HIPAA 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.

This privacy notice (“Notice”) applies to Sunshine Hospice of Logan, Utah (“the Hospice”) including its employees, staff, and volunteers.

Protected Health Information (PHI) is information, including demographic information, that may identify you and that relates to health care services provided to you, the payment of health services provided to you, or your physical or mental health, or condition, in the past, present or future. This Notice of Privacy Practices describes how the Hospice may use and disclose your PHI. It also describes your rights to access and control your PHI.

We are required by law to:

  • Protect and maintain the privacy of your PHI;
  • Give you and other individuals this notice of our legal duties and privacy practices

    regarding PHI;

  • Follow the terms of the Notice of Privacy Practices currently in effect; and
  • Notify affected individuals in the event of a breach involving unsecured protected health

    information.

    We reserve the right to change the Notice of Privacy Practices at any time. We reserve the right to make the revised or changed Notice effective for PHI we already have about you as well as any information we receive in the future. The Notice will contain the effective date on the first page. If we change our Notice, we will provide a copy of the revised Notice to you upon request. We will also post a copy of the current Notice in the Hospice main office and on our website: http://www.sunshineterrace.com.

    HOW WE USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION

    We may use and disclose your PHI as described below. We are required to comply with any state laws that impose stricter standards than the uses and disclosures described in this Notice of Privacy Practices. Your PHI may be stored electronically and is subject to electronic disclosure, including through health information exchanges.

• To Provide Treatment. We may use and disclose your PHI for treatment purposes, including coordinating your care within the Hospice and with others involved in your care, such as your attending physician, members of the Hospice interdisciplinary team and other health care professionals. For example, physicians involved in your care will need information about your symptoms in order to prescribe appropriate medications.

• For Payment Purposes. We may use and disclose your PHI to receive payment for the care you receive. For example, we may provide information to your health insurance company so that the insurer will reimburse you or the Hospice; we may need to obtain prior approval from your insurer for hospice care; and we may use or disclose your PHI to determine whether you are eligible for health benefits.

To Conduct Health Care Operations. We may use and disclose PHI in order to facilitate our internal operations and to provide quality care to all of our patients. Health care
operations include quality assessment and improvement activities; accreditation reviews; internal audits; training of staff and volunteers; activities designed to improve health or reduce health care costs; arranging for legal services; assessing care and outcome of your case; and providing appointment reminders.

  • For a Facility Directory. We may use and disclose certain information about you including your name, your general health status and where you are in our facility in a directory while you are in the Hospice residence. We may disclose this information to people who ask for you by name, and we may disclose this information plus your religions affiliation to clergy. Please inform us if you do not want your information to be included in the directory.
  • For Fundraising. We may use and disclose information about you, including your name, address, telephone number and the dates you received care, in order to contact you or your family to raise money for the Hospice. You may opt out of receiving fundraising communications. To opt out, please notify our Privacy Officer at the address listed below under “Contact Person” and indicate that you do not wish to be contacted. The Hospice will not condition your treatment on your choice to receive or not receive fundraising communications. We will only include specific information about a patient in generally distributed fundraising materials (for example in videos, brochures, and testimonials) if we receive written authorization to do so.
  • When Legally Required. We will disclose your health information when it is required to do so by any Federal, State or local law.
  • For Public Health Purposes. As authorized by law, we may disclose PHI for public health purposes, including reporting vital statistics (including reports of death), disease information, information related to recalls of dangerous products and similar information to public health authorities.
  • To Report Abuse, Neglect Or Domestic Violence. As authorized by law, we may notify government authorities if we believe a patient is the victim of abuse, neglect, or domestic violence.
  • To Conduct Health Oversight Activities. We may disclose your PHI to a health oversight agency for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action and similar activities.
  • In Connection With Judicial And Administrative Proceedings. We may disclose your PHI in response to an order of a court or administrative tribunal. We may also disclose your PHI in response to a subpoena, discovery request or other lawful process, but only when reasonable efforts have been made to notify you about the request or to obtain an order protecting your PHI.
  • For Law Enforcement Purposes. As authorized by law, we may disclose your health information to law enforcement officials for certain law enforcement purposes.
  • To Coroners, Medical Examiners and Funeral Directors. We may disclose your health information to coroners, medical examiners and funeral directors as authorized by law, prior to and in reasonable anticipation of death.
  • For Organ, Eye Or Tissue Donation. We may use or disclose your PHI 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. We may use and disclose PHI for research if certain requirements are met, such as approval by an Institutional Review Board.
  • To Business Associates. We may disclose your PHI to third parties known as “Business Associates” that perform various activities (e.g. consulting services, billing services) for us and that agree to protect the privacy of your health information.
  • In the Event of A Serious Threat To Health Or Safety. We may disclose your PHI if we in good faith believe 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 or another person.
  • For Specified Government Functions. In certain circumstances, we may use or disclose your PHI to facilities specified government functions relating to military and veterans, national security and intelligence activities, protective services for the President and others, medial suitability determinations and inmates and law enforcement custody.
  • For Workers Compensation. We may release your PHI for workers’ compensation or similar programs as permitted by law.
  • Communication with Family/Disaster Notification. Unless you object, we may disclose to your family members or others involved in your care or payment for your care, information relevant to their involvement in your care or payment for your care or information necessary to inform them of your location and condition. We may also release information to disaster relief agencies so they may assist in notifying those involved in your care of your location and general condition.

