Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU
MAY BE USED AND DISCLOSED. PLEASE REVIEW IT CAREFULLY.
This Notice is effective January 1, 2008.
This Notice (“Notice”) describes the health information practices of Hospice by the Sea, Inc. (“Hospice”). Hospice by the Sea creates a record of the care and services we provide. We need this record to provide you with excellent care and to comply with certain legal requirements. This Notice applies to all of the records of your care that Hospice generates or receives. This Notice will inform you about (1) the ways in which we may use and disclose your health information; (2) your rights; and (3) certain obligations we have regarding the use and disclosure of health information. We are required by law to do the following:
• except as otherwise described in this Notice, keep health information that identifies you private;
• give you notice of our legal duties and privacy practices with respect to your health information;
• follow the terms of this Notice or later revisions.
We may use and disclose health information about you:
• to provide you with health care treatment or services. We may disclose health information about you to doctors, nurses, technicians, medical students, members of a Hospice interdisciplinary team or other Hospice personnel (including volunteers), or other persons or companies who are involved, at our request, in taking care of you. We may also disclose your information to people outside Hospice who may be involved in your care, such as medical equipment suppliers.
• to bill and to collect payment for your treatment and services. For example, we may need to give information to your insurance company so the insurance company will pay us or reimburse you.
• for day-to-day Hospice operations. These uses and disclosures are necessary to run Hospice and make sure that all our patients receive excellent care. We may use health information to review our treatment and services and to evaluate the performance of our staff in caring for you; to decide what additional services we should offer, what services are not needed; and how we can improve on the services provided. We may disclose your health information to Hospice personnel (including volunteers) for review and learning purposes.
• to tell you about or recommend possible treatment options; health-related benefits or services; or other alternatives that may be of interest to you.
• such as your name, address, phone number and the dates you received care in order to contact you and your family for fundraising purposes. Hospice may also release this information to the Hospice by the Sea Foundation, Inc. If you do not want Hospice to contact you or your family for these purposes, please enter this restriction on the ‘Informed Consent for Care and Treatment’ or the ‘Consent for Bereavement Services’ as applicable. These forms are referred to in this Notice as the “Consent.”
• to a friend or family member who is involved in or paying for your Hospice care.
• to an entity assisting in a disaster relief effort if we deem it to be in your best interest.
• for research purposes, if pursuant to a research project approved by an appropriate institutional review board.
• when necessary to facilitate organ or tissue donation and/or transplantation, if you are an organ or tissue donor.
• as required by military command authorities, if you are a member of the armed forces.
• for workers’ compensation or similar programs that provide benefits for work-related injuries or illnesses.
• when necessary to prevent a serious threat to your health or safety, or the health or safety of the public or another person.
• for public health purposes or activities. These generally include the following purposes or activities:
• prevent or control disease, injury, or disability;
• report births or deaths;
• report child or elder abuse or neglect;
• report reactions to medications or problems with products;
• notify persons of recalls of products they may be using;
• notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
• notify appropriate government authorities if we believe a patient has been a victim of abuse, neglect, or domestic violence
• to a health oversight or accreditation agency for activities authorized by law such as audits, surveys, investigations, inspections, government programs, licensing compliance and compliance with civil rights laws.
• in response to a court or administrative order.
• to report a suspected crime; the location of the crime or victims; or the identity, description or location of the person suspected to have committed the crime.
• to a coroner, medical examiner, or to funeral directors.
• to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
• to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.
• to a correctional institution or law enforcement official if you are an inmate of the correctional institution or under the custody of the law enforcement official.
• to your named health care surrogate both during your lifetime and after your death, as well as to other legal representatives of your estate. If you have not named a health care surrogate, we may release your health information after your death to your next of kin or to a person known to us to have been involved in your care. If there are persons to whom you do NOT wish information released under this exception, please enter this restriction on the Consent.
• to a military supervisor, a transportation carrier, a school or an employer, if requested by someone in connection with visiting during your illness or after your death. If you wish to restrict this information, please enter your restriction on the Consent.
• as otherwise required by federal or state law.
You have the following rights regarding health information we maintain about you:
• except in limited circumstances, to inspect and copy health information. Submit your request in writing to the Manager of Health Information Management. We may charge a fee for the associated cost.
• to request that we amend your health information if you think that it is incorrect or incomplete. Submit your request in writing to the Manager of Health Information Management. You must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
- • was not created by Hospice, or the individual or entity that created the information is no longer available to make the amendment;
• is not part of the information kept by Hospice;
• is not part of the information that you would be permitted to inspect and copy; or
• is accurate and complete.
• to request an “accounting of disclosures.” This is a list of disclosures we made of your health information. Submit your request for an accounting in writing to the Manager of Health Information Management. Your request must state a time period, which may not be longer than six (6) years and may not include dates before February 26, 2003. We may charge you for our costs.
• to request a restriction or limitation on the use or disclosure of your health information. We are not required to agree to your request. Make your request for restrictions on the Consent. Tell us (1) what information you want to limit; (2) whether you want to limit use, disclosure, or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.
• to request that we communicate with you about medical matters in a certain way or at a certain location. Make your request specifying how and/or where you wish to be contacted in writing to the Manager of Health Information Management. We will not ask you the reason for your request. We will accommodate all reasonable requests.
• to ask for and receive a copy of this Notice (or a later version of it) at any time.
Changes to this Notice
We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for health information we already have about you and any information we receive in the future. We will post a copy of the current Notice in the Quality Management Department of the Hospice by the Sea offices located at 1489 W. Palmetto Park Rd., Boca Raton, FL 33486.
If you believe that privacy rights have been violated, you may file a complaint with Hospice or with the Secretary of the U.S. Department of Health and Human Services. To file a complaint with Hospice, contact the Manager of Health Information Management. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
Other Uses of Health Information
Uses and disclosures of health information not covered by this Notice or applicable laws will be made only with your written permission. You may revoke that permission, in writing, at any time, except to the extent that we already have disclosed information in reliance on your permission.
For Questions or Comments regarding this Notice please contact:
Hospice by the Sea, Inc.
Manager of Health Information Management
1531 W. Palmetto Park Rd., Boca Raton, FL 33486
This Notice is effective January 1, 2008.
Hospice by the Sea employees and volunteers respect your right to privacy and are committed to safeguarding the privacy of your health information.