NOTICE OF PROVIDER 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.
Hospice de la Luz is required by law to protect the privacy of your health information. We are required to provide you with this Notice of Privacy Practices to describe our legal duties and your rights with respect to your protected health information. We are also required to abide by the terms of this Notice which is currently in effect, and to notify you in the event of a breach of your unsecured health information.
HOW WE MAY USE AND DISCLOSURE YOUR HEALTH INFORMATION
The following describes the ways we may use and disclose your health information for treatment, payment and health care operations.
Treatment: We may use and disclose 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’s interdisciplinary team and other health care professionals who have agreed to assist us in coordinating your care. For example, we may disclose your health information to a physician involved in your care who needs information about your symptoms to prescribe appropriate medications.
Payment: We may use and disclose your health information so that we or others may bill and receive payment for the care you receive from us. For example, we may be required by your health insurer to provide information regarding your health care status, your need for care and the care that the hospice intends to provide to you so that the insurer will reimburse you or the hospice for services provided and received.
Health Care Operations:
We may use and disclose health information for its own operations to facilitate the functioning of the hospice and as necessary to provide quality care to all of our patients. Health care operations may include 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.
ADDITIONAL PERMITTED USES AND DISCLOSURES OF HEALTH INFORMATION
As Required by Law: We will disclose your health information when we are required to do so by any Federal, State or local law.
Public Health Risks: We 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 employer’s workforce in certain limited situations, as authorized by law.
Health Oversight Activities: We may disclose your health information to a health oversight agency for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action. However, 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.
Judicial And Administrative Proceedings: We 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 we make reasonable efforts to either notify you about the request or to obtain an order protecting your health information.
Law Enforcement: As permitted or required by State law, we 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 we have a suspicion that your death was the result of criminal conduct, including any criminal conduct of the hospice.
In an emergency in order to report a crime.
Coroners and Medical Examiners: We 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.
Funeral Directors: We 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, we may disclose your health information prior to and in reasonable anticipation of your death.
Organ, Eye or Tissue Donation: We 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.
Research Purposes. We may, under certain circumstances, use and disclose your health information for research purposes. Before we disclose any of your health information for research purposes, the project will be subject to an extensive approval process. This process includes evaluating a proposed research project and its use of health information and trying to balance the research needs with your need for privacy. Before we use or disclose health information for research, the project will have been approved through this research approval process. Additionally, when it is necessary for research purposes and so long as the health information does not leave our organization, it may disclose your health information to researchers preparing to conduct a research project, for example, to help the researchers look for individuals with specific health needs. Lastly, if certain criteria are met, we may disclose your health information to researchers after your death when it is necessary for research purposes.
Limited Data Set. We may use or disclose a limited data set of your health information, that is, a subset of your health information for which all identifying information has been removed, for purposes of research, public health, or health care operations. Prior to our release, any recipient of that limited data set must agree to appropriately safeguard your health information.
Serious Threat to Health or Safety. We may, consistent with applicable law and ethical standards of conduct, disclose your health information if, in good faith, we believe 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.
Specified Government Functions. In certain circumstances, the 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 inmates and law enforcement custody.
Worker’s Compensation. We may release your health information for worker’s compensation or similar programs.
OTHER USES AND DISCLOSURES OF YOUR HEALTH INFORMATION TO WHICH YOU MAY AGREE OR OBJECT
Facility Directory: We may disclose certain information about you, including your name, your general health status, your religious affiliation and where you are in the hospice’s facility, or in a hospice directory if you are in a hospice inpatient facility. We may disclose this information to people who ask for you by name. Please inform us if you want to restrict or prohibit some or all of the information that may be provided in the directory.
Persons Involved in Your Care: When appropriate, we may share your health information with a family member, other relative or any other person you identify if that person is involved in you care and the information is relevant to your care or the payment of your care. We also may notify your family about your location or general condition or disclose such information to an entity assisting in a disaster relief effort.
You may ask us at any time not to disclose your health information to any person(s) involved in your care. We will agree to your request unless circumstances constitute an emergency or if the patient is a minor.
Fundraising Activities: The hospice, our Hospice foundation, or our business associate may use information about you, including your name, address, telephone number and the dates you received care, in order to contact you for fundraising purposes. You have the right to opt-out of receiving these communications from us. If you do not want us to contact you for fundraising purposes, notify the Administrator at (505) 217-2490, and indicate that you do not wish to receive fundraising communications.
AUTHORIZATIONS TO USE OR DISCLOSE HEALTH INFORMATION
Other than the permitted uses and disclosures described above, the hospice will not use or disclose your health information without an authorization signed by you or your personal representative. If you or your representative sign a written authorization allowing us to use or disclose your health information, you may cancel the authorization (in writing) at any time. If you cancel your authorization, we will follow your instructions except to the extent that we have already relied upon your authorization and taken action.
The following uses and disclosures for your health information will only be made with your signed authorization:
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
You have the following rights regarding your health information:
● Right to request restrictions: You have the right to request restrictions on uses and disclosures of your health information for treatment, payment and health care operations. You have the right to request a limit on the disclosure of your health information to someone who is involved in your care or the payment of your care. We are not required to agree to your request, unless your request is for a restriction on a disclosure to a health plan for purposes of payment or health care operations (and is not for purposes of treatment) and the medical information you are requesting to be restricted from disclosure pertains solely to a health care item or service for which you have paid out-of-pocket in full. If you wish to make a request for restrictions, please contact the Administrator at (505) 217-2490.
CHANGES TO THIS NOTICE
We reserve the right to change this Notice. We reserve the right to make the revised Notice effective for health information we already have about you, as well as any health information we receive in the future. The Notice also is available to you upon request. The Notice contains, at the end of this document, the effective date. In addition, if we revise the Notice, we will offer you a copy of the current Notice in effect.
IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE
We have designated the Privacy Officer as our contact person for all issues regarding patient privacy and your rights under the Federal privacy standards. You may contact the Privacy Officer at 3812 Academy Parkway North NE, Albuquerque, New Mexico, 87109, at 505-938-7460, or via email at email@example.com.
You or your personal representative have the right to express complaints to the hospice, if you or your representative believe that your privacy rights have been violated as a result of actions by the hospice. Any complaints to the hospice regarding privacy rights should be made in writing to the Privacy Officer, 3812 Academy Parkway North NE, Albuquerque, New Mexico, 87109, by calling 505-938-7460, or via email at firstname.lastname@example.org. We encourage you to express any concerns you may have regarding the privacy of your information. You will not be penalized in any way for filing a complaint.
This Notice is effective September 23, 2013.