Notice of Hospice Privacy Practices

HIPAA, which stands for “Health Insurance Portability and Accountability Act”, is a government regulation that protects the privacy of health information effective April 14, 2003.  Good Samaritan Hospice respects the privacy of personal health information and is committed to maintaining patient confidentiality.  THIS INFORMATION INFORMS YOU OF EFFORTS TO PROTECT THIS INFORMATION AND HOW YOU MAY OBTAIN THIS INFORMATION.  PLEASE READ IT CAREFULLY.  If you have questions, call the Good Samaritan Hospice Privacy Official at (888) 466-7809.

  How We May Use and Disclose Health Information

Good Samaritan Hospice may use your health information to (1) provide treatment to you; (2) obtain payment for your care, and (3) conduct health care operations.  We may use and disclose this information for other purposes only after obtaining your written consent or the consent of someone who is allowed by law to give consent for you.  We have described these uses and disclosures below and provide examples in each category.

To Provide Treatment.  We may use your health information to coordinate care within Good Samaritan Hospice and with others involved in your care, such as your attending physician, members of the Hospice interdisciplinary team, and other healthcare providers involved in your care such as pharmacists and suppliers of medical equipment.  For example, your hospice nurse may contact your physician when you need medication for a particular symptom.   Your hospice team members will need to share information among the team in order to meet your special needs.  For example, the social worker may share your request for services of our home health aide with your nurse.  We may also need to disclose health information to other people involved in your care, such as family members and clergy whom you have designated, or other outside agencies who can help you, such as “Meals on Wheels”.

To Obtain Payment.  We may disclose health information so that we may bill and collect payment from an insurance company, another third party, or from you.  For example, we may need to provide information to your health plan regarding the services we provide to you so that your health plan will reimburse us for these services.  We may also disclose health information to a healthcare provider that provides services to you and needs this information for their treatment, billing, or operations.

To Conduct Health Care Operations.  We may use and disclose health information that enables us to conduct regular business activities and to monitor and improve the quality of our care.   These activities include the following:

• Identifying ways to improve the quality, efficiency, and cost of our services
• Developing protocols
• Contacting health care providers and patients with information about treatment alternatives and other related activities that do not necessarily include treatment
• Coordinating and managing care, such as arranging a visit from our staff
• Reviewing and evaluating the skills and performance of our staff
• Training students, other health care practitioners, and non-health care professionals
• Obtaining accreditation, certification, licensure, or credentialing from organizations that have this authority
• Reviewing and auditing records, including medical, legal, financial and compliance records
• Business planning and development, including decisions about future operations
• Business management and general administrative activities of our Hospice
• Fundraising and marketing activities for the benefit of Good Samaritan Hospice.  We may use information such as your name, address, phone number and the dates you received care from Hospice in order to contact you or your family to announce opportunities to financially support Hospice or the Good Samaritan Hospice Fund, which is managed by the Foundation for Roanoke Valley.  If you do not want us to contact you or your family, please notify the Hospice Privacy Official in writing.

Use and Disclosure of Health Information Without Consent or Authorization

Federal privacy regulations allow Hospice to use or disclose your health information without your consent or authorization for the following reasons:

	When legally required by Federal, State, or local law.
	When there are risks to public health.  Information may be released 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
	Promote public health surveillance, investigations and interventions
	Report adverse events, product defects, or to track products or enable product recalls, repairs and replacement
	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 employer’s workforce as legally required

• To report abuse, neglect or domestic violence.   We will make this disclosure only when specifically required or authorized by law or when your or someone legally acting on your behalf agrees to the disclosure.
• To conduct health oversight activities.  We may disclose your health information to a health oversight agency for activities including audits; civil, administrative or criminal investigations; inspections; or licensure or disciplinary action.  We 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.
• In connection with judicial and administrative proceedings.   We may use or disclose your health information when required by a court or in response to subpoenas, discovery requests, or other legal processes after we have made efforts to notify you about the request or to obtain an order protecting your health information.
• For law enforcement purposes.  We may disclose your health information to a law enforcement official for the following law enforcement purposes:

	As required by law to comply with reporting requirements;
	In response to a court order, warrant, subpoena, summons, investigative demand or similar legal process;
	To identify or locate a suspect, fugitive, material witness, or missing person
	Under certain limited circumstances, when you are the victim of a crime
	If we suspect that death was the result of criminal conduct, including criminal conduct at Hospice
	In an emergency in order to report a crime

