Notice of Privacy Practices as of September 23, 2013
THIS NOTICE DESCRIBES HOW HOSPICE OF MARTHA’S VINEYARD MAY USE YOUR HEALTH INFORMATION AND YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION.
PLEASE REVIEW IT CAREFULLY
Hospice of Martha’s Vineyard 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.
Hospice of Martha’s Vineyard may use or disclose your health information for the following purposes and circumstances.
Treatment: Hospice of Martha’s Vineyard may use and disclose your health information to coordinate care within hospice and with others involved in your care, such as your attending physician, members of 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. Hospice of Martha’s Vineyard may also disclose your health care information to individuals outside of hospice involved in your care including family members, clergy who you have designated, pharmacists, suppliers of medical equipment or other health care professionals.
Payment: Under the Health Insurance Portability and Accountability Act, health care practitioners and agencies may disclose your health information in order to receive payment. Because Hospice of Martha’s Vineyard provides all services free of charge, this aspect of the Act does not apply.
Health Care Operations: Hospice of Martha’s Vineyard may use and disclose your health information for its own operations to facilitate the functions 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 Hospice of Martha’s Vineyard.
For example, Hospice of Martha’s Vineyard may use your health information to evaluate its performance, combine your health information with other patients in evaluating how to more effectively serve all hospice patients, or disclose your health information to members of the hospice’s workforce for training purposes.
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.
Abuse, Neglect Or Domestic Violence: Hospice of Martha’s Vineyard is allowed to notify government authorities if we believe a patient is the victim of abuse, neglect or domestic violence. We will make this disclosure only when specifically required or authorized by law or when the patient agrees to the disclosure.
Health Oversight Activities: Hospice of Martha’s Vineyard 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: Hospice of Martha’s Vineyard 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, Hospice of Martha’s Vineyard 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.
• In an emergency in order to report a crime.
Coroners And Medical Examiners: Hospice of Martha’s Vineyard 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: Hospice of Martha’s Vineyard 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: Hospice of Martha’s Vineyard 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: Hospice of Martha’s Vineyard may, under certain circumstances, use and disclose your health information for research purposes. Before we disclose any of your health information for such research purposes, the project will be subject to an extensive approval process.
Serious Threat To Health Or Safety: Hospice of Martha’s Vineyard 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 Hospice of Martha’s Vineyard 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: Hospice of Martha’s Vineyard may release your health information for worker’s compensation or similar programs.
Fundraising Activities: Under the Health Insurance Portability and Accountability Act, Hospice of Martha’s Vineyard may use certain health information in order to contact you for fundraising purposes. However, Hospice makes every effort to not contact patients for fundraising. If Hospice contacts you inadvertently for fundraising and you do not want this contact, please notify Terre Young, Executive Director 508-693-0189.
AUTHORIZATIONS TO USE OR DISCLOSE HEALTH INFORMATION
Other than is stated above, Hospice of Martha’s Vineyard will not disclose your health information other than with your written authorization. If a circumstance arises other than those stated above in which we need or wish to disclose your health information, we will contact you for your written authorization. If you or your representative authorizes Hospice of Martha’s Vineyard to use or disclose your health information, you may revoke that authorization in writing at any time.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
You have the following rights regarding your health information that Hospice of Martha’s Vineyard maintains:
Right to request restrictions: You have the right to request restrictions on uses and disclosures of your health information for treatment and health care operations. You have the right to request a limit on Hospice of Martha’s Vineyard’s disclosure of your health information to someone who is involved in your care. However, Hospice of Martha’s Vineyard is not required to agree to your request, if it would negatively affect your care or if the request creates an impossible barrier to providing your care. If you wish to make a request for restrictions, please contact Terre Young, Executive Director 508-693-0189.
• Right to receive confidential communications: You have the right to request that Hospice of Martha’s Vineyard communicates with you in a certain way. For example, you may ask that we 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 Terre Young, Executive Director 508-693-0189. Hospice of Martha’s Vineyard will not request that you provide any reasons for your request and will attempt to honor any reasonable requests for confidential communications.
Right of access to inspect and copy your health information: You have the right to inspect and copy your health information. A request to inspect and copy records containing your health information may be made to Terre Young, Executive Director 508-693-0189.
• Right to amend health care information: You or your representative have the right to request that Hospice of Martha’s Vineyard 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 us. A request for an amendment of records must be made in writing to Terre Young, Executive Director, P.O. Box 1748, Vineyard Haven, MA 02568. Hospice of Martha’s Vineyard 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 Hospice of Martha’s Vineyard, if the records you are requesting to amend are not part of our 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 Hospice of Martha’s Vineyard, the records containing your health information are accurate and complete.
• Right to an accounting: You or your representative has the right to receive an accounting of disclosures of your health information made by Hospice of Martha’s Vineyard for the previous six (6) years. The request for an accounting must be made in writing to Terre Young, Executive Director, P.O. Box 1748, Vineyard Haven, MA 02568. The request should specify the time period for the accounting starting on or after September 23, 2013.
• Right to a paper copy of this notice: You or your representative has a right to a separate paper copy of this Notice at any time, even if you or your representative has received this Notice previously. To obtain a separate paper copy, please contact Terre Young, Executive Director, at 508-693-0189.
CHANGES TO THIS NOTICE
Hospice of Martha’s Vineyard reserves 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. We will post a copy of the current Notice in a clear and prominent location to which you have access. 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
Hospice of Martha’s Vineyard has designated Terre Young, Executive Director, as its contact person for all issues regarding patient privacy and your rights under the Federal privacy standards. You may contact this person at P.O. Box 1748, Vineyard Haven, MA 02568, 508-693-0189.
You or your personal representative has the right to express complaints to Hospice of Martha’s Vineyard and to the Secretary of the U.S. Department of Health and Human Services if you or your representative believes that your privacy rights have been violated. Any complaints to Hospice of Martha’s Vineyard should be made in writing to Terre Young, Executive Director, P.O. Box 1748, Vineyard Haven, MA 02568. 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.