NOTICE OF PRIVACY PRACTICES

As required by the Privacy Regulations Promulgated Pursuant to the Health Insurance Portability and Accountability Act of 1996
(HIPPA)

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO YOUR IDENTIFIABLE HEALTH INFORMATION.

PLEASE REVIEW THIS NOTICE CAREFULLY

 OUR COMMITMENT TO YOUR PRIVACY

Hospice of Orange and Sullivan Counties, Inc. is dedicated to maintaining the privacy of your health information. In the course of care, we will create records regarding you and the treatment and services provided to you. We are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and privacy practices concerning your identifiable health information. By law, we must follow the terms of the notice of privacy practices that we have in effect at this time.

To summarize, this notice provides you with the following important information:

• How we may use and disclose your identifiable health information
• Your privacy rights in your identifiable health information
• Our obligations concerning the use and disclosure of your identifiable health information

A. The following categories describe the different ways in which we may use and disclose your identifiable health information on a daily or routine basis:

1.Treatment.  This organization may use your identifiable health information to treat you. For example, we may ask you to undergo laboratory tests (such as blood or urine tests), and we may use the results to help us reach a diagnosis. Many of the people who work for our organization may use or disclose your identifiable health information to others who may assist in your care, such as your physician, therapists, spouse, children or parents.

2.Payment.  This organization may use and disclose your identifiable health information in order to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. We also may use and disclose your identifiable health information to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your identifiable health information to bill you directly for services and items.

3.Health Care Operations.  This organization may use and disclose your identifiable health information to operate our business. As examples of the ways in which we may use your health information to evaluate the quality of care you received from use, or to conduct cost-management and business planning activities for our practice.

4. Appointment Reminders.  This organization may use and disclose your identifiable health information to contact you and remind you of visits/deliveries.

5.Health-Related Benefits and Services.  This organization may use and disclose your identifiable health information to inform you of health-related benefits or services that may be of interest to you.

6.Release of Information to Family/Friends.  This organization may release your identifiable health information to a friend or family member that is helping you pay for your healthcare, or who assists in taking care of you.

B.There are also unique situations where we may release health information based upon special circumstances. The following categories describe unique scenarios in which we may use or disclose your identifiable health information:

• Maintaining vital records, such as births and deaths.
• Reporting child abuse or neglect.
• Preventing or controlling disease, injury or disability.
• Notifying a person regarding potential exposure to a communicable disease.
• Notifying a person regarding a potential rise for spreading or contracting a disease or condition.
• Reporting reactions to drugs or problems with products or devices.
• Notifying individuals if a product or device they may be using has been recalled.
• Notifying appropriate government agency(ies) and authority(ies) regarding the potential abuse or neglect of an adult patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information.
• Notifying your employer under limited circumstances related primarily to workplace injury and illness or medical surveillance.

Lawsuits and Similar Proceedings.  This organization may use and disclose your identifiable health information in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We may also disclose your identifiable health information in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.

Law Enforcement.  We may release identifiable health information if asked to do so by a law enforcement official:

• Regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement.
• Concerning a death we believe might have resulted from criminal conduct.
• Regarding criminal conduct at our offices.
• In response to a warrant, summons, court order, subpoena or similar legal process.
• To identify/locate a suspect, material witness, fugitive or missing person.
• In an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator).

 Military.  This organization may disclose your identifiable health information if you are a member of the U.S. foreign military forces (including veterans) and if required by the appropriate military command authorities.

National Security.  This organization may disclose your identifiable health information to federal officials for intelligence and national security activities authorized by law. We also may disclose your identifiable health information to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigation.

Inmates.  This organization may disclose your identifiable health information to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary: (a) for the institution to provide health care services to you, (b) for the safety and security of the institution, and/or (c) to protect your health and safety or the health and safety of other individuals.

Worker’s Compensation.  This organization may release your identifiable health information for worker’s compensation and similar programs.

YOUR PRIVACY RIGHTS

You have the following rights regarding the identifiable health information that we maintain about you:

• Confidential Communications.  You have the right to request that our organization communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than work. In order to request a type of confidential communication, you must make a verbal request to your primary nurse who will inform the Interdisciplinary Team members specifying the requested method of contact, or the location where you wish to be contacted. Our organization will accommodate reasonable requests. You do not need to give a reason for your request.
  
