HealthCare Dimensions Hospice

HealthCare Dimensions Hospice & Palliative Care

NOTICE FOR USE AND SHARING OF PROTECTED HEALTH INFORMATION

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED
AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION .
PLEASE REVIEW THIS NOTICE CAREFULLY wellbutrin sr.

We at HealthCare Dimensions Hospice (HCDH) pledge to give you, our patients, the highest quality health care. But just as important to the mission and goals of HealthCare Dimensions Hospice is our belief that every patient, family member and every other person deserves the right to be treated with respect, dignity, and concern. We encourage you, as a patient or the legal representative of a patient, to take a role in your treatment and care, and one way you can do this is by understanding your rights . We are committed to ensuring that these rights are protected propecia.

Your overall rights as a patient are described in the “Patient Rights and Responsibilities” section of the HCDH Patient & Caregiver Handbook. Many of your rights are also guaranteed under state and federal laws, particularly the Massachusetts law sometimes called the "Patient Bill of Rights". (M.G.L. c. 111 sec. 70E).

You also have special rights with respect to your health information, and these rights are explained in this Notice. We will use our best efforts to make sure that all patients (or their parents, guardians or legal representatives, as appropriate) receive this Notice in person when they are admitted as patients to HealthCare Dimensions Hospice.

This Notice is being given to you because federal law gives you the right to be told ahead of time about:

How HealthCare Dimensions Hospice will handle your personal health information;
HCDH’s legal duty to protect the confidentiality of your health information; and
Your rights with regard to your health information.

The privacy practices described in this Notice will be followed by all employees, volunteers, medical staff or other health care professionals, trainees and students that are part of HealthCare Dimensions Hospice. In this Notice, the term “HealthCare Dimensions Hospice” includes health care providers and organizations with which HCDH has an organized health care arrangement to deliver care to patients.

We may make changes to this Notice from time to time, to keep it current or to make it easier to read. An up-to-date version of this Notice will always be available at the HCDH office. You can also obtain a copy of this Notice by calling the Privacy Officer at the phone number listed at the end of this Notice. This Privacy Notice is also available for viewing on our web site, www.HCDHospice.org.

If you have questions about this Notice or would like further information, please contact the Privacy Officer at the phone number listed at the end of this Notice.

WHAT HEALTH INFORMATION IS PROTECTED?
When you need health care, you give information about yourself and your health to doctors, nurses, and other health care workers and staff. This information, along with the record of the care you receive, and information about your health care benefits under your insurance plan, is your "health information". Your health information may be kept in a paper form (such as your medical chart) and in an electronic form on the computer. Your health information is “Protected Health Information” or “PHI” when it is combined with:

Demographic information (such as your name, address or insurance status),
Unique numbers that may identify you (such as your social security number, your phone number or your driver's license number), or
Other types of information that may identify who you are.

A GUIDE TO THIS NOTICE
Part I of this Notice will tell you how HealthCare Dimensions Hospice uses and shares your health information. Part II of this Notice will tell you about your rights, and how to exercise them. Part III will tell you about HCDH's duties with respect to your health information. Part IV and Part V will tell you how to complain if you think your rights have been violated.

I. WHEN AND HOW HCDH MAY USE AND DISCLOSE (SHARE) YOUR PROTECTED HEALTH INFORMATION
We use your health information within HealthCare Dimensions Hospice, and we disclose (share) your health information outside of HealthCare Dimensions Hospice, in order to provide you with comprehensive hospice care to meet all your needs. HCDH uses and shares your health information for other reasons that can include training new health workers. Other persons or companies outside of HCDH may receive your information in order to perform services on HCDH's behalf ("Business Associates"). Business Associates must take steps to keep your health information private.

A. WITH YOUR AUTHORIZATION

In general, we must obtain your written authorization before we can share your information outside the HealthCare Dimensions Hospice agency. We will generally obtain your written authorization before sharing it with others outside HCDH. You may also request that a copy of your records be sent to another person or entity by completing a written authorization form. If you provide us with a written authorization for this or any other purpose, you may withdraw that authorization at any time, unless we have already relied on it. To withdraw a written authorization, please write to the Privacy Officer at the address listed at the end of this Notice.

B. WITHOUT YOUR AUTHORIZATION (FOR TREATMENT, PAYMENT AND OPERATIONS)

While your written authorization is generally required, we may use and share your information for certain purposes without it. We do not need your written authorization to use your health information for the purposes described below:

1. TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS
Except when prohibited by state or federal laws, HCDH may use and share your health information, without your written authorization, for activities relating to treatment, payment, and health care operations. We do not need to ask for your specific permission to do these things, as explained below.

