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.
Ohio’s Hospice and its affiliates have established a policy to protect against unnecessary disclosure of your health information. As defined in the Privacy Rule of the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996, Ohio’s Hospice and its affiliates may use your health information for the purposes explained below, including provision of your treatment, obtaining payment for your care and conducting its health operations.
Ohio’s Hospice and its affiliates may use or disclose your health information:
- To provide treatment
- To obtain payment
- To conduct healthcare operations
- For fundraising activities
- For appointment reminders
- For treatment alternatives
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 by Federal, State and/or local laws
- When there are risks to public health
- To report abuse, neglect or domestic violence
- To conduct health oversight activities
- In connection with judicial and administrative proceedings
- For law enforcement purposes
- To coroners and medical examiners
- To funeral directors
- For organ, eye or tissue donation
- For research purposes
- In the event of a serious threat to health or safety
- For specified government functions
- For worker’s compensation
Authorization to use or disclose health information
Other than stated above, Ohio’s Hospice and its affiliates will not disclose your health information other than with your written authorization. If you or your representative authorizes Ohio’s Hospice and its affiliates to use or disclose your health information, you may revoke that authorization in writing at any time.
Your right with respect to your health information
- Right to request restrictions
- Right to receive confidential communications
- Right to inspect and copy your health information
- Right to amend health care information
- Right to an accounting of disclosures of your health information
- Right to a paper copy of this notice
Your choices in the way that we use and share information as we
– Answer coverage question from your family and friends
– Share information in a disaster relief situation
– Market our services and sell your information
Following is a summary of the circumstances under which, and purposes for which, your health information may be used and disclosed:
Treatment. Ohio’s Hospice and its affiliates may use your health information to coordinate care within the agency and with others involved in your care, such as your attending physician, members of the hospice interdisciplinary team and other health care professionals who have agreed to assist in your care. For example, physicians involved in your care will need information about your symptoms in order to prescribe appropriate medications. Ohio’s Hospice and its affiliates may also disclose your health care information to individuals outside of the hospice who are involved in your care including family members, clergy whom you have designated, pharmacists, suppliers of medical equipment or other health care professionals that hospice uses to coordinate your care.
Payment. Your protected health information will be used, as needed, to obtain payment for your healthcare services. This may include certain activities that your health insurance plan may undertake before it approves or pays for healthcare services we recommend for you such as: making a determination of eligibility or coverage of your benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, Ohio’s Hospice and its affiliates may be required by your health insurer to provide information regarding your healthcare status to the insurer, and may need to explain to the insurer your need for hospice care and the services that will be provided to you.
Healthcare Operations. Ohio’s Hospice and its affiliates may use and disclose healthcare 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. Healthcare operations include such activities as:
Quality assessment and improvement activities;
Activities designed to improve health or reduce
Protocol development, case management and care coordination;
Contacting healthcare 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 healthcare learn under supervision;
Training of non-healthcare professionals;
Accreditation, certification, licensing and
Review and auditing, including compliance review, medical reviews, legal services and compliance programs;
Business management and general administrative activities of hospice; and
Fundraising for the benefit of the hospice and certain
For Fundraising Activities. Ohio’s Hospice and its affiliates 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. Ohio’s Hospice and its affiliates may also release this information to a related hospice foundation. If you do not want Ohio’s Hospice and its affiliates to contact you or your family, please notify the HIPAA Privacy Officer at 937.256.4490 and indicate that you do not wish to be contacted.
For Appointment Reminders. Ohio’s Hospice and its affiliates 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. Ohio’s Hospice and its affiliates may use and disclose your health information to tell you about or recommend possible treatment options or alternatives that might be of interest to you.
When Legally Required. Ohio’s Hospice and its affiliates 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. Ohio’s Hospice and its affiliates 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.
To 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.
To notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading
To an employer about an individual who is a member of the workforce as legally require.
To Report Abuse, Neglect or Domestic Violence. Ohio’s Hospice and its affiliates is allowed to notify government authorities if there is reason to believe a patient is a victim of abuse, neglect or domestic violence. Ohio’s Hospice of Dayton 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. Ohio’s Hospice and its affiliates may disclose your health information to a health oversight agency for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action. Ohio’s Hospice and/or all affiliates, 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 healthcare or public benefits.
