WHO WILL FOLLOW THIS NOTICE
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.
USE AND DISCLOSURE OF HEALTH INFORMATION
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:
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:
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:
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.
AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION
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.
YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION
You have the following rights regarding your health information that Hospice maintains:
DUTIES OF HOSPICE
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 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