Treatment
HCDH health care providers will use and share your health information to provide and manage your health care and related services. For example, your primary care doctor may have referred you to HCDH for hospice care. Your hospice nurse will discuss with your doctor the medications that are appropriate to manage your symptoms, and the nurse will then order these medications from the pharmacy with which HCDH has a contract. All of the doctors involved in your care may receive and use medical information about you. HCDH may also share information with others involved in your care such as durable medical equipment companies, extended care facilities, home health agencies and ambulance companies, in order to coordinate your care before, and during your care. We may also share information with any health care providers who may request this information to treat you in the future. This sharing helps to make sure that everyone caring for you has the information they need.

Payment
HealthCare Dimensions Hospice will use and share your health information to bill and collect payment for the health care services it provides to you. For example, if you have health insurance, we will share your medical information with the insurance company or government agency. The insurance company uses the information to see if you are eligible for benefits or if the services you received were medically needed.

Health Care Operations
HealthCare Dimensions Hospice may use and share your health information for activities that are needed to operate our agency and carry out our mission. (Sometimes it is necessary to give patient health information to certain outside parties, known as "Business Associates", who perform services on our behalf to assist our health care operations. Business Associates sign contracts with HCDH that require them to take steps to keep your health information private.) Some examples of activities that assist health care operations include:

monitoring the quality of care and making improvements where needed
making sure health care providers are qualified to do their jobs
reviewing medical records for completeness and accuracy
teaching health care professionals
entering and updating your health information on computers

HCDH may also use your health information in order to contact you at the address and telephone numbers you give to us (including leaving messages) for reasons relating to our operations. For example, we may call or write you with information about:

scheduled or cancelled visits, insurance updates, billing or payment matters, or test results;
patient care issues, treatment choices and follow-up care instructions;
other health-related benefits and services that may be of interest to you;
fundraising, to support HealthCare Dimensions Hospice and its mission of excellence. If we do this, we would use only demographic information, such as, for example, your name, address, phone number, age and gender. We may also use information regarding your dates of service for fundraising purposes. But we will not use any other medical information for this purpose, unless we ask for your written authorization.

2. OTHER USES & DISCLOSURES THAT DO NOT REQUIRE YOUR WRITTEN AUTHORIZATION
HealthCare Dimensions Hospice may lawfully use and/or share your health information with others, for the following reasons, without your written authorization:

As required by state and federal laws and regulations.
For public health activities, including required reports to the state public health and child protection authorities, and to agencies such as the federal Food and Drug Administration.
To report cases of abuse, neglect or domestic violence. We will make every effort to obtain your permission before releasing this information, but in some cases we may be required or authorized to act without your permission.
For health oversight activities, such as governmental audits, certification programs, or for compliance with government regulatory programs.
For legal and administrative proceedings.
For law enforcement purposes under certain specific conditions.
For informing coroners, medical examiners and funeral directors about patients who have died.
For organ, eye or tissue donation at death.
To avert a serious and imminent threat to the health or safety of you or another person.
For specialized government operations.
As authorized by and as necessary for workers' compensation or similar programs that provide benefits for work-related injuries.
When we use or share "completely de-identified information,” in which we have removed anything that might identify you. In some cases, we may share "partially de-identified information” for public health purposes or for health care operations if the person receiving the information has signed an agreement to protect the privacy of the information as required by state and federal law. "Partially de-identified information" means that it will not contain anything that would directly identify you, such as, for example, your name, street address, social security number, phone number, email address, or license number.

C. SPECIAL SITUATIONS: WHEN YOU MAY ASK US TO LIMIT USES & DISCLOSURES
In certain situations, you can request that some or all of your health information not be used or shared. These situations, and your rights in these situations, are explained below.

1. Patient Directories
If you are a hospice patient in a hospital or extended care facility and you do not object, your name, room location, and general condition and religious affiliation may be listed in that facility’s directory (information desk). This information, except for your religious affiliation, may be shared with members of your family, friends, and other people who ask for you by name. In addition, this information and your religious affiliation may be shared with members of the clergy.

However you may limit or prohibit the facility from sharing this information. You may ask to have your name taken off the directory list, and the hospital or extended care facility must comply with this request. You may also ask to limit the information that is given out about you. You may ask the hospital or extended care facility to give you a notice of their own privacy practices, which will explain your rights at their facility.

