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Notice of
Hospice Privacy Practices |
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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. |
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Use and Disclosure of
Health Information |
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Walla Walla Community Hospice ("WWCH")
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.
WWCH 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 WWCH your health information may be
used and disclosed:
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To Provide Treatment. WWCH
may use your health information to coordinate care within
WWCH and with others involved in your care, such as your
attending physician, members of WWCH interdisciplinary team
and other health care professionals who have agreed to
assist WWCH in coordinating care. For example, physicians
involved in your care will need information about your
symptoms in order to prescribe appropriate medications. WWCH
also may disclose your health care information to
individuals outside of WWCH involved in your care including
family members, clergy who you have designated, pharmacists,
suppliers of medical equipment or other health care
professionals.
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To Obtain Payment. WWCH
may include your health information in invoices to collect
payment from third parties for the care you receive from
WWCH. For example, WWCH may be required by your health
insurer to provide information regarding your health care
status so that the insurer will reimburse you or WWCH. WWCH
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.
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To Conduct Health Care Operations. WWCH
may use and disclose health information for its own
operations in order to facilitate the function of WWCH and
as necessary to provide quality care to all of WWCH's
patients. Health care operations includes such activities
as:
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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 WWCH.
For example WWCH may use your health information to
evaluate its staff performance, combine your health
information with other WWCH patients in evaluating how to
more effectively serve all Hospice patients, disclose your
health information to WWCH staff and contracted personnel
for training purposes, use your health information to
contact you as a reminder regarding a visit to you. |
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For Hospice Communications. The WWCH
may contact you, your primary caregiver, or family through
mailing information such as newsletters, annual reports or
fundraising literature. If you do not want WWCH to contact
you or your family, notify WWCH and indicate that you do not
wish to be contacted.
WWCH sometimes uses patient and family testimonials in
promotional publications, broadcasts and events. Permission
to use your name or your family's name would be requested on
a case-by-case basis.
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For Appointment Reminders. The WWCH may
use and disclose your health information to contact you as a
reminder that you have an appointment for a home visit.
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For Treatment Alternatives. The WWCH
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
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The following is a summary of the
circumstances under which and purposes for which your health
information may also be used and disclosed. |
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When Legally Required. WWCH will
disclose your health information when it is required to do
so by any Federal, State, or local law.
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When There Are Risks to Public Health.
WWCH may disclose your health information for public
activities and purposes in order to:
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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.
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To Report Abuse, Neglect or Domestic
Violence. WWCH is allowed to notify government
authorities if WWCH believes a patient is the victim of
abuse, neglect or domestic violence. WWCH will make this
disclosure only when specifically required or authorized by
law or when the patient agrees to the disclosure.
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To Conduct Health Oversight Activities.
WWCH may disclose your health information to a health
oversight hospice for activities including audits, civil
administrative or criminal investigations, inspections,
licensure or disciplinary action. WWCH, 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.
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In Connection with Judicial and
Administrative Proceedings. WWCH 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 WWCH makes reasonable
efforts to either notify you about the request or to obtain
an order protecting your health information.
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For Law Enforcement Purposes. As
permitted or required by State law, WWCH 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 WWCH has a suspicion
that your death was the result of criminal conduct including
criminal conduct at WWCH.
In an emergency in order to report a crime.
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To Coroners and Medical Examiners. WWCH
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.
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To Funeral Directors. WWCH 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, WWCH may disclose your health
information prior to and in reasonable anticipation of your
death.
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For Organ, Eye or Tissue Donation. WWCH
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.
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For Research Purposes. WWCH may, under
very select circumstances, use your health information for
research. Before WWCH discloses any of your health
information for such research purposes, the project will be
subject to an extensive approval process.
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In the Event of a Serious Threat to Health
or Safety. WWCH may, consistent with applicable law and
ethical standards of conduct, disclose your health
information if WWCH, 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.
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For Specified Government Functions. In
certain circumstances, the Federal regulations authorize
WWCH 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.
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For Worker's Compensation. WWCH may
release your health information for worker's compensation or
similar programs.
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Authorization
to Use or Disclosure of Health Information |
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Other than is stated above, WWCH
will not disclose your health information other than with
your written authorization. If you or your representative
authorizes WWCH to use or disclose your health information,
you may revoke that authorization in writing at any time. |
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Your
Rights with Respect to Your Health Information |
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You have the following rights
regarding your health information that WWCH maintains: |
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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 WWCH's
disclosure of your health information to someone who is
involved in your care or the payment of your care. However,
WWCH is not required to agree to your request. If you wish
to make a request for restrictions, please contact WWCH.
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Right to receive confidential
communications. You have the right to request that WWCH
communicate with you in a certain way. For example, you may
ask that WWCH 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 WWCH. WWCH will not request
that you provide any reasons for your request and will
attempt to honor your reasonable requests for confidential
communications.
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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 WWCH. If you request a copy of
your health information, WWCH may charge a reasonable fee
for copying and assembling costs associated with your
request.
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Right to amend health care
information. You or your representative have the right
to request that WWCH 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 WWCH. A request for an amendment of records must be made
in writing to WWCH. WWCH 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 WWCH, if the records you are
requesting are not part of WWCH'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 WWCH, the records
containing your health information are accurate and
complete.
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Right to an accounting.
You or your representative have the right to request an
accounting of disclosures of your health information made by
WWCH 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 WWCH.
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. WWCH 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.
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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 WWCH.
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Duties
of WWCH |
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WWCH 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. WWCH is required to abide by
the terms of this Notice as may be amended from time to
time. WWCH 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 WWCH changes
its Notice, WWCH 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 WWCH and to the Secretary of DHHS if you or your
representative believe that your privacy rights have been
violated. Any complaints to WWCH should be made in writing
to Walla Walla Community Hospice, P.O. Box 2026, Walla
Walla, WA 99362. WWCH 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. |
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Contact
Person |
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WWCH has designated the Executive
Director as its contact person for all issues regarding
patient privacy and your rights under the Federal privacy
standards. If you have any questions regarding this notice,
please contact:
Rebecca Hendricks, CPA
Executive Director
1067 E. Isaacs
Ave.
P.O. Box 2026
Walla Walla, WA 99362
(509)525-5561
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Effective
Date |
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This notice is effective April
14, 2003. |
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©2004 Walla Walla Community Hospice
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