• Requesting Restrictions.  You have the right to request a restriction in our use and disclosure of your identifiable health information and treatment, payment or health care operations. Additionally, you have the right to request that we limit our disclosure of your identifiable health information to individuals involved in your care or the payment for your care, such as family members and friends. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. In order to request a restriction in our use of disclosure of your identifiable health information, you must make your request in writing to Clayton Burton, Corporate Compliance Officer, Hospice of Orange & Sullivan Counties, Inc., 800 Stony Brook Court, Newburgh, N.Y. 12550 (845) 561- 7382. Your request must describe in a clear and concise fashion; (a) the information you wish to restrict; (b) whether you are requesting to limit our practice’s use, disclosure or both; and (c) to whom you want the limits to apply. 

• Inspection and Copies.  You have the right to inspect and obtain a copy of the identifiable health information that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes. You must submit your request in writing to Clayton Burton, Corporate Compliance Officer, Hospice of Orange & Sullivan Counties, Inc., 800 Stony Brook Court, Newburgh, N.Y. 12550 (845) 561- 7382 in order to inspect and/or obtain a copy of your identifiable health information. Our organization may charge a fee for the costs of copying, mailing, labor and supplies associated with your request. Our practice may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Reviews will be conducted by another licensed health care professional chosen by us.

• Amendment.  You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our organization. To request an amendment, your request must be made in writing and submitted to Clayton Burton, Corporate Compliance Officer, (845) 561- 7382. You must provide us with a reason that supports your request for amendment. Our organization will deny your request if you fail to submit your request (and the reason supporting your request) in writing. Also, we may deny your request if you ask us to amend information that is: (a) accurate and complete; (b) not part of the identifiable health information kept by or for the organization; (c) not part of the identifiable health information which you would be permitted to inspect and copy or (d) not created by our organization, unless the individual or entity that created the information is not available to amend the information.

• Accounting for Disclosures.  All of our patients have the right to request an “accounting of disclosures.” An “accounting of disclosures” is a list of certain disclosures our organization has made of your identifiable health information. In order to obtain an accounting of disclosures, you must submit your request in writing to Clayton Burton, (845) 561- 7382. All requests for an “accounting of disclosures” must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. The first list you request within a 12-month period is free of charge, but we may charge you for additional lists within the same 12-month period. Our organization will notify you of the costs involved with additional requests, and you may withdraw your requests before you incur any costs.

• Right to a Paper Copy of this Notice.  You are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice contact Clayton Burton, Corporate Compliance Officer, (845) 561- 7382.

• Right to File a Complaint.  If you believe your privacy rights have been violated, you may file a complaint with our organization or with the Secretary of the Department of Health and Human Services. To file a complaint with our organization, contact Clayton Burton, Corporate Compliance Officer, (845) 561- 7382. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

• Right to Provide an Authorization for Other Uses and Disclosures.  This organization will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide us regarding the use and disclosure of your identifiable health information may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your identifiable health information for the reason described in the authorization. Please note, we are required to retain records of your care.

 OUR OBLIGATIONS UNDER THE LAW

As a health care provider, we have obligations under the Federal privacy laws. Under this law, we must:

• Maintain the privacy of protected health information and to provide individuals with notice of our legal duties and privacy practices with respect to protected health information;

• Abide by the terms of the notice currently in effect;

• Notify you that we may change the terms of its notice and to make the new notice provisions effective for all protected health information that we maintain, and describe how we will provide individuals with a revised notice;

• Inform you on how you may complain to us and to the Secretary of the Department of Health and Human Services. We have given you a brief description of how such a complaint may be filed and that you will not be retaliated against for filing such complaint;

• This notice will be available at our offices for inspection; it will be posted in a clear and prominent location where it is reasonable to expect individuals seeking service will be able to read the notice, and this notice will be posted on our website.

 ACKNOWLEDGMENT OF OUR PROCEDURES

The Federal privacy law requires that we obtain your signature as an acknowledgment that you have received this notice and that we have procedures in place to notify you of changes to our privacy practices.

• By signing the acknowledgment of this notice, you are simply acknowledging receipt of this Privacy Notice. In addition, by providing us with a current mailing address, you are allowing us to assure that any changes in our privacy practices are properly mailed to you so that you may be notified of such changes. In order to endure that our records are accurate, you should notify us of any change in your current address at least five (5) days before you move.

• The terms of this notice apply to all records containing your identifiable health information that are created or retained by our practice. It is effective as of the date indicated above. We reserve the right to change our notice and privacy practices. Any change will be effective for all of your records, which we have created or maintained in the past, and for any of your records we may create or maintain in the future. Our organization will post a copy of our current notice in our offices in a prominent location, and you may request a copy of our most current notice during any office visit. A copy will also be mailed to you at your address on file.