The Hospice of Baton Rouge [“THBR”] 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. THBR has established policies to guard against unnecessary disclosure of your health information.
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. THBR may use your health information to coordinate care within THBR and with others involved in your care, such as your attending physician, members of the THBR interdisciplinary team and other health care professionals who have agreed to assist THBR in coordinating care. For example, physicians involved in your care will need information about your symptoms in order to prescribe appropriate medications. THBR also may disclose your health care information to individuals outside of THBR involved in your care including family members, clergy whom you have designated, pharmacists, suppliers of medical equipment or other health care professionals.
To Obtain Payment. THBR may include your health information in invoices to collect payment from third parties for the care you receive from THBR. For example, THBR may be required by your health insurer to provide information regarding your health care status so that the insurer will reimburse you or THBR. THBR 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. THBR may use and disclose health information for its own operations in order to facilitate the function of THBR and as necessary to provide quality care to all of THBR’s patients. Health care operations 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.
- Giving health care providers and patients 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.
- Reviewing 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 THBR.
- Fundraising for the benefit of THBR.
For example THBR may use your health information to evaluate its staff performance, combine your health information with that of other hospice patients in evaluating how more effectively to serve all hospice patients, disclose your health information to THBR 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 as part of general fundraising and community information mailings (unless you tell us you do not want to be contacted).
For Treatment Alternatives. THBR 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.
For Fundraising Activities. THBR may publish the patient’s name for memorial services. THBR may publish the patient’s name in a newsletter to acknowledge memorial donations. THBR may use information about you including your name, address, phone number and the dates you received care in order to contact you or your family to raise money for THBR. If you do not want THBR to contact you or your family, notify The Hospice of Baton Rouge at 225.767.4673 and indicate that you do not wish to be contacted. Your name will be removed from mailing lists.
For Appointment Reminders. THBR may use and disclose your health information to contact you as a reminder that you have an appointment for a home visit. THBR may leave a message on your answering machine regarding your care. THBR may speak to any member of your household about your condition.
THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY ALSO BE USED AND DISCLOSED
When Legally Required. THBR 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. THBR may disclose your health information for public activities and purposes in order to:
- Prevent or control disease, injury, disability; report disease, injury, events such as birth or death, 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 workforce as legally required.
To Report Abuse, Neglect Or Domestic Violence. THBR is allowed to notify government authorities if THBR believes a patient is the victim of abuse, neglect or domestic violence. THBR 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. THBR may disclose your health information to a health oversight hospice for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action. THBR, however, 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. THBR 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 THBR makes reasonable efforts to either notify you about the request or to obtain an order protecting your health information.
For Law Enforcement Purposes. As permitted or required by State law, THBR 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 THBR has suspicion that your death was the result of criminal conduct.
- In an emergency in order to report a crime.
To Coroners And Medical Examiners. THBR may disclose your health information to coroners and medical examiners for purposes of determining the cause of your death or for other duties, as authorized by law.
To Funeral Directors. THBR 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, THBR may disclose your health information prior to and in reasonable anticipation of your death.
For Worker’s Compensation. THBR may release your health information for worker’s compensation or similar programs.
For Organ, Eye Or Tissue Donation. THBR 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. THBR may, under very select circumstances, use your health information for research. Before THBR 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. THBR may, consistent with applicable law and ethical standards of conduct, disclose your health information if THBR, in good faith, believes that such disclosure is necessary to prevent or lessen a serious and imminent threat to your health and safety or to the health and safety of the community.
For Specified Government Functions. In certain circumstances, Federal regulations authorize THBR 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
AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION Except as stated above, THBR will not disclose your health information without your written authorization. If you or your representative authorizes THBR 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 You have the following rights regarding your health information THBR has acquired:
Right to request restrictions. You may request restrictions on certain uses and disclosures of your health information to someone involved in your care. However, THBR is not required to agree to your request. You have the right to request a limit on THBR’s disclosure of your health information to a health plan related to a service for which you paid in full, out-of-pocket. If you wish to make a request for restrictions, please contact the CEO or the Director of Nurses at 225.767.4673.
Right to receive confidential communications. You have the right to request that THBR communicate with you in a certain way. For example, you may ask that THBR conduct communications pertaining to your health information only with you privately, with no other family members present. If you wish to receive confidential communications, please contact CEO or the Director of Nurses at 225.767.4673. THBR will not request that you provide any reasons for your request and will attempt to honor your reasonable requests for confidential communications.
Right to inspect and copy your health information. You have the right to inspect and copy your health information, including billing records. A request to inspect and copy records containing your health information may be made to the CEO at 225.767.4673. If you request a copy of your health information, either printed or in an electronic format, THBR may charge a reasonable fee associated with your request.
Right to amend health care information. You or your representative have the right to request that THBR 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 THBR. A request for an amendment of records must be made in writing to CEO, The Hospice of Baton Rouge 9063 Siegen Lane Baton Rouge, LA 70810. THBR 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 THBR, if the records you are requesting are not part of THBR’s 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 THBR, the records containing your health information are accurate.
Right to an accounting. You or your representative have the right to request an accounting of disclosures of your health information made by THBR for certain reasons, including reasons related to public purposes authorized by law and certain research. The request for an accounting must be made in writing to Accounting Department, The Hospice of Baton Rouge 9063 Siegen Lane Ste. A Baton Rouge, LA 70810. The request should specify the time period for the accounting starting on or after April 14, 2003. Accounting requests may not be made for periods of time in excess of six (6) years. THBR will provide the first accounting you request during any 12-month period without charge. 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 at any time, even if you or your representative have received the Notice previously. To obtain a separate paper copy, please contact the CEO at 225.767.4673.
DUTIES OF THBR THBR 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. We must notify you of a breach of unsecured Personal Health Information by THBR or its Business Associates. THBR is required to abide by the terms of this Notice as may be amended from time to time. THBR 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 THBR changes its Notice, THBR 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 THBR and to the Secretary of DHHS if you or your representative believe that your privacy rights have been violated. Any complaints to THBR should be made in writing to the CEO, The Hospice of Baton Rouge, 9063 Siegen Lane Ste. A, Baton Rouge, LA 70810. THBR encourages you to express any concerns you may have regarding the privacy of your information. You will not be subject to retaliation for filing a complaint.
CONTACT PERSON THBR has designated the CEO as its contact person for all issues regarding patient privacy and your rights under the Federal privacy standards. You may contact the CEO at 9063 Siegen Lane Ste. A, Baton Rouge, LA 70810, 225-767-4673.