NOTICE OF PRIVACY PRACTICES FOR
HEART ‘N HOME HOSPICE
& PALLIATIVE CARE, LLC
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. THE PRIVACY OF YOUR
MEDICAL INFORMATION IS IMPORTANT TO US.
Our Legal Duty
We are required by applicable federal and state laws
such changes are permitted by applicable law. We
to maintain the privacy of your protected health
reserve the right to make the changes in our privacy
information. We are also required to give you this
practices and the new terms of our notice effective for
notice about our privacy practices, our legal duties,
all protected health information that we maintain,
and your rights concerning your protected health
including medical information we created or received
information. We must follow the privacy practices
before we made the changes.
that are described in this notice while it is in effect.
You may request a copy of our notice
(or any
This notice takes effect November 1, 2012, and will
subsequent revised notice) at any time. For more
remain in effect until we replace it.
information about our privacy practices, or for
We reserve the right to change our privacy practices
additional copies of this notice, please contact us using
and the terms of this notice at any time, provided that
the information listed at the end of this notice.
Uses and Disclosures of Protected Health Information
We will use and disclose your protected health
who, at the request of your physician, becomes
information about you for treatment, payment, and
involved in your care by providing assistance with your
health care operations.
health care diagnosis or treatment to your physician.
Following are examples of the types of uses and
Payment: Your protected health information will be
disclosures of your protected health care information
used, as needed, to obtain payment for your health
that may occur. These examples are not meant to be
care services. This may include certain activities that
exhaustive, but to describe the types of uses and
your health insurance plan may undertake before it
disclosures that may be made by our office.
approves or pays for the health care services we
recommend for you, such as: making a determination
Treatment: We will use and disclose your protected
of eligibility or coverage for insurance benefits,
health information to provide, coordinate or manage
reviewing services provided to you for protected
your health care and any related services. This
health necessity, and undertaking utilization review
includes the coordination or management of your
activities. For example, obtaining approval for a
health care with a third party. For example, we would
hospital stay may require that your relevant protected
disclose your protected health information, as
health information be disclosed to the health plan to
necessary, to a home health agency that provides care
obtain approval for the hospital admission.
to you. We will also disclose protected health
information to other physicians who may be treating
Health Care Operations: We may use or disclose,
you. For example, your protected health information
as needed, your protected health information in order
may be provided to a physician to whom you have
to conduct certain business and operational activities.
been referred to ensure that the physician has the
These activities include, but are not limited to, quality
necessary information to diagnose or treat you.
assessment activities, employee review activities,
training of students, licensing, and conducting or
In addition, we may disclose your protected health
arranging for other business activities.
information from time to time to another physician or
health care provider (e.g., a specialist or laboratory)
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For example, we may use a sign-in sheet at the
interest based on our professional judgment. We may
registration desk where you will be asked to sign your
use or disclose protected health information to notify
name. We may also call you by name in the waiting
or assist in notifying a family member, personal
room when your doctor is ready to see you. We may
representative or any other person that is responsible
use or disclose your protected health information, as
for your care of your location, general condition or
necessary, to contact you by telephone or mail to
death.
remind you of your appointment.
Marketing: We may use your protected health
We will share your protected health information with
information to contact you with information about
third party “business associates” that perform various
treatment alternatives that may be of interest to you.
activities
(e.g., billing, transcription services) for the
We may disclose your protected health information to
Agency. Whenever an arrangement between our
a business associate to assist us in these activities.
office and a business associate involves the use or
Unless the information is provided to you by a general
disclosure of your protected health information, we
newsletter or in person or is for products or services
will have a written contract that contains terms that
of nominal value, you may opt out of receiving further
will protect the privacy of your protected health
such information by telling us using the contact
information.
information listed at the end of this notice.
We may use or disclose your protected health
Research; Death; Organ Donation: We may use
information, as necessary, to provide you with
or disclose your protected health information for
information about treatment alternatives or other
research purposes in limited circumstances. We may
health-related benefits and services that may be of
disclose the protected health information of a
interest to you. We may also use and disclose your
deceased person to a coroner, protected health
protected health information for other marketing
examiner, funeral director or organ procurement
activities. For example, your name and address may be
organization for certain purposes.
used to send you a newsletter about our Agency and
Public Health and Safety: We may disclose your
the services we offer. We may also send you
protected health information to the extent necessary
information about products or services that we
to avert a serious and imminent threat to your health
believe may be beneficial to you. You may contact us
or safety, or the health or safety of others. We may
to request that these materials not be sent to you.
disclose your protected health information to a
Uses and Disclosures Based On Your Written
government agency authorized to oversee the health
Authorization: Other uses and disclosures of your
care system or government programs or its
protected health information will be made only with
contractors, and to public health authorities for public
your authorization, unless otherwise permitted or
health purposes.
required by law as described below.
Health Oversight: We may disclose protected
You may give us written authorization to use your
health information to a health oversight agency for
protected health information or to disclose it to
activities authorized by law, such as audits,
anyone for any purpose.
If you give us an
investigations and inspections. Oversight agencies
authorization, you may revoke it in writing at any time.
seeking this information include government agencies
Your revocation will not affect any use or disclosures
that oversee the health care system, government
permitted by your authorization while it was in effect.
benefit programs, other government regulatory
Without your written authorization, we will not
programs and civil rights laws.
disclose your health care information except as
Abuse or Neglect: We may disclose your protected
described in this notice.
health information to a public health authority that is
Others Involved in Your Health Care: Unless you
authorized by law to receive reports of child abuse or
object, we may disclose to a member of your family, a
neglect. In addition, we may disclose your protected
relative, a close friend or any other person you
health information if we believe that you have been a
identify, your protected health information that
victim of abuse, neglect or domestic violence to the
directly relates to that person’s involvement in your
governmental entity or agency authorized to receive
health care. If you are unable to agree or object to
such information. In this case, the disclosure will be
such a disclosure, we may disclose such information as
made consistent with the requirements of applicable
necessary if we determine that it is in your best
federal and state laws.
