Portsbridge Hospice

Notice of Information 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.

Your Health Information

We will collect, use and disclose information provided by you and about you for health care treatment , payment and  operations or when we are otherwise permitted or required by law to do so.

Disclosures for Treatment, Payment, and Health Operations

For Health Care TreatmentWe will use your healthcare information for treatment. For example, a physician, nurse or other member of your healthcare team will record information in your record to diagnose, plan and determine the best course of treatment for you. We will also provide your physician, other healthcare professionals, or subsequent healthcare providers with copies of your records to assist them in providing care or placement as deemed necessary.

For Health Payment:  We will use your health information for payment. For example, we may send a bill to a third- party payer, such as a health insurer. The information on or accompanying the bill may include information that identifies you, your diagnosis, treatment received and supplies / equipment used.

For Health Operations:We will use your health information for health operations. For example, members of the treatment team, the risk or quality improvement manager and team members may use information in your health record to assess the care and outcomes in your cases and the competence of the team members. We will use this information in an effort to continually improve the quality and effectiveness of the care and services we provide.

Other Disclosures as Necessary:We will use your health information for business contracts. For example, we provide some services through contracts with business associates. When we use these services, we may disclose your health information to the business associate so that they can perform the function (s) we have contracted them to do and bill for the services rendered. To protect your information, however, we require the business associate to appropriately safeguard your information.

As permitted or Required by Law: We may disclose health information about you to DHHS( Department of Health and Human Services), health oversight agencies and public health authorities as required by law or in response to a valid subpoena.

Your Rights: Under federal regulations that will be in effect in April 2003, you will have the right to:

• Request restrictions on uses and disclosures of your health information for treatment, payment and healthcare operations. We do not however have to agree with the restriction.
• Request that we communicate with you by reasonable alternate means.
• Inspect and copy your health information that you believe is incomplete or inaccurate upon written request. In certain situations we can deny access. If we grant access, we will tell you what, if anything, you have to do to get access. We reserve the right to charge a reasonable, cost-based fee for making copies.
• Request amendment / correction of your health information. We do have to grant this request if we did not create the record, the records are not available to you or the record is accurate and complete.
• Receive an accounting of our disclosures of your medical information, except other than for treatment, payment and health care operations or the law otherwise restricts the accounting. We are not required to give you a list of disclosures made before April 14, 2003.
• Revoke your consent or authorization to use or disclose health information except to the extent that we have already used your information based on your authorization.

Our Responsibilities: In addition to providing you your rights as detailed above, we are required to:

• Maintain the privacy of your health information, including implementing reasonable and appropriate physical, administrative and technical safeguards to protect the information.
• Provide you with this notice as to our legal duties and privacy practices with respect to individually identifiable health information we collect and maintain about you.
• Abide by the terms of this notice.
• Train our personnel concerning privacy and confidentiality.
• Implement a sanction policy to discipline and mitigate any breach of privacy / confidentiality o our policies.

Copies and Changes

You have the right to receive an additional copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy.

We reserve the right to revise this notice. A revised notice will be effective for any information we already have about you as well as any information we may receive in the future. We are required by law to comply with whatever privacy notice is in effect. We will communicate any changes to our notice through direct mail and /or our website.

How to Get More Information or Report a Problem

If you have questions and /or would like additional information, you may contact Portsbridge’s Privacy Office at (770) 716 – 5545.

For a printable version click on the link below.

Notice of Information Practices

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