Privacy

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.

Pacific Hospice Care is committed to protecting the confidentiality of your health information.

We are required by law to maintain the privacy of your medical information. We are also required to notify you of our legal duties and privacy practices regarding your medical information and abide by the practices of this Notice, unless more stringent laws or regulations apply.

WHO THIS APPLIES TO
This Notice describes this hospice's practices and those of:
Any health care professional authorized to enter information into your medical record;
Any member of the medical staff credentialed to practice with this hospice;
All departments and units of this hospice;
All employees, staff, and other health care personnel;
Any volunteer we allow to help you while you are a patient of this hospice.

This Notice of Privacy Practices provides detailed information about how we may use and disclose your medical information with or without authorization as well as more information about your specific rights with respect to your medical information.

DISCLOSURES OF YOUR MEDICAL INFORMATION THAT WE MAY MAKE WITHOUT AUTHORIZATION FOR TREATMENT, PAYMENT, AND OPERATIONS

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, caregivers, clergy who you have designated, pharmacists, suppliers of medical equipment or other health care professionals. Your information may be shared with any provider who is providing you with health care services. This includes coordinating your care with other providers and providing referrals to other providers. Examples of health care providers who may need your information to treat you include your doctor, pharmacist, nurse, and other providers such as physical therapists, home health providers, and x-ray technicians. We may also use your information to contact you for appointments and to provide information about health-related products and services that we believe may be helpful to you. We may share your information electronically with your health care providers in order to make sure they have your information as quickly as possible to treat you. We will use the utmost care in any situation where we need to disclose your information electronically. We may also share your medical information with any family member or friend who is involved in assisting with your health care. We will only do this if you agree, and will only share with them the information they need in order to help you. If you are unable to either agree or object to such a disclosure, we may disclose your health care information as necessary if we determine that it is in your best interest based on our professional judgment.

To Obtain Payment: The Hospice may use and disclose your health information 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. For this purpose, your health information may be used and disclosed on invoices, correspondence and other communications with your health insurer. The Hospice also may need to obtain prior approval from your insurer and may need to use and disclose health information to explain to the insurer your need for hospice care and the services that will be provided to you. In order to get your health care services paid for, we may have to provide your medical information to the party responsible for paying. This may include Medicare, Medicaid (state health plan), or your insurance company. Your insurance company or health plan may need your information for activities such as determining your eligibility for coverage, reviewing the medical necessity of the health care services, or providing approval for hospital stays.

To Conduct Health Care Operations: Your medical information may be used by us in order to support the business activities of the hospice and to ensure that quality health care services are being provided. Some of the activities which would be part of our operations would be quality assessment activity, employee review, training of medical personnel, licensure and accreditation, data aggregation, and audits by regulatory agencies. We may share your protected health information with third parties who perform services for us, such as transcription or billing. In those cases, we have written agreements with the third parties that they will not use or disclose your information for any other purposes, except as required by law. If you request a visit from your faith or religious community, your religious affiliation may be disclosed to outside clergy. 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 use and disclose your health you as a reminder that you have an appointment for a visit. 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.

OTHER DISCLOSURES THAT WE MAY MAKE WITHOUT YOUR AUTHORIZATION OR CONSENT, UNLESS SUCH DISCLOSURE IS FURTHER RESTRICTED OR LIMITED BY CALIFORNIA LAW:

There are a number of ways that your medical information may be used without your authorization, generally either because they are required by law or for public health and safety purposes. Those include:

Required by Law: The Hospice will disclose your health information when it is required to do so by any Federal, State or local law. Your medical information may be used or disclosed by us when required by law. If this happens, we will comply with the law and will only disclose the information necessary. You will be notified, as required by law, of any such uses or disclosures.

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. Your medical information may be used for public health activities. Public health authorities are authorized to collect or receive the information for purposes such as controlling disease, injury or disability.

Disaster Relief: We may disclose health care information about you to an entity assisting in a disaster relief effort so that your family and friends can be notified about your condition, status, and location.

Incidental Disclosures: Certain incidental disclosures of your health care information may occur as a by-product of lawful and permitted use and disclosures of your health care information. For example, a visitor may overhear a discussion about your care at the nursing station. These incidental disclosures are permitted if we apply reasonable safeguards to protect the confidentiality of your health care information.

Limited Data Set Information: We may disclose limited health care information to third parties for purposes of research, public health and health care operations. Before disclosing this information, we must enter into an agreement with the recipient of the information that limits who may use or receive the data and requires the recipient to agree not to re-identify the data or contact you. The recipient of your information is required to have appropriate safeguards to prevent inappropriate use or disclosure of your information.

Communicable Diseases: If required by law to do so, we may disclose your medical information to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.

Health Oversight: 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. Health oversight agencies are authorized to have access to medical information maintained by us for activities such as audits, investigations, and inspections. Agencies with this authority include government agencies that oversee the health care system, government benefit programs, government regulatory programs and civil rights laws.

Abuse or Neglect: 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. We may disclose your medical information to a public health authority that is authorized by law to receive reports of child abuse or neglect. We may also disclose your protected health information to the governmental agency authorized to receive such information if we believe that you have been a victim of abuse, neglect or domestic violence. Any disclosures of this nature will be made consistent with state and federal law.