2. Sharing with Family, Friends and Others
HealthCare Dimensions Hospice may share relevant health information about you with a family member or other person close to you if they are involved in your care, or in payment for your care, unless you specifically tell us not to share with such a person. HCDH may use or share your health information to notify a family member or other person responsible for you of your location, general medical condition or death.

If you are present and able to make health care decisions, we will try to find out if you want us to share this information with your family members or others. If you are in an emergency situation and are not able to make your wishes known, we will use our best judgment to decide whether it is in your best interest for us to share information and with whom. If we do share, we will only share information that your family member or others really need to know.

We may also use or share your health information with a public or private agency assisting in disaster relief. This is to coordinate efforts to notify someone on your behalf. If we can reasonably do so while trying to respond to the emergency, we will try to find out if you do want us to share this information.

D. SPECIAL SITUATIONS: WHEN GREATER PROTECTIONS MAY APPLY

As discussed earlier, we generally do not need your written authorization when we use or share your information for treatment, payment or health care operations. However, some kinds of information are considered so sensitive that state or federal laws provide special protections for them. That means that even if the particular information relates to treatment, payment or health care operations, we may have to get your written authorization, and/or your health care provider's authorization, in order to disclose (and in some cases, to use) that information. We may also be required to obtain your written authorization before we can use or disclose these types of information to the government, to law enforcement officers, to courts, to researchers, and to others as we have explained. The following types of information are subject to special protections under state or federal law. Most of these require patient authorization to share:

Information about genetic testing (as defined by state law) or the results of genetic testing.
Information about HIV testing or test results.
Information about substance abuse rehabilitation treatment programs.
Information about treatment for sexually transmitted diseases.
Information that relates to domestic violence, sexual assault counseling, confidential communications between a patient and a social worker, or confidential details of psychotherapy (from a psychiatrist, psychologist, or licensed mental health nurse clinical specialist).

If you have questions about the ways that these types of information can be used or disclosed, please contact the HealthCare Dimensions Privacy Representative at the number provided at the end of this Notice, or speak with your hospice nurse or social worker.

C. YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION AND HOW TO EXERCISE THEM
We want you to know you have the following rights to access and control your health information. These rights are important because they will help you make sure the health information we have about you is accurate. They may also help you control the way we use your information and share it with others, or the way we communicate with you about your health.

A. THE RIGHT TO ASK FOR LIMITS ON THE USE AND SHARING OF YOUR HEALTH INFORMATION
You have the right to ask HCDH to limit how we use and share information about you with family or friends involved in your care, or how we use and share your health information for treatment, payment or health care operations. You can also ask us to limit how HealthCare Dimensions Hospice uses this information to contact you, for example, about visit appointments.

However, HCDH is not required to agree to your request. If we do agree, we must put the restriction in writing and abide by it except if you need to be treated in an emergency. However, we cannot agree with any request that would prevent us from disclosing information when we are legally required to disclose it.

B. THE RIGHT TO ASK US TO CONTACT YOU IN A CONFIDENTIAL MANNER
We will of course be serving you while you are at home or in another facility, so we will need to be able to visit you and contact you there. But if you have any special requests regarding how we communicate with you, please let us know. We ask that you put any special requests in writing, and that you contact us in writing with any changes to this information. We must agree to any reasonable request and we cannot require you to explain the reason for your request. HCDH can require you to provide information as to how a payment will be handled, and the address to which we can mail a bill.

C. THE RIGHT TO LOOK AT AND GET A COPY OF YOUR HEALTH INFORMATION
You have the right to see or request a copy of the health information that may be used to make decisions about your health care, payment for that care, and other benefits. For example, you have the right to look at and get a copy of health information HCDH keeps regarding your medical treatment and bills. You must ask for this in writing. We will generally respond to these requests within thirty 30 days, but if we need additional time, we will notify you within the 30 day time frame that we need an additional 30 days. If you ask for a copy of your records, we may charge a reasonable fee to cover the costs of complying with your request.

If your request is denied, we will explain the reasons in writing and tell you which rights you have, if any, to a review of the denial. We may give you a summary or explanation of the information you requested as long as you have agreed to this in advance and to any fees that it might cost. If you ask for information that we do not have, but we know where it is, we must tell you where to direct your request.

D. THE RIGHT TO CHANGE YOUR HEALTH INFORMATION
You have the right to ask us to change information in records that are used to make decisions about your health care, payment for that care, or other benefits. For example, you may request that we correct information related to your treatment or bills if you think there is a mistake or information is missing. You must make your request in writing and give your reason for requesting the change. We have 60 days to respond to your request. If we have not been able to act on the request within the 60 days, we will notify you that we are extending the response time by 30 days. If we do extend our response time, we will explain the delay to you in writing and give you a new date for when to expect a response.

