Effective Date: April 14, 2003
FOR YOUR PROTECTION
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.
YOUR HEALTH INFORMATION IS PRIVATE
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:
- We must keep your health care information from others who do not need to know it.
- You may ask that we not share certain health care information.
(In some instances, we may not be able to agree with your request.)
WHO SEES AND SHARES MY HEALTH INFORMATION?
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.
HOW IS PAYMENT MADE?
Your health care provider sends a bill (also called a "claim") to an insurance company or to a government program such as Maryland Medical Assistance, or Medicare. The bill has all of the information about what services you received. We review health care information and bills to make sure that you get quality care and that all laws providing and paying for your health care are being followed.
MAY I SEE MY HEALTH INFORMATION?
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.
WHAT IF MY HEALTH INFORMATION NEEDS TO GO SOMEWHERE ELSE?
You may be asked to sign a separate form, called an authorization form, allowing your health care information to go somewhere else if:
- Your health care provider needs to send it to other places;
- You want us to send it to another health care provider; or
- 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.
COULD MY HEALTH INFORMATION BE RELEASED WITHOUT MY AUTHORIZATION?
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:
- Contagious diseases;
- Reactions and problems with medicine and equipment to the Food and Drug Administration;
- 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;
- To the government to review how Hospice of the Chesapeake's program is working;
- Work-related injuries to Workers Compensation;
- Death information;
- To the Federal Government when they are investigating something important to protect our country, the President, and/or other government workers.
MAY I HAVE A COPY OF THIS NOTICE?
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.
QUESTIONS OR COMPLAINTS?
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
Office of Civil Rights, USDHHS
Public Ledger Building, Suite 372
150 South Independence Mall West
Philadelphia, PA 19106
WHAT WILL HAPPEN TO MY BENEFITS IF DO FILE A COMPLAINT?
Absolutely nothing. Your hospice benefits will NOT be affected if you file a complaint. It is against the law for us to take any retaliatory or other negative action against you if you file a complaint.