NOTICE OF PRIVACY PRACTICES
HOSPICE AND PALLIATIVE CARE OF WESTCHESTER

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

USE AND DISCLOSURE OF HEALTH INFORMATION

Hospice and Palliative Care of Westchester (the Hospice) may use your health information, information that constitutes protected health information as defined in the privacy Rule of the Administrative Simplification provision of the Health Insurance Portability and Accountability Act of 1996, for purpose of providing you treatment, obtaining payment for your care and conducting health care operations. The Hospice has established policies to guard against unnecessary disclosure of your health information.

THE SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSURE

To Provide Treatment. The Hospice may use your health information to coordinate care within the Hospice and with others involved in you care, such as your physician, members of the Hospice interdisciplinary team and other health care professionals who have agreed to assist the Hospice in coordinating care, individuals outside of Hospice involved in your care including family members, pharmacists, suppliers of medical equipment or other health care professionals.

To Obtain Payment. The Hospice may use/disclosure your health information to obtain prior approval from your insurer and may include it in invoices to collect payment from third parties for the care you receive from the Hospice.

To Conduct Health Care Operations. The Hospice may use and disclosure health information for its own operations in order to facilitate the function of the Hospice and as necessary to provide quality care to all of the Hospice’s patients. Health care operations include such activities as:

• Quality assessment and improvement activities.
• Activities designed to improve health or reduce health care costs.
• Protocol development, case management and care coordination.
• Contacting health care 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 health care learn under supervision.
• Training of non-health care professionals.
• Accreditation, certification, licensing or credentialing activities.
• Review and auditing, including compliance reviewers, medical reviews, legal services and compliance programs.
• Business planning and development including cost management and planning related analyses and formulary development.
• Business management and general administrative activities of the Hospice.
• Fundraising for the benefit of the Hospice.

When Legally Required. The Hospice will disclosure your health information when it is required to do so by any Federal, State or local law. In connection with judicial and administrative proceedings, the Hospice may disclosure your health information in response to and 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. As permitted or required by State Law, the Hospice may disclose your health information to a law enforcement official for certain law enforcement purpose.

When There Are Risks to Public Health. The Hospice may disclose your health information for public activities and purpose 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.
• 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.
• Notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease.

In The Event of A Serious Threat To Health Or Safety. The Hospice may consistent with applicable law and ethical standards of conduct, discloser your health information if the Hospice, in good faith, believes that such disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or the health and safety of the public.

To Report Abuse, neglect Or Domestic Violence. The Hospice is allowed to notify government authorities if the Hospice believes a patient is the victim of abuse, neglect or domestic violence. The Hospice 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. The Hospice may disclosure your health information to health oversight agency for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action. The Hospice, 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 health care or public benefits.

For Organ, Eye Or Tissue Donation. The Hospice may use or 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 and transplantation.

For Research Purpose. The Hospice may, under very selected circumstances, use your health information for research. Before the hospice discloses any of your health information for such purposes, the project will be subject to an extensive approval process.

AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION

Other than is stated above, the Hospice will not disclose your health information other than with your written authorization. If you or your representative authorizes the Hospice 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 you health information that the Hospice maintains:

• Rights to request restrictions. You may request restriction on certain uses and disclosures of your health information. However, the Hospice is not required to agree to your request. If you with to make a request for the restrictions, please contact HIPAA Compliance Officer of the Hospice.
• Rights to receive confidential communications. You have right to request that the Hospice communicate with you in a certain way (for example - privately with no other family members present). If you wish to receive confidential communication, please contact Patient Care Coordinator. The Hospice will attempt to honor your reasonable requests for confidential communication.
• Right to inspect and copy your health information. A request to inspect and copy records containing your health information may be made to Patient Care Coordinator, the Hospice may charge a reasonable fee for copying and assembling costs associated with your request.
• Right to amend health care information. You or your representative have the right to request that the Hospice amend your records, if you believe that your health information is incorrect or incomplete. A request for an amendment of records must be made in writing to Patient Care Coordinator at 914-682-1484 ext.15. The Hospice may deny the request if: it is not in writing, does not include a reason for the amendment, your health information records were not created by the Hospice, or information your wish to amend is not part of the health information you or your representative are permitted to inspect or copy, or if, in the opinion of the hospice, 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 the Hospice for certain reasons, including reasons related to public purposes authorized by law and certain research. The request for an accounting must be made in writing to HIPAA compliance officer. The request should specify the time period for the accounting starting on or after April 14, 2003, and may not be made for periods of time in excess of six (6) years. The accounting request may be subject to a reasonable 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. To obtain a copy, please contact HIPAA Compliance Officer at Hospice.

DUTIES OF THE HOSPICE

The Hospice is 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. The Hospice is required to abide by the terms of this Notice as may be amended from time to time. The Hospice reserves 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 the Hospice changes its Notice, the Hospice will provide a copy of the revised Notice to you or your appointed representative. You or Your personal representative have the right to express complaints to the Hospice and to the Secretary of DHHS if you or your representative believe that your privacy rights have been violated. Any complaints to the Hospice should be made in writing to HIPAA Compliance Officer at Hospice and Palliative Care of Westchester, 95 S. Broadway, White Plains, NY 10601. The Hospice 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 filling a complaint.

CONTACT PERSON

The Hospice has designated the HIPAA Compliance Officer as its contact person for all issues regarding patient privacy and your rights under the Federal privacy standards. You may contact this person at Hospice and Palliative Care of Westchester, 95 S. Broadway, White Plains, NY 10601, telephone #(914)682-1484.

EFFECTIVE DATE:

This Notice is effective April 14, 2003
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