’s opinion, the records containing your health information are accurate and complete.
Right to an accounting
You or your representative has the right to receive an accounting of disclosures of your health information made by HPCS for the previous six (6) years. The accounting will not include disclosures made for treatment, payment or health care operations unless HPCS maintains your health information in an Electronic Health Record (EHR). 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. HPCS 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 opt-out of fundraising
You or your representative have the right to opt-out of receiving fundraising communications. Instructions for how to opt-out are included in each fundraising solicitation you receive.
Right to receive notification of a breach
You or your representative has the right to receive notification of a breach of your unsecured health information. If you have questions regarding what constitutes a breach or your rights with respect to breach notification, please
contact the Privacy Officer at (607) 272-0212.
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 Privacy Office at (607) 272-0212.
Changes to This Notice
HPCS reserves the right to change this Notice. HPCS reserves the right to make the revised Notice effective for health information HPCS already has about you, as well as any health information HPCS receives in the future. HPCS will post a copy of the current Notice in a clear and prominent location to which you have access. The Notice also is available to you upon request. The Notice contains, at the end of this document, the effective date. In addition, if HPCS revises the Notice, HPCS will offer you a copy of the current Notice in effect.
If You Have Any Questions Regarding This Notice
HPCS has designated the Privacy Officer as its contact person for all issues regarding patient privacy and your rights under the 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.
You or your personal representative has the right to express complaints to HPCS and to the Secretary of the U.S. Department of Health and Human Services if you or your representative believes that your privacy rights have been violated. Any complaints to HPCS should be made in writing to:Privacy Officer
172 East King Road
Ithaca, New York, 14850
Complaints, in writing or by telephone, to the Department of Health and Human Services 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
Phone (800) 368-1019. Fax (212) 264-3039
HPCS encourages you to express any concerns you may have regarding the privacy of your information. You will not be penalized in any way for filing a complaint.
This Notice is effective September 23, 2013.
The following page 9, indicating you or your personal representative has been provided a copy of HPCS’s Notice of Privacy Practices, will be detached from this Notice and made a part of your medical record.
Patient Name: _________________________ ID# __________
ACKNOWLEDGEMENT OF HAVING BEEN PROVIDED A COPY OF THE NOTICE OF PRIVACY PRACTICES
I am the patient or am duly authorized to act in the patient’s behalf. I acknowledge that I have been provided a copy of Hospicare and Palliative Care Services Notice of Privacy Practices.
Printed Name Relationship to the Patient
Signature of Witness Date
(Please insert this page in the patient’s medical record)