www.hospiceofdavidson.org, Hospice of Davidson County, NC, The Mission of Hospice of Davidson County is to affirm the significance of human life and recognize dying as a natural process. Our services are provided to enrich the quality of life for persons in Davidson County with limited life expectancies and their loved ones.

HOSPICE OF DAVIDSON COUNTY, INC.
NOTICE OF PRIVACY PRACTICES
DOWNLOAD PDF OF PRIVACY NOTICE

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATIN ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN HAVE ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY

USE AND DISCLOSURE OF HEALTH INFORMATION:
Hospice of Davidson County, Inc. may use your health information for purposes of providing you treatment, obtaining payment for your care and conducting health care operations. Your health information 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. Hospice of Davidson County has established policies to guard against unnecessary disclosure of your health information.

THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES AND PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED:

To Provide Treatment: Hospice of Davidson County may use your health information to coordinate care within our organization and with other involved in your care such as:

Physicians
Family members
Designated clergy
Pharmacist, suppliers of medical equipment
Other health care professionals providing care

To Obtain Payment: Hospice of Davidson County may include your health information in invoices to collect payment from third parties 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 so that the insurer will reimburse you or us. Hospice of Davidson County 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: Hospice of Davidson County may use and disclose health information for its own operations in order to provide quality care to all of our Hospice patients. Health care operations include, but are not necessarily limited to, 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. (Only contracted programs)
Training of non-health care professionals
Accreditation, certification, licensing or credentialing activities
Review and auditing, including compliance reviews and programs, medical reviews, and legal services
Business planning and development including cost management
Business management and general administrative activities of the Hospice
Fundraising for the benefit of the Hospice

For Fundraising Activities: Hospice of Davidson County may use information about you including your name, address and phone number in order to contact you or your family to raise money for our organization. If you do not want us to contact you or your family, notify the Privacy Officer at Hospice of Davidson County at (336) 248-6185 and indicate that you do not wish to be contacted.

For Appointment Reminders: Hospice of Davidson County may use and disclose your health information to contact you as a reminder that you have an appointment for a home visit.

For Treatment Alternatives: Hospice of Davidson County may use and disclose your heath information to tell you about or recommend possible treatment options or alternative that may be of interest to you.

When Legally Required: Hospice of Davidson County will disclose your health information when it is required by any Federal, State, or Local law.

When There are Risks to Public Health: Hospice of Davidson County may disclose your health information for public activities and purposes in:

Reporting, preventing or controlling disease, injury or disability, vital events such as birth or death, conducting public health surveillance, and aiding in investigations and interventions
Reporting adverse events and/or product defects, tracking products and enabling product recalls, repairing and replacing products, conducting post-marketing surveillance, and complying with requirements of the Food and Drug Administration
Notifying a person/persons who have been exposed to a communicable disease or who may be at risk of contracting or spreading a disease
Notifying an employer about an individual who is a member of the workforce as legally required

To Report Abuse, Neglect or Domestic Violence: Hospice of Davidson County is required to notify government authorities if we believe a patient is the victim of abuse, neglect or domestic violence.

To Conduct Health Oversight Activities: Hospice of Davidson County may disclose your health information to a health oversight organization for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action.

In Connection With Judicial and Administrative Proceedings: Hospice of Davidson County 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. We will notify you about requests for your health information. In some instances we will try to obtain an order protecting your health information. We however, may not disclose your health information if you are the subject of an investigation and your health information are not directly related to the investigation.

For Law Enforcement Purposes: As permitted or required by State Law, Hospice of Davidson County 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 criminal conduct by our organization.
In an emergency, to report a crime

To Coroners and Medical Examiners: Hospice of Davidson County may disclose your health information to coroners and medical examiners for purposes of determining your cause of death or for other reasons, as authorized by law.

To Funeral Directors: Hospice of Davidson County 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.

For Organ, Eye, Or Tissue Donation: If it is your desire, Hospice of Davidson County 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: Hospice of Davidson County may, under select circumstances, use your health information for research. Before we disclose 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: Hospice of Davidson County 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 and imminent threat to:

Your health and/or safety
The health and/or safety of the public

For Specified Government Functions: In certain circumstances, Federal Regulations authorize Hospice of Davidson County 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
Inmates in law enforcement custody

For Worker’s Compensation: Hospice of Davidson County may release your health information for worker’s compensation or similar programs.

AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION:
Other than as is stated above, Hospice of Davidson County 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 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 of Davidson County maintains:

Right to Request Restrictions: You may request restrictions on certain uses and disclosure of your health information. You have the right to request a limit on the disclosures of your health information to someone who is involved in your care or the payment of your care. However, Hospice of Davidson County is not required to agree to your request. If you wish to make a request for restrictions, please contact the Privacy Officer at Hospice of Davidson County, at (336) 248-6185.

Right to Receive Confidential Communications: You have the right to request that Hospice of Davidson County communicate 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 the Privacy Officer at (336) 248-6185. Hospice of Davidson County 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 at (336) 248-6185. If you request a copy of your health information, Hospice of Davidson County may charge a reasonable fee for the copying and assembling that is associated with your request.

Right to Amend Health Care Information: You or your representative have the right to request that Hospice of Davidson County amend your records, if you believe that your health information is incorrect or incomplete. That request may be made as long as we maintain the information. A request for an amendment for records must be made in writing to the Medical Records Coordinator at 524 South State Street, Lexington, N.C. 27292. Hospice of Davidson County may deny the request if it is not in writing or does not include a reason for the amendment. The request may also be denied for the following reasons:

If your health information records were not created by us
If the records you are requesting 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,
If, in the opinion of Hospice of Davidson County, the records containing your health information are accurate and complete.

Right to an accounting of disclosures: You or your representative have the right to request an accounting of disclosures of your health information made by Hospice of Davidson County 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 Privacy Officer at 524 South State Street, Lexington, NC, 27292. 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. Hospice of Davidson County would 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 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 the Privacy Officer at (336) 248-6185.

DUTIES OF THE HOSPICE:
Hospice of Davidson County 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 reserve the right to change the terms of this Notice and to make the new Notice provisions effective for all health information that it maintains. If we change the Notice, we will provide a copy of the revised Notice to your and/or your appointed representative. You or your personal representative has the right to express complaints to us and to the Secretary of DHHS if you or your representative believes that your privacy rights have been violated. Any complaints to Hospice of Davidson County should be made in writing to the Privacy Officer at 524 South State Street, Lexington, NC, 27292. Hospice of Davidson County encourages 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:
Hospice of Davidson County has designated the Privacy Officer as its contact person for all issues regarding patient privacy and your rights under the Federal privacy standards. You may contact this person at 524 South State Street, Lexington, NC, 27292 and at (336) 248-6185.

EFFECTIVE DATE:
This Notice is effective April 14, 2003.

IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT THE PRIVACY OFFICER AT 524 SOUTH STATE STREET, LEXINGTON, NC, 27292, OR AT (336) 248-6185.