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Food and Drug Administration: We may disclose
disclose your protected health information when
your protected health information to a person or
authorized by workers’ compensation or similar laws.
company required by the Food and Drug
Process and Proceedings: We may disclose your
Administration to report adverse events, product
protected health information in response to a court
defects or problems, biologic product deviations, to
or administrative order, subpoena, discovery request
track products; to enable product recalls; to make
or other lawful process, under certain circumstances.
repairs or replacements; or to conduct post marketing
Under limited circumstances, such as a court order,
surveillance, as required.
warrant or grand jury subpoena, we may disclose your
Criminal Activity: Consistent with applicable federal
protected health information to law enforcement
and state laws, we may disclose your protected health
officials.
information, if we believe that the use or disclosure is
Law Enforcement: We may disclose limited
necessary to prevent or lessen a serious and imminent
information to a law enforcement official concerning
threat to the health or safety of a person or the
the protected health information of a suspect, fugitive,
public. We may also disclose protected health
material witness, crime victim or missing person. We
information if it is necessary for law enforcement
may disclose the protected health information of an
authorities to identify or apprehend an individual.
inmate or other person in lawful custody to a law
Required by Law: We may use or disclose your
enforcement official or correctional institution under
protected health information when we are required to
certain circumstances. We may disclose protected
do so by law. For example, we must disclose your
health information where necessary to assist law
protected health information to the U.S. Department
enforcement officials to capture an individual who has
of Health and Human Services upon request for
admitted to participation in a crime or has escaped
purposes of determining whether we are in
from lawful custody.
compliance with federal privacy laws. We may
Patient Rights
Access: You have the right to look at or get copies
2011 [January 1, 2014] and only applies to disclosures
of your protected health information, with limited
for the three (3) years preceding your request. We
exceptions. You must make a request in writing to the
will provide you with the date on which we made the
contact person listed herein to obtain access to your
disclosure, the name of the person or entity to whom
protected health information. You may also request
we disclosed your protected health information, a
access by sending us a letter to the address at the end
description of the protected health information we
of this notice. If you request copies, we will charge
disclosed, the reason for the disclosure, and certain
you 10¢ for each page, $15.00 per hour for staff time
other information. If you request this list more than
to locate and copy your protected health information,
once in a 12-month period, we may charge you a
and postage if you want the copies mailed to you. If
reasonable, cost-based fee for responding to these
the Agency keeps your health information in
additional requests. Contact us using the information
electronic form, you may request that we send it to
listed at the end of this notice for a full explanation of
you or another party in electronic form. If you prefer,
our fee structure.
we will prepare a summary or an explanation of your
Restriction Requests: You have the right to
protected health information for a fee. Contact us
request that we place additional restrictions on our
using the information listed at the end of this notice
use or disclosure of your protected health
for a full explanation of our fee structure.
information. Except as noted herein, we are not
Accounting of Disclosures: You have the right to
required to agree to these additional restrictions, but
receive a list of instances in which we or our business
if we do, we will abide by our agreement (except in an
associates disclosed your non-electronic protected
emergency). We are required to accept and follow
health information for purposes other than treatment,
requests for restrictions of health information to
payment, health care operations and certain other
insurance companies if you have paid out-of-pocket
activities during the past six (6) years. For disclosures
and in full for the item or service we provide to you.
of electronic health information, our duty to provide
Any agreement we may make to a request for
an accounting only covers disclosures after January 1,
additional restrictions must be in writing signed by a
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person authorized to make such an agreement on our
explanation. You may respond with a statement of
behalf. We will not be bound unless our agreement is
disagreement to be appended to the information you
so memorialized in writing.
wanted amended. If we accept your request to amend
the information, we will make reasonable efforts to
Confidential Communication: You have the right
inform others, including people or entities you name,
to request that we communicate with you in
of the amendment and to include the changes in any
confidence about your protected health information
future disclosures of that information.
by alternative means or to an alternative location.
You must make your request in writing. We must
Electronic Notice: If you receive this notice on our
accommodate your request if it is reasonable, specifies
website or by electronic mail (e-mail), you are entitled
the alternative means or location, and continues to
to receive this notice in written form. Please contact
permit us to bill and collect payment from you.
us using the information listed at the end of this notice
to obtain this notice in written form.
Amendment: You have the right to request that we
amend your protected health information. Your
Notice of Unauthorized Disclosures: If the
request must be in writing, and it must explain why
Agency causes or allows your health information to be
the information should be amended. We may deny
disclosed to an unauthorized person, and such may
your request if we did not create the information you
cause harm to you, the Agency will notify you of this
want amended or for certain other reasons. If we
and help you mitigate the effects.
deny your request, we will provide you a written
Questions and Complaints
If you want more information about our privacy
Health and Human Services. We will provide you
practices or have questions or concerns, please
with the address to file your complaint with the U.S.
contact us using the information below.
Department of Health and Human Services upon
request.
If you believe that we may have violated your privacy
rights, or you disagree with a decision we made about
We support your right to protect the privacy of your
access to your protected health information or in
protected health information. We will not retaliate in
response to a request you made, you may complain to
any way if you choose to file a complaint with us or
us using the contact information below. You also may
with the U.S. Department of Health and Human
submit a written complaint to the U.S. Department of
Services.
Name of Contact Person: Director of Compliance and Quality Improvement
Phone: (208) 452-2662 x124
Fax:
(208) 452-2884
Address:
1100 NW 12th Street, Fruitland, ID 83619
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