Food and Drug Administration: We may disclose your medical information to a person or agency required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, or for product recalls, repairs or replacements.

Legal 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. We may disclose your medical information if required to by a court or administrative order to do so for an administrative or judicial proceeding, or in some cases in response to a subpoena, discovery request or other legal process.

Law Enforcement: 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. We may disclose your medical information, so long as applicable legal requirements are met, for law enforcement purposes. Examples of these purposes would be: (1) legal processes and otherwise required by law; (2) limited information requests for identification and location purposes; (3) pertaining to crime victims; (4) suspicion that death has occurred as a result of criminal conduct, (5) if crime occurs on the premises, and (6) for medical emergencies where it appears likely a crime occurred.

Coroners, Funeral Directors, and Organ Donation: 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. 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. 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. Your medical information may be disclosed to a coroner or medical examiner for identification purposes, determining cause of death or other legally required duties. Your medical information may also be released to a funeral director in order to permit him/her to perform their duties. Your information may be disclosed if we reasonably anticipate your death, and may also be used and disclosed for cadaveric organ, eye or tissue donation purposes.

Research: 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. Your medical information may be disclosed to researchers, provided that the research has been approved by an Institutional Review Board and the research protocols have been approved to ensure your privacy. We may disclose health care information about you to people preparing to conduct a research project; for example, to help the researcher identify patients with specific medical needs that would relate to the proposed research. Information used for this screening purpose will not leave the hospice.

Criminal Activity: As required by state and federal laws, we may disclose your medical information if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or of the public. We may also disclose your medical information if it is necessary for law enforcement authorities to identify or apprehend an individual.

Military Activity and National Security: Under certain circumstances, the medical information of Armed Forces personnel may be disclosed (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military service. Your medical information may also be disclosed to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President or others legally authorized.

Workers' Compensation: The Hospice may release your health information for worker's compensation or similar programs. Your medical information may be used or disclosed as necessary to comply with workers' compensation laws and other similar legally established programs.

Inmates: Your medical information may be used or disclosed by us if you are an inmate of a correctional facility and your physician created or received your medical information in the course of providing care to you.

In the Event of 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.

HOW WE WILL USE AND DISCLOSE YOUR MEDICAL INFORMATION WITH AUTHORIZATION
Other uses and disclosures of your medical information will be made only with your written authorization, unless otherwise permitted or required by law. You may revoke the authorization, at any time, in writing, except to the extent that we have already taken an action in reliance on the use or disclosure indicated in the authorization. If you need for us to share your medical information with someone for purposes other than those listed here, you should request an Authorization Form.

YOUR RIGHTS
The following information describes your rights with respect to your medical information that we maintain.

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 the Privacy Officer. You have the right to ask us to place restrictions on the way we use or disclose your medical information for treatment, payment, or healthcare operations. We are not required to agree to the restriction, but if we agree to a restriction, we will not use or disclose your medical information in violation of that restriction, unless it is needed for an emergency. If a restriction is no longer feasible, we will notify you..

Confidential Communications: You have the right to request that the Hospice communicate with you in a certain way. 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 the Privacy Officer. The Hospice will not request that you provide any reasons for your request and will attempt to honor your reasonable requests for confidential communications. We will accommodate reasonable requests to communicate with you about your medical information by different methods or alternative locations. For example, if you are covered on a health plan, but are not the subscriber, and would like your medical information sent to a different address than the subscriber, we can do that for you.

Access to Your Medical 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 the Privacy Officer. 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. You have the right to receive a copy of your medical information that we maintain, with some limited exceptions. You may request access to those records in writing and provide us with information about the specific information you need so that we can fulfill your request. We reserve the right to charge a reasonable fee for the cost of producing and mailing the copies.

Amendment of Your Medical 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 the Privacy Officer. 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. You have the right to ask us to change any of your medical information. You need to request this amendment in writing and submit it to us. In certain situations, we may have to deny your request, such as when the medical information in your records was created by another provider. Any denials will be in writing. You have the right to appeal our denial by filing a written statement of disagreement. For more information about this process, contact our Privacy Officer.

Accounting of Certain Disclosures. 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 the Privacy Officer. 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. You have a right to a listing of the disclosures we make of your medical information, except for those disclosures made for treatment, payment, or healthcare operations, or those disclosures made pursuant to your authorization. The type of disclosures typically contained in a listing would be disclosures made for mandatory public health purposes, law enforcement, legal proceedings, or for other required reporting such as birth and death certificates. If you would like to receive an accounting of your disclosures, you should contact our Privacy Officer.

QUESTIONS AND COMPLAINTS
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 the hospice. 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. To exercise any of the above rights, or if you are concerned that any of your privacy rights have been violated, please contact our Privacy Officer at (800) 787-5147. You also have the right to complain to the Secretary of Health and Human Services, at the Hubert H. Humphrey Building, 200 Independence Avenue SW, Washington, DC 20201. You will not be retaliated against for filing a complaint.

CHANGES FOR PRIVACY PRACTICES
The hospice reserves the right to change its privacy practices and its Notice of Privacy Practices at any time. The new notice will be effective for any medical information we create or maintain as of the date of the change. You may view a copy of our most current Notice of Privacy Practices on our website or request a copy from us. 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 the Privacy Officer at the hospice.