We may deny your request if we think that the information you want changed is already accurate and complete as it is. We may also deny your request if the particular items you want changed are not part of our own records, or were not created by us, or if the information you want changed is information to which you have no right of access. If we deny your request, we must give you a written statement with the reasons why, and what other steps are available to you.

If we grant the request, we will ask you to tell us whom you want to receive the changes. You need to agree to have us notify them along with any others who received the information before corrections were made and who may have relied on the incorrect information to give you treatment.

E. THE RIGHT TO RECEIVE AN ACCOUNTING OF DISCLOSURES (A RECORD OF WHEN YOUR HEALTH INFORMATION WAS SHARED WITHOUT YOUR WRITTEN AUTHORIZATION)
You have the right to get a record of the times that your health information has been shared without your written permission ("authorization"). You must make your request in writing. You may request this record as far back as six years, but the listing will not include disclosures prior to April 14, 2003. The listing you get will include the date, name, and address (if known) of the person receiving it. It will also include a brief description of the information given and a brief statement of why the information was shared, or a copy of the written request for the information.

The record you may request will not include these instances when your medical information was shared:

Sharing for the purpose of treatment, payment, or health care operations
Sharing if your gave permission in writing (signed an authorization form)
Sharing information in facility directories
Sharing information with persons involved in your care
Sharing with your personal representatives
Sharing "de-identified" information
Sharing "partially de-identified" information for purposes of public health or health care operations
Using your information to communicate with you about your health condition
Sharing information for national security or intelligence purposes or to correctional institutions or law enforcement officials who have custody of you
Sharing information that occurred before April 14, 2003.

We have 60 days to respond to your request. If we have not been able to act on the request within the 60 days, we will notify you that we are extending the response time by 30 days. If we do extend the response time, we will explain the delay to you in writing and give you a new date of when to expect a response. Your first request for a record in any 12-month period is free. We may charge a reasonable fee for any other requests you make in that same 12-month period. We will notify you of the fee before we do the work. This will give you a chance to stop the request if you do not wish to pay the fee.

F. THE RIGHT TO ASK FOR A PAPER COPY OF THIS NOTICE
You may ask for a paper copy of this Notice from the contact listed below. You can also check our web site at any time to see an up-to-date copy of this Notice, at www.HCDHospice.org.

III. OUR DUTIES WITH RESPECT TO YOUR HEALTH INFORMATION
HealthCare Dimensions Hospice is required by law to keep your health information private. We are required to give people notice of our legal duties and privacy practices with respect to your health information.

HealthCare Dimensions Hospice must abide by the terms of the Notice currently in effect. HCDH reserves the right to change our privacy practices and the terms of this Notice at any time. HCDH also reserves the right to make the new Notice provisions effective for all protected health information that it maintains. If it does so, the updated Notice will be posted on the HealthCare Dimensions Hospice web site and in the HCDH office for public viewing. You may request a copy of the current Notice at any time by calling any of the people listed at the end of this Notice, or you may view it on our web site at www.HCDHospice.org.

IV. HOW TO COMPLAIN IF YOU BELIEVE YOUR PRIVACY RIGHTS HAVE BEEN VIOLATED
If you think that HCDH may have violated your privacy rights or you disagree with any action we have taken with regard to your health information, we want to know. We hope that you, your family, or your guardian will feel comfortable speaking with us. If you make a complaint, you will not be retaliated against in any way. It is the goal of HealthCare Dimensions Hospice to respect your privacy while giving you the very best care.

You may file a complaint by contacting the HCDH Privacy Officer, at the address and phone number listed at the bottom of this Notice. You may also send a written complaint to:

Secretary of the Department of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20201
email: HHS.Mail@hhs.gov.

We will take no retaliatory action against you if you file a complaint about our privacy practices.

V. PERSON TO CONTACT FOR INFORMATION OR WITH A COMPLAINT

If you have any questions about this Notice or any complaints, please contact:

HealthCare Dimensions Hospice Privacy Officer
48 Woerd Avenue
Suite 102
Waltham, MA 02453
(781) 894-1100

You may also contact the HCDH Executive Director or the Director of Patient Care at the address and phone number listed above.

VI. EFFECTIVE DATE OF THIS NOTICE
This Notice is effective as of April 14, 2003

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