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.
PLEASE REVIEW IT CAREFULLY
We at Homeside Hospice in keeping with our high standards of care and in abidance of the laws are required to protect the privacy of your health information and are also required to provide you with this Notice of Privacy Practices to inform you of our legal duties and your rights with respect to your protected health information. We are 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.
*The following describes the ways Homeside Hospice may use and disclose your Personal Health Information or PHI, for treatment, payment and health care operations.
For Treatments: Homeside Hospice may use and disclose your PHI to coordinate care within the hospice and with others involved in your care, such as your attending physician, members of the hospice’s interdisciplinary team and other health care professionals who have agreed to assist us in coordinating your care. For example, we may disclose your health information to a physician involved in your care who needs information about your symptoms to prescribe appropriate medications.
For Payments: Homeside Hospice may use and disclose your PHI so that we or others may bill and receive payment for the care you receive from us. For example, we may be required by your health insurer to provide information regarding your health care status, your need for care and the care that Homeside Hospice intends to provide to you so that the insurer will reimburse you or the hospice for services provided and received.
For Health Care Operations: Homeside Hospice may use and disclose PHI for its own operations to facilitate the functioning of the hospice and as necessary to provide quality care to all of our 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 the Hospice.
*For example Homeside Hospice may use your PHI to evaluate its performance, combine your health information with other patients in evaluating how to more effectively serve all hospice patients or disclose your health information to members of the hospice’s workforce for training purposes.
ADDITIONAL PERMITTED USES AND DISCLOSURES
OF HEALTH INFORMATION
As Required by Law: We will disclose your PHI when we are required to do so by any Federal, State or local law.
Public Health Risks: We may disclose your PHI 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 and 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.
Abuse, Neglect or Domestic Violence: We are allowed to notify government authorities if we believe a patient is the victim of abuse, neglect or domestic violence. We will make this disclosure only when specifically required or authorized by law or when the patient agrees to the disclosure.
Health Oversight Activities: We may disclose your PHI to a health oversight agency for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action. However, we 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.
Judicial and Administrative Proceedings: We may disclose your PHI 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 we make reasonable efforts to either notify you about the request or to obtain an order protecting your health information.
Law Enforcement: As permitted or required by State law, we may disclose your PHI 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 we have 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.
Coroners and Medical Examiners: We may disclose your PHI to coroners and medical examiners for purposes of determining your cause of death or for other duties, as authorized by law.
Funeral Directors: We may disclose your PHI 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, we may disclose your PHI prior to and in reasonable anticipation of your death.
Organ, Eye or Tissue Donation: We may use or disclose your PHI 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.
Research Purposes: We may, under certain circumstances, use and disclose you’re PHI for research purposes. Before we disclose 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 we use or disclose 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, it 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, we may disclose your health information to researchers after your death when it is necessary for research purposes.
Limited Data Set: We may use or disclose a limited data set of your PHI 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.
Serious Threat to Health or Safety: We may, consistent with applicable law and ethical standards of conduct, disclose your PHI if, in good faith, we believe 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.
Specified Government Functions: In certain circumstances, the Federal regulations authorize us to use or disclose your PHI 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.
Worker's Compensation: We 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, we may share your PHI with a family member, other relative or any other person you identify that is involved in your care and the information is relevant to your care or the payment of your care. We 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 us at any time not to disclose your health information to any person(s) involved in your care. We will agree to your request unless circumstances constitute an emergency or if the patient is a minor.
Fundraising Activities: Homeside Hospice, our hospice foundation, or our 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 us. If you do not want us to contact you for fundraising purposes, notify
Barbara Sost, LPN, Director of QAPI and Compliance at Homeside Hospice, 732-381-3444 and indicate that you do not wish to receive fundraising communications.
AUTHORIZATIONS TO USE OR DISCLOSE HEALTH INFORMATION
Other than the permitted uses and disclosures described above, Homeside Hospice 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 us to use or disclose your health information, you may cancel the authorization in writing at any time. If you cancel your authorization, we 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:
1. Uses and disclosures for marketing purposes;
2. Uses and disclosures that constitute a sale of health information;
3. Most uses and disclosures of psychotherapy notes, if we maintain psychotherapy
4. 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:
*Right to request restrictions: You have the right to request restrictions on uses and disclosures of your PHI for treatment, payment and health care operations. You have the right to request a limit on the disclosure of your PHI to someone who is involved in your care or the payment of your care. We are 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:
Barbara Sost, LPN, Director of QAPI and Compliance at Homeside Hospice, 732-381-3444.
*Right to receive confidential communications: You have the right to request that we 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:
Barbara Sost, LPN, Director of QAPI and Compliance at Homeside Hospice, 732-381-3444. We 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 Barbara Sost, LPN, Director of QAPI and Compliance at Homeside Hospice, 732-381-3444. If you request a copy of your PHI, we may charge a reasonable fee for copying and assembling costs associated with your request. You have the right to request that we provide you, an entity or a designated individual with an electronic copy of your electronic health record containing your health information, if we use or maintain electronic health records containing patient health information. We may require you to pay the labor costs incurred in responding to your request.
* Right to amend health care information: You or your representative has the right to request that we 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 us. A request for an amendment of records must be made in writing to:
Barbara Sost, LPN, Director of QAPI and Compliance 67 Walnut Ave., Clark, NJ 07066.
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 us, if the records you are requesting are not part of our 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 our opinion, the records containing your health information are accurate and complete.
* Right to an accounting: You or your representative have the right to receive an accounting of disclosures of your health information made by Homeside Hospice for the previous six (6) years. The accounting will not include disclosures made for treatment, payment or health care operations unless we maintain your health information in an Electronic Health Record (EHR). The request for an accounting must be made in writing to:
Barbara Sost, LPN, Director of QAPI and Compliance 67 Walnut Ave., Clark, NJ 07066. The request should specify the time period for the accounting starting on or after April 14, 2003. We 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 please contact:
Barbara Sost, LPN, Director of QAPI and Compliance at Homeside Hospice, 732-381-3444.
*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:
Barbara Sost, LPN, Director of QAPI and Compliance at Homeside Hospice, 732-381-3444.
CHANGES TO THIS NOTICE
Homeside Hospice reserves the right to change this Notice. We reserve the right to make the revised Notice effective for health information we already have about you, as well as any health information we receive in the future. We 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 we revise the Notice, we will offer you a copy of the current Notice in effect.
SAMPLE NOTICE OF PRIVACY PRACTICES FOR HOSPICE
IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE
Homeside Hospice has designated Barbara Sost, LPN, Director of QAPI and Compliance as its contact person for all issues regarding patient privacy and your rights under the Federal privacy standards. You may contact this person at 67 Walnut Ave. Suite 205, Clark, NJ 07066. Phone: 732-381-3444
You or your personal representative has the right to express complaints to the hospice 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 the hospice should be made in writing to Barbara Sost, LPN, Director of QAPI and Compliance 67 Walnut Ave. Suite 205, Clark, NJ 07066.
We encourage 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 20, 2013
Providing Dignity, Comfort, and Inner Peace
Call Us: +1 732 381 3444