NOTICE OF 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.
USE AND DISCLOSURE OF HEALTH INFORMATION
Hospice Advantage 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. Hospice Advantage 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. Hospice Advantage may use your health information to coordinate care within Hospice Advantage and with others involved in your care, such as your attending physician, members of Hospice Advantage interdisciplinary team and other health care professionals who have agreed to assist Hospice Advantage in coordinating care. For example, physicians involved in your care will need information about your symptoms in order to prescribe appropriate medications. Hospice Advantage also may disclose your health care information to individuals outside of Hospice Advantage involved in your care including family members, clergy who you have designated, pharmacists, suppliers of medical equipment or other health care professionals.
To Obtain Payment. Hospice Advantage may include your health information in invoices to collect payment from third parties for the care you receive from Hospice Advantage. For example, Hospice Advantage may be required by your health insurer to provide information regarding your health care status so that the insurer will reimburse you or Hospice Advantage. Hospice Advantage 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 Advantage may use and disclose health information for its own operations in order to facilitate the function of Hospice Advantage and as necessary to provide quality care to all of Hospice Advantage’s patients. Health care operations includes 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 Advantage.
For example Hospice Advantage may use your health information to evaluate its staff performance, combine your health information with other Hospice patients in evaluating how to more effectively serve all Hospice patients, disclose your health information to Hospice Advantage 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 Bereavement services and/or community information mailings (unless you tell us you do not want to be contacted).
Hospice Advantage may disclose certain information about you including your name, your general health status, your religious affiliation and where you are in Hospice Advantage’s facility in a Hospice directory while you are in Hospice Advantage inpatient facility. Hospice Advantage may disclose this information to people who ask for you by name. Please inform us if you do not want your information to be included in the directory.
For Appointment Reminders. Hospice Advantage 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 Advantage 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 AND PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY ALSO BE USED AND DISCLOSED.
When Legally Required. Hospice Advantage 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. Hospice Advantage 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 workforce as legally required.
To Report Abuse, Neglect Or Domestic Violence. Hospice Advantage is allowed to notify government authorities if Hospice Advantage believes a patient is the victim of abuse, neglect or domestic violence. Hospice Advantage 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. Hospice Advantage may disclose your health information to a health oversight hospice for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action. Hospice Advantage, 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. Hospice Advantage 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 Advantage 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, Hospice Advantage 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 Hospice Advantage has a suspicion that your death was the result of criminal conduct including criminal conduct at Hospice Advantage.
In an emergency in order to report a crime.
To Coroners And Medical Examiners. Hospice Advantage 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. Hospice Advantage 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, Hospice Advantage may disclose your health information prior to and in reasonable anticipation of your death.
For Organ, Eye Or Tissue Donation. Hospice Advantage 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 Advantage may, under very select circumstances, use your health information for research. Before Hospice Advantage 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. Hospice Advantage may, consistent with applicable law and ethical standards of conduct, disclose your health information if Hospice Advantage, 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 Hospice Advantage 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 Advantage may release your health information for worker's compensation or similar programs.
AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION
Other than is stated above, Hospice Advantage will not disclose your health information other than with your written authorization. If you or your representative authorizes Hospice Advantage 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 Advantage 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 Advantage’s disclosure of your health information to someone who is involved in your care or the payment of your care. However, Hospice Advantage is not required to agree to your request. If you wish to make a request for restrictions, it must be made in writing to the Director of Quality Assurance at Hospice Advantage,
Right to receive confidential communications . You have the right to request that Hospice Advantage communicate with you in a certain way. For example, you may ask that Hospice Advantage 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 Director of Quality Assurance at 1-888-822-5515. Hospice Advantage 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 must be made in writing on the Hospice Advantage Request for Access Protected Health Information form. In order to obtain this form contact the Director of Quality Assurance at 1-888-822-5515. If you request a copy of your health information, Hospice Advantage may charge a reasonable fee for copying and assembling costs associated with your request. Hospice Advantage may not deny the patient access to health information due to the inability to pay the requested fees.
Right of Access to Health Information: Exceptions and Grounds for Denial.
EXCEPTIONS -information to which individuals do not have access.
Psychotherapy Notes.
Health information compiled for civil, criminal and/or administrative actions and proceedings.
Health information subject to or exempted from the CLIA Amendments of 1998.
GROUNDS FOR DENIAL-with no right to appeal the denial decision.
If the request is for any of the exceptions listed above.
Inmates in correctional facilities may be denied a copy of their health information under certain situations related to security and safety.
Health information related to treatment of research participants if the research is still in progress.
Information that is subject to the Privacy Act of 1974. q If the health information was obtained from someone other than a health care provider and a promise of confidentiality was made.
GROUNDS FOR DENIAL-with the right to appeal the denial decision.
If a licensed health care provider determines that the access requested is reasonably likely to endanger the life or physical safety of the individual requesting it or another person (this does not include the potential for access causing emotional or psychological harm).
If the information requested also refers to another person and, in the opinion of a licensed health professional, access would likely cause harm to that other person.
If the access is requested by a personal representative of the individual and there is reasonable belief that it is not in the best interest of the individual to treat the requestor as a personal representative.
Right to amend health care information. You or your representative, have the right to request that Hospice Advantage 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 Hospice Advantage. A request for an amendment of records must be made in writing to the Director of Quality Assurance at Hospice Advantage, 401 Center Ave. Bay City, MI 48708. Hospice Advantage 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 Advantage, if the records you are requesting are not part of Hospice Advantage’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 Advantage, 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 Advantage 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 Director of Quality Assurance at Hospice Advantage, 401 Center Ave. Bay City, MI 48708. 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 Advantage 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, have 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 Director of Quality Assurance at 1-888-822-5515 or the current version of Hospice Advantage’s Notice of Privacy Practices is at its website, www.hospiceadvantage.net
DUTIES OF THE HOSPICE
Hospice Advantage 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. Hospice Advantage is required to abide by the terms of this Notice as may be amended from time to time. Hospice Advantage 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 Hospice Advantage changes its Notice, Hospice Advantage 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 Hospice Advantage and to the Secretary of DHHS if you or your representative believe that your privacy rights have been violated. Any complaints to Hospice Advantage should be made in writing to the Director of Quality Assurance at Hospice Advantage, 401 Center Ave. Bay City, MI 48708. Hospice Advantage 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 Advantage has designated the Director of Quality Assurance as its contact person for all issues regarding patient privacy and your rights under the Federal privacy standards. You may contact this person at Hospice Advantage, 401 Center Ave. PO box 190, Bay City, MI 48707-0190. For over nighting use area code 48708.
EFFECTIVE DATE This Notice is effective April 14, 2003.
IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT the Director of Quality Assurance at Hospice Advantage, 1-888-822-5515, 401 Center Ave. Bay City, Mi 48708. You may also call locally to our Bay City office at 989-893-0500 or Fax Us at 989-893-0200.
If you wish to contact Hospice Advantages Sheboygan office you may reach a representative at 3325 Behrens Parkway Sheboygan, Wisconsin 53081.
You may reach our Sheboygan offices at 1-866-720-5903 or call us locally at 920-452-1851 or fax us at 920-452-1854.