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HIPAA Notification 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.

 

Use and Disclosure of Health Information

The Agency 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 Agency has established

policies to guard against unnecessary disclosure of your health information.

A. The following is a summary of the circumstances under which and purposes for which your

health information may be used and disclosed:

1. To Provide Treatment. The Agency may use your health information to coordinate care

within the Agency and with others involved in your care, such as you attending

physician and other health care professionals who have agreed to assist the Agency in

coordinating care. For example, physicians involved in your care will need information

about your symptoms in order to prescribe appropriate medications. The Agency also

may disclose your health care information to individuals outside of the Agency involved

in your care including family members, pharmacists, suppliers of medical equipment or

other health care professionals. There are some services provided in our Agency

through contacts with business associates. Examples may include therapy or social

worker services in the provision of services or treatment. When these services are

contracted, we may disclose your health information to our business associate so that

they can provide services and treatment. To protect your health information, however,

we require the business associate to appropriately safeguard your information.

2. To Obtain Payment. The Agency may include your health information in invoices to

collect payment from third parties for the care you receive from the Agency. For

example, the Agency may be required by your health insurer to provide information

regarding your health care status so that the insurer will reimburse you or the Agency.

The Agency also may need to obtain prior approval from your insurer and may need to

explain to the insurer your need for home care and the services that will be provided to

you.

3. To Conduct Health Care Operations. The Agency may use and disclose health

information for its own operations in order to facilitate the function of the Agency and

as necessary to provide quality care to all of the Agency’s patients. Health care

operations include such activities as:

a. Quality assessment and improvement activities.

b. Activities designed to improve health or reduce health care costs.

c. Protocol development, case management and care coordination.

d. Contacting health care providers and patients with information about treatment

alternatives and other related functions that do not include treatment.

e. Professional review and performance evaluation.

 

HIPAA Notification of Privacy Practices

 

f. Training programs including those in which students, trainees or practitioners in

health care learn under supervision.

g. Training on non-health care professionals.

h. Accreditation, certification, licensing or credentialing activities.

i. Review and auditing, including compliance reviews, medical review, legal

services and compliance programs.

j. Business planning and development including cost management and planning

related analyses and formulary development.

k. Business management and general administrative activities of the Agency.

l. Fundraising for the benefit of the Agency.

 

For example the Agency may use your health information to evaluate its staff performance, combine

your health information with other Agency patients in evaluating how to more effectively serve all

Agency patients, disclose your health information to Agency 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).

4. For Fundraising Activities. The Agency may use information about you including your

name, address, phone number and the dates you received care in order to contact you

to raise funds for the Agency. The Agency may also release this information to a

related Agency foundation. If you do not want the Agency to contact you, notify

Privacy Officer and indicate that you do not wish to be contacted to receive these

communications. You have a choice of opting out of all future fundraising

communications or just campaign-specific communications. The Agency does not

condition treatment or payment based on an individual’s choice with respect to the

receipt of fundraising communications.

5. For Appointment Reminders. The Agency may use and disclose your health information

to contact you as a reminder that you have an appointment for a home visit.

6. For Treatment Alternatives. The Agency 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.

 

B. The following is a summary of the circumstances under which and purposes for which your

health information may also be used and disclosed:

1. When Legally Required. The Agency will disclose your health information when it is

required to do so by any Federal, State or local law.

2. When There Are Risks to Public Health. The Agency may disclose your health

information for public activities and purposes in order to:

a. 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.

 

HIPAA Notification of Privacy Practices

 

b. 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.

c. Notify a person who has been exposed to a communicable disease or who may

be at risk of contracting or spreading a disease.

d. Notify and employer about an individual who is a member of the workforce as

legally required.

 

3. To Report Abuse, Neglect or Domestic Violence. The Agency is allowed to notify

government authorities if the Agency believes a patient is the victim of abuse, neglect

or domestic violence. The Agency will make this disclosure only when specifically

required or authorized by law or when the patient agrees to the disclosure.

4. To Conduct Health Oversight Activities. The Agency 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 Agency, however, may not disclose your health information if you are the subject

of an investigation is not directly related to your receipt of health care or public

benefits.

5. In Connection with Judicial and Administrative Proceedings. The Agency 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 Agency makes reasonable efforts to either notify you about the request

or to obtain an order protecting your health information.

6. For Law Enforcement Purposes. As permitted or required by State law, the Agency may

disclose your health information to a law enforcement official for certain law

enforcement purposes as follows:

a. 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.

b. For the purpose of identifying or locating a suspect, fugitive, material witness or

missing person.

c. Under certain limited circumstances, when you are the victim of a crime.

d. To a law enforcement official if the Agency has a suspicion that your death was

the result of criminal conduct including criminal conduct at the Agency.

e. In an emergency in order to report a crime.