• To coroners and medical examiners for the purpose of determining cause of death or identification
• To funeral directors in order to carry out their duties with respect to funeral arrangements.  If necessary in order to carry out their duties, this information may be given out prior to and in reasonable anticipation of death.
• For organ, eye, or tissue donation.  Health information may be given to organ procurement organizations or other entities engaged in the procurement, banking, or transplanting of organs, eyes, or tissue in order to facilitate the donation and transplantation.
• For research purposes.  We may, under very select circumstances, use your health information for research.  Before we disclose any or your health information for such research purposes, the project will be subject to approval.  We will ask your permission if any researcher will be granted access to your individual information by which you could be identified.
• In the event of a serious threat to health or safety.  We may, consistent with applicable law and ethical standards of conduct, disclose your health information if we, in good faith, believe that such disclosure is necessary to prevent or lessen a serious or imminent threat to your health or safety or the health or safety of the public.  This information will be made only to a person who is able to help prevent the threat.
• For specified government functions.  In certain circumstances, Federal regulations authorize us 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 inmate and law enforcement custody.
• For worker’s compensation.  We may use or disclose your personal health information to comply with laws relating to workers’ compensation or similar programs.

Other than as stated above, we will not disclose your health information without your written authorization.  If you or your representative authorizes us to use or disclose your health information, you may revoke that authorization in writing at any time. 

Your Rights with Respect to Your Health Information

Although your health record is the physical property of Good Samaritan Hospice, under federal law, you have the following rights regarding your health information that we maintain:

Right to request restrictions.  You may request restrictions on certain uses and disclosure of your health information, including health information to someone who is involved in your care or the payment of your care.  If you wish to request a restriction, please contact the Good Samaritan Hospice Privacy Officer to obtain a written request form.  Although you may request this restriction, we are not required to agree to your request.

Right to receive confidential communications.  You have the right to request that we communicate with you about your medical information in a certain way, for example by mail, or in private without other family members present.  You do not need to give us a reason for your request, and we will do our best to honor reasonable requests.  If you wish to receive confidential communications, please contact the Good Samaritan Hospice Privacy Official. 

Right to inspect and copy.  You have the right to inspect and copy your health information, including billing records.  We may charge a reasonable fee for copying and assembling costs related to this request.  To make a request, please contact the Good Samaritan Hospice Privacy Official.  You will be asked to provide this request in writing.  We may deny your request in certain limited circumstances (such as for psychotherapy notes or information not created by Hospice).  If your request is denied, you may have the right to request a review of this denial.

Right to amend health care information.  If you or your representative believes that your health information records are incorrect or incomplete, you may request that we amend the record.  Please make this request in writing, including a reason for your request, to the Good Samaritan Hospice Privacy Official.  We may deny your request if it is not made in writing, you do not include a reason for the amendment, it involves information we did not create, the request you wish to amend is not part of the Hospice record, the request involves information which you are not permitted to inspect and copy, or the information, in our opinion, is accurate and complete.

Right to an accounting of disclosure.  You or your representative have a right to request a list of disclosures we have made for any reason other than for treatment, payment, or health operations.  This request, including the time period for the accounting, must be made in writing to the Good Samaritan Hospice Privacy Official.  This request is for disclosures made starting on April 14, 2003, and may not exceed periods of time in excess of six years.  Your first request within a 12-month period will be free; subsequent accounting requests may be subject to a reasonable cost-based fee.

Right to a paper copy of this notice.   You or your representative have a right to a separate paper copy of this Notice requested at any time even if you have received this Notice previously.  Please contact the Good Samaritan Hospice Privacy Official.  You may also obtain a copy of this Notice from our website: www.goodsamhospice.org.

Duties of the Hospice

We are required by law to maintain the privacy of your health information and to provide to you or your representative a copy of this Notice, including our duties and privacy practices.  We are required to abide by the terms of this Notice as it may be amended from time to time.  We reserve the right to change the terms of this Notice and make the new Notice provisions effective for all health information that we maintain.  If we change this Notice, we will provide a copy of the revised Notice to you or your representative. 

If You Have Concerns…

If you believe that your privacy rights have been violated, we encourage you to express your concerns in writing to the Good Samaritan Hospice Privacy Official (3825-A Electric Rd. SW, Roanoke, VA   24018, Toll Free:  1-888-466-7809).  You also may express your concerns to the U.S. Secretary of Health and Human Services, Office of Civil Rights (200 Independence Avenue SW, Washington, DC   20201, Toll Free:  1-877-696-6775, or www.hhs.gov/ocr/hipaa/.) You will not be retaliated against in any way for filing a complaint.

Contact Person

The Good Samaritan Hospice contact person for all issues or questions regarding patient privacy and your rights under the Federal privacy standards is the Privacy Official, who can be reached at 1-888-466-7809.