In Connection with Judicial and Administrative Proceedings. Ohio’s Hospice and its affiliates may disclose your health information in the course of any judicial or administrative proceedings 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 Ohio’s Hospice and its affiliates makes reasonable efforts to either notify you about the request or to obtain an order protecting your health information.
For Law Enforcement Purposes. Ohio’s Hospice and its affiliates may disclose your health information to a law enforcement official for 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 the hospice has a suspicion that your death was the result of criminal conduct.
In an emergency in order to report a crime.
To Coroners and Medical Examiners. Ohio’s Hospice and its affiliates 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. Ohio’s Hospice and its affiliates may disclose your health information to funeral directors consistent with applicable laws and if necessary, to carry out their duties with respect to your funeral arrangements. If necessary to carry out their duties, Ohio’s Hospice and its affiliates may disclose your health information prior to, or in reasonable anticipation of your death.
For Organ, Eye or Tissue Donation. Ohio’s Hospice and its affiliates may 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 or transplantation.
For Research Purposes. Ohio’s Hospice and its affiliates may, under very select circumstances, use your health information for research. Before Ohio’s Hospice and its affiliates discloses any of your health information for such research purposes, the project will be subject to an extensive approval process. Ohio’s Hospice and its affiliates will ask your permission if any researcher will be granted access to your individually identifiable health information.
In the Event of a Serious Threat to Health or Safety. Ohio’s Hospice and its affiliates may, consistent with applicable law and ethical standards of conduct, disclose your health information if Ohio’s Hospice and its affiliates, 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 or safety of the public.
For Specified Government Functions. In certain circumstances, the Federal regulations authorize the Ohio’s Hospice and its affiliates 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.
For Worker’s Compensation. Ohio’s Hospice and its affiliates may
release your health information for worker’s compensation or
Authorization to Use or Disclose Health Information
Other than is stated above, Ohio’s Hospice and its affiliates will not disclose your health information other than with your written authorization. If you or your representative authorizes Ohio’s Hospice and its affiliates 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 Ohio’s Hospice and/or all affiliates 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 the disclosure of your health information to someone who is involved in your care or the payment of your care. However, Ohio’s Hospice and its affiliates is not required to agree with your request.
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, Ohio’s Hospice and its affiliates may charge a reasonable fee for copying and assembling costs associated with your request.
Right to amend health care information. If you or your representative believes that your health information records are incorrect or incomplete, you may request an amendment of the records. That request may be made as long as the information is maintained by Ohio’s Hospice and/or all affiliates. A request for an amendment of records must be made in writing to the Privacy Officer. Ohio’s Hospice and its affiliates 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 Ohio’s Hospice and its affiliates, if the records you are requesting are not part of Ohio’s Hospice and its affiliates’ 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 Ohio’s Hospice and its affiliates, 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 Ohio’s Hospice and its affiliates for any reasons other than for treatment, payment or health operations. The request for an accounting must be made in writing to the Privacy Officer. The request should specify the time period for the accounting, which should not exceed six years from the date of the request. Ohio’s Hospice and its affiliates would provide the first accounting you request during a 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 Privacy Officer
Duties of the Hospice
Ohio’s Hospice and its affiliates are 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. Ohio’s Hospice and its affiliates are required to abide by terms of this Notice of Privacy Practices as may be amended from time to time. Ohio’s Hospice and its affiliates reserve 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 Ohio’s Hospice and its affiliates change its Notice, you will be provided a copy of the revised Notice. You, or your representative, have the right to express complaints to Ohio’s Hospice and its affiliates and to the Secretary of Health and Human Services if you believe that your privacy rights have been violated. Any complaints to Ohio’s Hospice and its affiliates should be made in writing to the Privacy Officer. Ohio’s Hospice and its affiliates 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.
Ohio’s Hospice and its affiliates’ contact person for all issues regarding patient privacy and your rights under the Federal privacy standards is:
HIPAA Privacy Officer
7575 Paragon Rd.
Dayton, OH 45459