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Privacy Practices

 

 

 

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU   MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS   INFORMATION.  PLEASE REVIEW IT   CAREFULLY. 

USE AND DISCLOSURE OF HEALTH   INFORMATION

Hospice of Acadiana, Inc. [“Hospice”] 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.  The Hospice has   established policies 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:

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 the Hospice in coordinating care.  For example, physicians involved in your   care will need information about your symptoms in order to prescribe   appropriate medications.  The Hospice   also may disclose your health care information to individuals outside of the   Hospice 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.  The Hospice   may include your health information in invoices to collect payment from third   parties for the care you 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.  If the hospice is paid out of pocket in   full for services rendered, you have the right to request restriction of   disclosure to third party health plans. You also have the right to restrict   disclosure to a health plan for carrying out payment or healthcare operations   as long as the disclosure is not otherwise required by law.

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

-         Fundraising for   the benefit 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, 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 as part of general fundraising and community   information mailings (unless you tell us you do not want to be contacted).

The Hospice may disclose   certain information about you including your name, your general health status,   your religious affiliation while you are receiving care in a inpatient   facility.  The Hospice may disclose   this information to people who ask for you by name.  If you do not wish for this information to   be available, please inform us in writing.

For Fundraising Activities.  The Hospice   may use information about you including your name, address, phone number and   the dates you received care in order to contact you or your family to raise   money for the Hospice.  The Hospice may   also release this information to Hospice of Acadiana Foundation.  If you do not want the Hospice to contact   you or your family, notify Hospice of Acadiana, Inc.’s Privacy Officer   at 337-237-1332 ext. 3718 and indicate that you do not wish to be   contacted.

For Appointment Reminders.  The Hospice   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.  The Hospice   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.

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

When Legally   Required.  The Hospice 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.    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.

-     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 workforce as legally   required.

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.

To Conduct Health Oversight   Activities.  The Hospice may disclose your health   information to a health oversight hospice 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.

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, but only when the Hospice 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, the Hospice 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 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.

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.

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.

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 tissue for the purpose of facilitating the donation and   transplantation.

          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.

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.

For Specified Government Functions.  In certain   circumstances, the Federal regulations authorize the Hospice 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.  The Hospice   may release your health information for worker’s compensation or similar   programs.

AUTHORIZATION TO USE OR DISCLOSE   HEALTH INFORMATION

Other than is 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.

YOUR RIGHTS WITH RESPECT TO YOUR   HEALTH INFORMATION

You have the following rights regarding your health   information that the Hospice 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 the Hospice ‘s disclosure of your health information to someone   who is involved in your care or the payment of your care.  However, the Hospice is not required to   agree to your request.  If you wish to   make a request for restrictions, please contact Hospice of Acadiana, Inc.’s   Privacy Officer.

-     Right to receive confidential   communications.  You have the   right to request 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.  If you wish to receive confidential   communications, please contact Hospice of Acadiana, Inc.’s Privacy Officer   at 337-706-3718. The Hospice 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 Hospice   of Acadiana, Inc.’s Privacy Officer at 337-706-3718.    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.  You or your representative have the right   to request that the Hospice 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 the Hospice.    A request for an amendment of records must be made in writing to Hospice   of Acadiana, Inc.’s Privacy Officer at 2600 Johnston Suite 200, Lafayette, LA   70503. 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.

-     Breach Notification. You have   the right to receive notification of any breach in protected health   information as well as unsecured protected health information.  Notification will be made by certified mail   with appropriate details as well as your rights and action to be taken, if   any.

-     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 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 Hospice of Acadiana, Inc.’s Privacy   Officer at 2600 Johnston Suite 200, Lafayette, LA 70503.  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.    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.

-         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 Hospice of Acadiana, Inc.’s Privacy Officer   at 337-706-3718.

DUTIES OF THE HOSPICE

The Hospice 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.    The Hospice is required to abide by the terms of this Notice as may be   amended from time to time.  The 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 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 the Hospice and to the   Secretary of DHHS if you or your representative believe that your privacy   rights have been violated.  Any   complaints to the Hospice should be made in writing to Hospice of Acadiana, Inc.’s   Privacy Officer at 2600 Johnston Suite 200, Lafayette, LA 70503.  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.

CONTACT PERSON

The Hospice has designated the Privacy Officer, Louis W.   Hebert, Jr., as its contact person for all issues regarding patient   privacy and your rights under the Federal privacy standards.  You may contact this person at 2600   Johnston Suite 200, Lafayette, LA 70503 and 337-706-3718.

EFFECTIVE DATE

 

This Notice is effective April 14,   2003.

 

IF YOU HAVE ANY QUESTIONS   REGARDING THIS NOTICE, PLEASE CONTACT Hospice of Acadiana, Inc.’s Privacy   Officer at 2600 Johnston Suite 200, Lafayette,    LA70503   and 337-706-3718.