    AUTHORIZATION TO USE OR DISCLOSE PHI

    Other than as stated above, we will not use or disclose your PHI other than with your written authorization. Subject to compliance with limited exceptions, we will not use or disclose psychotherapy notes, use or disclose your PHI for marketing purposes or sell your PHI unless you have signed an authorization. If you or your representative authorize us to use or disclose your PHI, you may revoke that authorization in writing at any time to stop future uses or disclosures. However, your decision to revoke the authorization will not affect or undo any use or disclosure of PHI that occurred before you notified us of your decision to revoke your authorization.

    YOUR RIGHTS WITH RESPECT TO YOUR PHI

You have the following rights regarding your PHI that we maintain. Please contact the Privacy Officer at the address listed below (under “Contact Person”) to obtain the appropriate form to exercise these rights.

  • Right to request restrictions. You may request restrictions on certain uses and disclosure of your PHI. However, we are not required to agree to your request, except for requests to restrict disclosures to a health plan for purposes of ______ when you or someone on your behalf has paid in full out-of-pocket for your care and when the disclosures are not required by law. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
  • Right to receive confidential communications. You have the right to request that we communicate with you through alternative means or locations. We will not request that you provide reasons for your request and will accommodate your reasonable
    requests. We may require you to provide information on how payment will be handled and an address or other method to reach you. Requests must be made in writing.
  • Right to inspect and copy your health information. You have the right to inspect and copy your PHI that is used to make decisions about you, including your medical record and billing records, by making a request in writing. If you request a copy of your health information, we may charge a reasonable fee for our labor and supply costs for creating the copy and postage, if applicable. If your information is stored electronically and you request an electronic copy, we will provide it to you in a readable electronic form and format.
  • Right to amend health care information. You have the right to request that we amend our records, if you believe that your PHI is incorrect or incomplete. We may deny the request if it does not include a reason for the amendment and for certain other reasons, including that the records are accurate and complete. Requests must be made in writing.
  • Right to an accounting. You have the right to request a list of disclosures of your health information made by us for certain reasons, including reasons related to public health purposes authorized by law and certain research disclosures. The list will not include disclosures that we are not required to record such as disclosures you authorize. We will provide the first accounting you request during any 12-month period without charge. Additional accounting requests made during the same 12-month period may be subject to a reasonable cost-based fee
  • Right to a paper copy of this notice. You have a right to request a paper copy of the

    Notice at any time even if you have received this Notice previously electronically. You may also obtain a copy of the current version of our Notice of Privacy Practices at our website, http://www.sunshineterrace.com

    Complaints

You or your personal representative has the right to complain to us and to the Secretary of Health and Human Services if you or your representative believes that your privacy rights have been violated. Any complaints to the Hospice should be made in writing to our Privacy Officer at the address listed below (under “Contact Person”). We encourage 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

We have designated the Privacy Officer as our contact person for all issues regarding patient privacy and exercising your rights under the HIPAA privacy standards. You may contact the Privacy Officer by writing Sunshine Hospice of Logan, Utah, Attn: Privacy Officer, 225 North 200 West, Logan, Utah 84321 and by phone at 435-716-8546.