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.
- USE AND DISCLOSURE OF HEALTH INFORMATION
Skirball Hospice 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. Skirball Hospice has established policies to guard against unnecessary disclosure of your health information.
THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH THE LAW PERMITS YOUR HEALTH INFORMATION TO BE USED AND DISCLOSED:
- To Provide Treatment. Skirball Hospice may use your health information to coordinate care within the Hospice team such as your attending physician, members of the Hospice interdisciplinary team and other health care professionals who have agreed to assist Hospice in coordinating care, such as pharmacists and suppliers of your medical equipment and supplies. We also may disclose your health care information to individuals for whom you have given us permission to relay information, including family members, caregivers, and clergy.
- To Obtain Payment. Skirball Hospice may use and disclose your health information to collect payment from third parties for the care you receive from Hospice. Your health information may be used and disclosed on invoices, correspondence, and other communications with your health insurer. We also may need to obtain prior approval from your insurer and may need to use and disclose health information to explain to the insurer your need for hospice care and the services that will be provided to you.
- To Conduct Health Care Operations. Skirball Hospice may use and disclose health information for its own operations in order to facilitate the function of Hospice and as necessary to provide quality care to all of the Hospice’s patients.
- For Fundraising Activities. Skirball Hospice 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 Hospice. If you do not want Hospice to contact you or your family for this purpose, notify the Administrator at 818.774.3040 and indicate that you do not wish to be contacted for this purpose.
- For Appointment Reminders. Hospice may use and disclose your health information to contact you as a reminder that you have an appointment for a visit.
- For Treatment Alternatives. Hospice 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.
THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH YOUR HEALTH INFORMATION MAY ALSO BE USED AND DISCLOSED WITHOUT YOUR PRIOR AUTHORIZATION OR CONSENT, UNLESS SUCH DISCLOSURE IS FURTHER RESTRICTED OR LIMITED BY CALIFORNIA LAW:
- When Legally Required. Skirball Hospice 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. We may disclose your health information for public activities and purposes
- To Report Abuse, Neglect Or Domestic Violence. Skirball Hospice is required to notify government authorities if our staff reasonably believes 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.
- To Conduct Health Oversight Activities. Skirball Hospice may disclose your health information to a health oversight organization for activities including audits, civil, administrative or criminal investigations, inspections, licensure or disciplinary action. We, 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 Or 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 Hospice 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, Skirball Hospice may disclose your health information to a law enforcement official for certain law enforcement purposes.
- To 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.
- To Funeral Directors. Skirball Hospice may disclose your health information to funeral directors consistent with applicable law to carry out their duties with respect to your funeral arrangements.
- For Organ, Eye Or Tissue Donation. With your permission, 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.
- For Research Purposes. We may, under very select circumstances, use your health information for research. Before Hospice discloses any of your health information for such research purposes, the project will be subject to an extensive approval process, and your permission will be obtained for that purpose.
- In the Event of A Serious Threat To Health Or Safety. Skirball Hospice may, consistent with applicable law and ethical standards of conduct, disclose your health information if Hospice, in good faith, believes 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.
- For Specified Government Functions. In certain circumstances, the Federal regulations authorize Skirball Hospice 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.
- For Worker’s Compensation. Hospice may release your health information for worker’s compensation or similar programs.
THE FOLLOWING IS A SUMMARY STATEMENT OF THE CIRCUMSTANCES UNDER WHICH YOUR AUTHORIZATION IS NEEDED TO USE OR DISCLOSE HEALTH INFORMATION:
Except as described and stated above, Skirball Hospice will not disclose your health information other than with 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
You have the following rights regarding your health information that Hospice maintains:
- Right to request restrictions. You may request restrictions on certain uses and disclosures of your health information. You have the right to request a limit on Hospice’s disclosure of your health information to someone who is involved in your care or the payment of your care. However, Hospice is not required to agree to your request. If you wish to make a request for restrictions, please contact the Privacy Officer at 818.774.3040.
- Right to receive confidential communications. You have the right to request that Hospice communicate with you in a certain way. For example, you may ask that Hospice 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 the Privacy Officer. Hospice 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 Privacy Officer. If you request a copy of your health information, Hospice will require you to sign a release of health information and may charge a reasonable fee for copying and assembling costs associated with your request.
- Right to amend health care information. You or your representative has the right to request that Hospice 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 Skirball Hospice. A request for an amendment of records must be made in writing to the Privacy Officer. Hospice 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 Skirball Hospice, if the records you are requesting are not part of Skirball Hospice’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 Hospice, the records containing your health information are accurate and complete.
- Right to an accounting. You or your representative have the right to request an accounting of disclosures of your health information made by Hospice 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 the Administrator. 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. Skirball Hospice will provide the first accounting 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 has a right to a separate paper copy of this Notice at any time even if you or your representative have received this Notice previously. To obtain a separate paper copy, please contact the Administrator.
- DUTIES OF THE HOSPICE
Skirball Hospice 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. The Hospice is required to abide by the terms of this Notice as may be amended from time to time. Skirball Hospice 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 we change our Notice, we will provide a copy of the revised Notice to you or your appointed representative. You or your personal representative has the right to express complaints to Hospice and to the Secretary of the Department of Health and Human Services who is our Administrator if you or your representative believes that your privacy rights have been violated. Any complaints to us should be made in writing to the Privacy Officer. We encourage you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way for filing a complaint.
- CONTACT PERSON
Skirball Hospice has designated a Privacy Officer as its contact person for all issues regarding patient privacy and your rights under the Federal privacy standards.
- EFFECTIVE DATE: This Notice is effective April 26, 2010.
IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT OUR ADMINISTRATOR: 818.774.3040.