
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.
HospiceCare of Boulder and Broomfield Counties (HospiceCare) 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. HospiceCare has established policies to guard against unnecessary disclosure of your health information. If you have any questions or concerns regarding patient privacy and your rights under the Federal privacy standards please contact the HospiceCare Privacy Officer; 2594 Trailridge Drive East, Lafayette, CO 80026; 303.449.7740.
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. HospiceCare may use your health information to coordinate care within our hospice and with others involved in your care, such as your attending physician, members of the HospiceCare interdisciplinary team and other health care professionals who have agreed to assist HospiceCare in coordinating care, including bereavement care for your family. For example, physicians involved in your care will need information about your symptoms in order to prescribe appropriate medications. HospiceCare also may disclose your healthcare information to individuals outside of the hospice involved in your care including family members, pharmacists, suppliers of medical equipment or other healthcare professionals.
Obtain Payment. HospiceCare may include your health information in invoices to collect payment from third parties for the care you may receive from our hospice. For example, HospiceCare may be required by your health insurer to provide information regarding your healthcare status so that the insurer will reimburse you or the hospice. HospiceCare 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.
To Conduct Health Care Operations. HospiceCare may use and disclose health care information for its own operations in order to facilitate the function of hospice and as necessary to provide quality care to all of HospiceCare 's patients. Healthcare operations include such activities as:
For example, HospiceCare 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 or your family as part of general fundraising and community information mailings (unless you tell us you do not want to be contacted).
HospiceCare may disclose certain information about you, including your name, your general health status, and where you are in the HospiceCare facility. HospiceCare may disclose this information to people who ask for you by name, unless you inform us that you do not want this information to be shared with people who ask for you by name.
THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED:
For Fundraising Activities. HospiceCare may use information about you, including your name, address, phone number and the dates you received care from this agency, in order to contact you or your family to raise money for HospiceCare. For example, listing your name as a patient or donor in HospiceCare newsletters mailed to the community at large. If you do not want HospiceCare to contact you or your family or use your name on donor lists, call our Privacy Officer (303.449.7740) and indicate that you do not wish to be contacted.
For Appointment Reminders. HospiceCare 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. HospiceCare 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.
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:
To Report Abuse, Neglect Or Domestic Violence. HospiceCare is allowed to notify government authorities if the agency believes a patient is the victim of abuse, neglect or domestic violence. HospiceCare 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. HospiceCare may disclose your health information to a health oversight agency for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action. HospiceCare 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 healthcare or public benefits.
In Connection With Judicial And Administrative Proceedings. HospiceCare 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 HospiceCare makes reasonable efforts to either notify you about the request or to obtain an order protecting your health information.
For Law Enforcement Purposes. HospiceCare may disclose your health information to a law enforcement official for law enforcement purposes as follows:
To Coroners And Medical Examiners. HospiceCare 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. HospiceCare 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, HospiceCare may disclose your health information prior to and in reasonable anticipation of your death.
For Organ, Eye Or Tissue Donation. If you notify HospiceCare that you are an organ, eye or tissue donor, HospiceCare 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. HospiceCare may, under very select circumstances, use your health information for research. Before HospiceCare 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. HospiceCare may, consistent with applicable law and ethical standards of conduct, disclose your health information if HospiceCare, 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, 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 in law enforcement custody.
For Worker's Compensation. HospiceCare may release your health information for worker's compensation or similar programs.
Other than is stated above, HospiceCare will not disclose your health information other than with your written authorization. If you or your representative authorizes HospiceCare to use or disclose your health information, you may revoke that authorization in writing at any time.
You have the following rights regarding your health information that the hospice maintains:
HospiceCare 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. HospiceCare is required to abide by terms of this Notice as may be amended from time to time. HospiceCare 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 HospiceCare makes significant changes to its Notice, HospiceCare 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 HospiceCare and to the Secretary of Health and Human Services if you or your representative believe that your privacy rights have been violated. Any complaints to HospiceCare should be made in writing to the HospiceCare Privacy Officer, 2594 Trailridge Drive East, Lafayette, CO 80026. HospiceCare 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. HospiceCare will maintain medical records for six years from the completion of service to the patient. Records older than six years will be destroyed in a confidential manner.
HospiceCare’s contact person for all issues regarding patient privacy and your rights under the federal privacy standards is the HospiceCare Privacy Officer; 2594 Trailridge Drive East, Lafayette, CO 80026; 303.449.7740.
This Notice is effective April 14, 2003.
IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT THE HOSPICECARE PRIVACY OFFICER AT 303.449.7740.