7. To Coroners and Medical Examiners. The Agency 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.

 

HIPAA Notification of Privacy Practices

 

8. To Funeral Directors. The Agency 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

Agency may disclose your health information prior to and in reasonable anticipation of

your death.

9. For Organ, Eye or Tissue Donation. The Agency 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.

10. For Research Purposes. The Agency may, under very select circumstances, use your

health information for research. Before the Agency discloses any of your health

information for such research purposes, the project will be subject to an extensive

approval process. Authorization will be required prior to use or disclosure of health

information for research purposes.

11. In the Event of a Serious Threat to Health or Safety. The Agency may, consistent with

applicable law and ethical standards of conduct, disclose your health information if the

Agency, 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.

12. For Specified Government Functions. In certain circumstances, the Federal regulations

authorize the Agency 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.

13. For Worker’s Compensation. The Agency may release your health information for

worker’s compensation or similar programs.

14. For Adverse Events. The Agency may disclose to the Food and Drug Administration

(FDA) health information relative to adverse events with respect to food, supplements,

product and product defects, or post marketing surveillance information to enable

product recalls, repairs, or replacement.

C. Authorization to use or Disclose Health Information

1. Other than is stated above, the Agency will not disclose your health information other

than with your written authorization. If you or your representative authorizes the

Agency to use or disclose your health information, you may revoke that authorization in

writing at any time.

2. Most uses and disclosures of psychotherapy notes (where appropriate), uses and

disclosures of protected health information for marketing purposes, require

authorization. Other uses and disclosures not described in the Notice of Privacy

Practices will be made only with authorization from you.

D. Authorization for the Sale of Protected Health Information

The Agency will not sell protected health information.

 

HIPAA Notification of Privacy Practices

 

E. Your Rights with Respect to Your Health Information

1. You have the following rights regarding your health information that the Agency

maintains:

a. Right to be notified. You will receive notifications of breaches of your

unsecured protected health information.

b. Right to certain restrictions. You may request to restrict certain disclosures of

protected health information to a health plan where you pay out of pocket in full

for the health care item or service.

c. 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 Agency’s disclosure of your health information to someone who is involved in

your care or the payment of your care. However, the Agency is not required to

agree to your request. If you wish to make a request for restrictions, please

contact the Privacy Officer.

d. Right to receive confidential communications. You have the right to request that

the Agency communicate with you in a certain way. For example, you may ask

that the Agency 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 Privacy Officer. The

Agency will not request that you provide any reasons for your request and will

attempt to honor your reasonable requests for confidential communications.

e. 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 the Privacy

Officer. A patient’s clinical record (whether hard copy or electronic form) must be

made available to a patient, free of charge, upon request at the next home visit,

or within 4 business days (whichever comes first).

f. Right to amend health care information. You or your representatives have the

right to request that the Agency 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 Agency. A request for an amendment of

records must be made in writing to Privacy Officer. The Agency 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 Agency, if the records you are requesting are not part of the

Agency’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 Agency, the records containing your health information

are accurate and complete.

 

HIPAA Notification of Privacy Practices

 

g. Right to an accounting. You or your representative have the right to request and

accounting of disclosures of your health information made by the Agency 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

Privacy Officer. 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 Agency 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.

h. Right to a paper copy of this notice. You or your representatives have a right to

a separate paper copy of this Notice at any time even if you or your

representatives have received this Notice previously. To obtain a separate paper

copy, please contact Privacy Officer.

 

F. Duties of the Agency

The Agency 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

Agency is required to abide by the terms of this Notice of its duties and privacy practices. The

Agency is required to abide by the terms of this Notice as may be amended from time to time.

The Agency 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 Agency changes its

Notice, the Agency will provide a copy of the revised Notice to you or your appointed

representative. You or your personal representatives have the right to express complaints to

the Agency and to the Secretary of the Texas Health and Human Services Commission if you

or your representatives believe that your privacy rights have been violated. Any complaints to

the Agency should be made in writing to Privacy Officer. The Agency 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.

G. Contact Person

The Agency has designated the Privacy Officer as its contact person for all issues regarding

patient privacy and your rights under the Federal privacy standards. You may contact this

person at Holy Hospice, 2300 Valley View Ln, Ste 915, Irving, TX. 75062, 214-556-3300.

H. Effective Date

This Notice is effective April 14, 2003.

Revision dates: August 19, 2013

January 13, 2018

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