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Notice of Privacy
Practices
1. Purpose:
Evergreen Hospice and its professional staff, employees and
volunteers and all of its affiliated
entities
follow the privacy
practices described in the Notice. Evergreen Hospice maintains
your medical information in
records that will be maintained in a confidential
manner, as required by law. However, Evergreen Hospice
must
use and disclose you
medical information a necessary for treatment, payment and health
care operations.
2. What Are
Treatment, Payment and Health Care Operations?
Treatment includes sharing information
among
health care
providers involved in your care. For example, your physician
may share information about
your
condition with the
pharmacist to discuss appropriate medications, or with radiologists
or other consultants in
order to make a diagnosis. Evergreen Hospice may use
your medical information as required by your
insurer,
Medicare, Medicaid
or HMO to obtain payment for your treatment and Hospice
care. We also may use and
disclose your medical information to improve the quality of
care, e.g., for review and training purposes.
3. How Will
Evergreen Hospice Use My Medical Information? Your
medical information may be used,
unless
you ask
for restrictions on a specific use or disclosure, for the
following purposes:
- Evergreen Hospice Directory, which may include your name
general condition and you location.
- Religious affiliation to an Evergreen Hospice
chaplain or member of the clergy.
- Family members or persons designated as your legal
representative involved in your care or payment for
your
treatment.
- Disaster relief agency if you are involved is a disaster
relief effort.
- Appointment reminders.
- To inform you of treatment alternatives or benefits or
services related to your health.
- As required by law.
- Public health activities, including disease prevention, injury
or disability; reporting births and deaths;
reporting child
abuse or neglect; reporting reactions to medications or product
problems; notification of
recalls; infectious disease control;
notifying government authorities of suspected abuse, neglect or
domestic
violence (if you agree or as required by law.)
- Health oversight activities, e.g., audits, inspections,
investigations and licensure.
- Lawsuits and disputes. (We will attempt or
provide you advance of a subpoena before disclosing the
information.)
- Law enforcement, e.g., in response to a court order
or other legal process; to identify or locate an
individual
may be the result of criminal conduct; about
criminal conduct that occurred on Evergreen Hospice
premises;
and in emergency circumstances relating to reporting
information about a crime.
- Coroners, medical examiners and funeral directors.
- Organ and tissue donation.
- Certain research projects.
- To prevent a serious threat to health or safety.
- To military command authorities if you are a member
of the armed forces or a member of a foreign military authority.
- National security and intelligence activities.
- Protections of the President or other authorized persons
for foreign heads of state, or to conduct special investigations.
- Inmates. (Medical information about inmates of
correctional institutions may be released to the institution.)
- Workers Compensation. (Your medical information
regarding benefits for work-related illnesses may be as
appropriate.)
- To carry out health care treatment, payment and operations
functions through business associates, e.g., to
install a new
computer system.
4. Your Authorization is Required for Other
Disclosures. Except as described
above, we will not use or
disclose your
medical information unless you authorize (permit) Evergreen Hospice
in writing to disclose your
information.
You may revoke your permission, which will be effective only after
the date of your written revocation.
5. You Have Rights Regarding Your Medical
Information. You have the following rights regarding
your medical
information, provided that you
make a written request to invoke the right on the form provided
by Evergreen Hospice.
Right
to request restriction. You may request
limitations on your medical information we use
and disclose
for
health care treatment, payment or operations, e.g., you may ask us
not to disclose that you have had
a
particular surgery,
but we are not required to agree to your request. If we agree,
we will comply with
your
request unless
the information is needed to provide you with emergency
treatment.
Right to confidential communications. You may
request communications in a certain way or at a
certain
location,
but you must specify how or where you
wish to
contacted.
Right
to inspect and copy. You have the right to inspect
and copy your medical information
regarding
decisions
about your care__however, psychotherapy notes may not be inspected
and copied. We
may
charge a
fee for copying, mailing and supplies. Under limited
circumstances, your request may be
denied;
you may
request review of the denial by another licensed health care
professional chosen by
Evergreen
Hospice. Evergreen Hospice will comply with the outcome of the
review.
Right
to request amendment. If you believe that the medical
information we have about you is incorrect
or
incomplete, you may
request an amendment on the form provided by Evergreen
Hospice, which
requires
certain
specific information. Evergreen Hospice is not required to
accept the amendment.
Right to accounting of disclosures. You
may request a list of the disclosures of your medical
information
that
have been made to persons or entities other than for health care
treatment payment or operations in
the
past six years,
but not prior to April 14, 2003. After the first request,
there may be a
charge.
Right
to copy this Notice. You may request a paper copy of
this Notice at any time, even if you have
been
provided
with an electronic copy. You may obtain an electronic copy of
this Notice at our
website, http://www.evergreenhospice.net.
6. Requirements Regarding This
Notice. Evergreen hospice is required by law to
provide you with this
Notice.
We
will be governed by this Notice for as long as it is in
effect. Evergreen Hospice may change this Notice
and
these
changes will be effective for medical information we have about you
as well as any information we
receive
in the
future. Each time you register at Evergreen Hospice for health
care services as a patient, you may
receive
a copy
of the Notice in effect at that time.
7. Complaints. If you
believe your privacy rights have been violated, you may file a
complaint with Evergreen
Hospice or with the Secretary of the United States
Department of Health and Human Services. You will
not
be penalized or retaliated against in any way for
making a complaint against Evergreen
Hospice
or the Department of Health and Human
Services.
Contact:
The Executive Director at Evergreen Hospice at (918) 250-5555
if:
~ You have a
complaint;
~ You
have any questions about this
Notice;
~ You wish
to request restrictions on uses and disclosures for health care
treatment, payment or
operations; or
~ You
wish to obtain a form to exercise your individual rights described
in paragraph 5.
Notice of
Privacy Practices
Evergreen Hospice
Effective Date: May 14,
2004 Contact
Person: Executive
Director
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