Privacy Statement





This notice describes Hospice of Lake & Sumter, Inc. d/b/a Cornerstone Hospice (the “Hospice”) practices and that of (a) any health care professional authorized to enter information into your medical record, (b) volunteers we allow to help you while you are receiving Hospice care, (c) all Hospice employees and staff, and (d) physician staff providing care under arrangement with Hospice.



Hospice may use your health information for purposes of providing you treatment, obtaining payment for your care and conducting health care operations. Unless otherwise indicated, your health information may be used or disclosed only after the Hospice has obtained your written consent or authorization. The Hospice has established a policy to guard against unnecessary disclosure of your health information.





Ÿ To Provide Treatment.  The Hospice may use 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 have agreed to assist Hospice in coordinating care. For example, physicians involved in your care will need information about your symptoms in order to prescribe appropriate medications.  With your consent, the Hospice also may disclose your health care information to individuals outside of the Hospice involved in your care including family members, clergy whom you have designated, pharmacists, suppliers of medical equipment or other health care professionals that Hospice uses in order to coordinate your care.

Ÿ To Obtain Payment.  With your consent, the Hospice may include your health information in invoices to collect payment from third parties for the care you may 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 you or the Hospice.  The Hospice 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.

Ÿ To Conduct Health Care Operations.  Hospice may use and disclose health care information for its own operations in order to facilitate the function of  Hospice and as necessary to provide quality care to all of 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.
  • 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 the Hospice.

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, or disclose your health information to the Hospice staff and contracted personnel for training purposes.

The Hospice may disclose certain information about you including your name, your general health status, your religious affiliation and where you are in the Hospice facility in a Hospice directory while you are in the Hospice inpatient facility.  The Hospice may disclose this information to people who ask for you by name.  Please inform us if you do not want your information to be included in the directory.

Ÿ Appointment Reminders. We may use and disclose health information to contact you with a reminder regarding a visit to you.

Ÿ Treatment Alternatives.  We may use and disclose health information to tell you about or recommend possible treatment options or alternatives.

Ÿ For Fundraising Activities.  The Hospice may use information about you including your name, address, phone number and the dates you received care at the Hospice in order to contact you or your family to raise money for the Hospice (unless you tell us you do not want to be contacted).  The Hospice may also release this information to a related Hospice foundation.




Ÿ When Legally Required.  The Hospice will disclose your health information when it is required to do so by Federal, State or local law.

Ÿ 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 and to conduct post-marketing surveillance and compliance with requirements 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.

Ÿ 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.

Ÿ 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.

Ÿ In Connection with Judicial and Administrative Proceedings.  The Hospice 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.

Ÿ 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
  • To a law enforcement official if the Hospice 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.


Ÿ 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 other duties, as authorized by law.

Ÿ To Funeral Directors.  The Hospice 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, the Hospice may disclose your health information prior to and in reasonable anticipation of your death.

Ÿ 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 tissues for the purpose of facilitating the donation and transplantation.

Ÿ 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.

Ÿ 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.

Ÿ Military and Veterans.  If you are a member of the Armed Forces, the Hospice may release health information about you as required by military command authorities.  The Hospice may also release health information about foreign military personnel to the appropriate foreign military authority.

Ÿ National Security and Intelligence Activities.   The Hospice may release health information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

Ÿ Protective Services for the President and Others.   The Hospice may disclose health information about you to authorized federal officials so they may provide protection to the President, other authorized Persons or foreign heads of state or conduct special investigations.

Ÿ Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, Hospice may release health information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the correctional institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.

Ÿ For Worker’s Compensation.  The Hospice may release your health information for worker’s  compensation or similar programs providing benefits for work related injuries or illnesses.



Other than as 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.  If you revoke your permission, the Hospice will no longer use or disclose health information about you for the reasons covered by your written authorization.  You understand that the Hospice is unable to take back any disclosures that have already been made with your authorization, and that the Hospice is required by law to retain our records of the care provided to you.



You have the following rights regarding your health information that Hospice maintains:

  • Right to Request Restrictions.  You have the right to request a restriction or limitation on the Health information Hospice uses or discloses about you for treatment, payment or health care operations, and to request a limit on the health information the Hospice discloses about you to someone who is involved in your care or payment, such as a family member or friend. The Hospice is not required to agree to your request. If the Hospice does agree, however, the Hospice will comply with your request unless the information is needed to provide you with emergency or other vital treatment. To request restrictions, you must tell the Hospice (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want to limits to apply, for example, disclosure to your spouse. To request restrictions, you must submit your request in writing to our Privacy Officer at the address shown below.
  • Right to Receive Confidential Communications. You have the right to request, in writing, 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. The Hospice will not require 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 health information about you.  Usually, this includes medical and billing records, but does not include psychotherapy notes or information compiled in reasonable anticipation of, or for use in a civil, criminal or administrative action or proceeding. To inspect and copy health information, you must submit your request in writing. 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. The Hospice 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 the Hospice, if the records you are requesting are not part of the Hospice’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 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 This is a list of the disclosures the Hospice made of health information about you but does not include disclosures (a) to carry out treatment, payment or health care operations; (b) made to you; (c) to other persons involved in your care; (d) for national security or intelligence purposes; or (e) to correctional institutions or law enforcement officials as provided by law. The request for an accounting must be made in writing. The request should specify the time period for the accounting and must be after April 14, 2003. 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.  The Hospice will notify you of the costs involved before completing your request, so that you will have the chance to withdraw or modify your request before any costs are incurred.
  • Right to a Paper Copy of this Notice.  No later than the date of the first service delivery on or after April 14, 2003, a copy of this Notice shall be provided to you. 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. The Hospice patient or a representative may also obtain a copy of the current version of the Hospice’s Notice of Privacy Practices at its website:



The Hospice is required by law to maintain the privacy of your health information, including medical identity, and to provide to you and your representative this Notice of its duties and privacy practices.  The Hospice is required to abide by terms of this Notice as may be amended from time to time.  Hospice 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 the Hospice changes its Notice, the Hospice will post a revised copy of the current notice at each of the Hospice facilities reflecting its effective date.


You or your personal representative have the right to express complaints to the Hospice and to the Secretary of Health and Human Services if you or your representative believe that your privacy rights have been violated. Any complaints to the Hospice should be made in writing to the Privacy Officer or designee. The Hospice 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.


The Hospice’s contact person for all issues regarding specific requests, patient privacy and your rights under The Federal privacy standards is:


Privacy Officer or Designee

 Hospice Program

Hospice of Lake & Sumter, Inc., d/b/a CORNERSTONE HOSPICE

2445 Lane Park Road

Tavares, FL  32778



This Notice is effective July 25, 2008.


If you have any questions regarding this notice, please contact:


Privacy Officer or Designee at Hospice Program

Hospice of Lake & Sumter, Inc., d/b/a CORNERSTONE HOSPICE

2445 Lane Park Road, Tavares, FL  32778

Telephone: 352-343-1341