We understand that information we collect about you and your health is personal. Keeping your health information private is one of our most important responsibilities. We are committed to protecting your health information and following all laws regarding the use of your health information. The law says:

1. We must keep your health care information
from others who do not need to know it.
2. You may ask that we not share certain health care information.
(In some instances, we may not be able to agree with your request.)

Your health care information may be shared to provide treatment. Health care providers such as doctors, nurses, therapists, social workers, chaplains, and volunteers who take care of you may use your private health information. They may need your private health information in order to determine your plan of care. This may cover health care services you had before or services you may have later on.

Hospice of the Chesapeake may use and disclose health care information for its own operations. Health care operations include such activities as:

Quality assessment and improvement, and ethics;
Training programs, including those in which students can learn under supervision;
Accreditation, certification, licensing, or credentialing activities;
Maryland Cancer Registry to monitor causes of cancer and treatments;
Residential facilities where you reside.

You may see your health information, unless it is the private notes taken by a mental health provider or it is a part of a legal case. Most of the time, you can receive a copy if you ask. You may be charged a small amount for the copying costs.

If you think some of the information is wrong, you may ask in writing that it be changed or that new information be added. You may ask that the changes or new information be sent to others who have received your health information from us. You may ask for a list of any places where health information may have been sent, unless it was sent for treatment, for payment, for checking to make sure you receive quality care, or to make sure the laws are being followed.

You may be asked to sign a separate form, called an authorization form, allowing your health care information to go somewhere else if:

1. Your health care provider needs to send it to other places;
2. You want us to send it to another health care provider; or
3. You want it sent to another person for you.

The authorization form tells us what, where, and to whom the information must be sent.Your authorization is good for six (6) months or until the date you specify on the form.You can cancel or limit the amount of information sent at any time by letting us know in writing.

NOTE: If you are less than 18 years old, your parents or guardians will receive your private health information, unless by law you are able to consent for your own health care treatment. If you are, then your private health information will not be shared with parents or guardians unless you sign an authorization form.   You may also ask to have your health information sent to a different person who is helping you with your health care.

When private health information is released without authorization, it is normally used to support treatment or payment of medical situations. The release of health information for this purpose is not tracked or accountable to you, the patient/recipient (HIPAA rule 164.506). Any other release made without your authorization is tracked and is accountable. We always report:

1. Contagious diseases;
2. Reactions and problems with medicine and equipment to the Food and Drug Administration;
3. To the police when they are investigating a crime, when child or elder abuse may be happening, or when the court orders us to do so;
4. To the government to review how Hospice of the Chesapeake's program is working;
5. Work-related injuries to Workers Compensation;
6. Death information;
7. To the Federal Government when they are investigating something important to protect our country, the President, and/or other government workers.

This notice is yours. If any change is made in this notice, you will be sent an updated one.

If you have other medical insurance, you may receive other privacy notices. The policies and procedures contained in this notice are those of Hospice of the Chesapeake only.

If you have any questions about this notice, or you think that we have not protected your private health information and you wish to complain about it, please contact either of the following:

Hospice of the Chesapeake
Attn: Quality Improvement Manager
445 Defense Highway
Annapolis, MD 21401
410.987.2003

OR

Office of Civil Rights, USDHHS
Region III
Public Ledger Building, Suite 372
150 South Independence Mall West
Philadelphia, PA 19106
1.800.368.1019

ANNE ARUNDEL COUNTY
445 Defense Highway
Annapolis, MD 21401
phone: 410.987.2003