Notice of Privacy Practices

Notice of Privacy 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 THIS NOTICE CAREFULLY.
USE AND DISCLOSURE OF HEALTH INFORMATION

Hospice may use your health information for purposes of providing you treatment, obtaining
payment for your care and conducting health care operations, as defined in the federal Health
Insurance Portability and Accountability Act (HIPAA) of 1996.
New York State Laws will prevail when they are more stringent with respect to the privacy of
health information, or when they allow individuals greater rights of access to or amendment of
their health information.

YOUR HEALTH RECORD/INFORMATION
When you become a patient of Hospice, a record is maintained that typically includes the
following: documentation of visits and other contacts from your Hospice team members,
information regarding your medical history and diagnoses, test results, medications and other
treatments, information about your Hospice plan of care, and documentation of communication
among team members regarding the development of your plan of care.

Your Hospice record serves as a:
 Basis for planning your care and treatment
 Means of communication among the healthcare personnel who contribute to your
care
 Legal document describing the care that you received
 Means by which you or a third party payor can verify that services billed were actually
provided
 Means for educating healthcare personnel/students
 Source of data for Hospice research
 Source of information for public health officials (for example, the NYS Department of
Health)
 Source of information for agency planning and marketing
 Means by which we can assess, and work to improve, the quality of the care we
provide and the outcomes we achieve
Understanding what information is contained in your record, and how it is used can help you
to:
 Understand the use and disclosure of your health information
 Ensure its accuracy
 Make informed decisions when authorizing disclosure to others
Created 2/21/10, revised 7/10; 2/13; 6/13, 8/15, 5/17, 6/17, (7/17), 4/19

EXAMPLES OF USES AND DISCLOSURES FOR TREATMENT, PAYMENT AND
HEALTH OPERATIONS
We will use your health information for treatment. Hospice will use your health
information to provide and coordinate your care. Your health care information may be
disclosed to: your family members, pharmacists, your attending physician, or other
health care professionals involved in your Hospice care.
Example: Information obtained by a nurse, physician, or other member of your Hospice
team will be recorded in the record and used in planning your care. Members of your
Hospice team will record information regarding the care provided to you and your family.
This information may be communicated to your attending physician.
We will use your health information for obtaining payment for the services
provided to you.
Example: A bill may be sent to a third party payer. The information on or accompanying
the bill may include information that identifies you, your diagnosis, and medications and
equipment that you have used. We also may need to obtain prior approval from your
insurer and may need to discuss your need for hospice care and the services that will
be provided to you.
We will use your health information for regular agency operations.
Examples:
Quality Improvement: Members of the Hospice team, the quality improvement
manager, or members of the quality improvement team, may use information in your
Hospice record to assess the care provided to you and your family, and to assess the
outcomes related to your care. This information will then be used in an effort to
continually improve the quality and effectiveness of the Hospice services that we
provide.
Business Associates: There are some services provided by Hospice through contracts
with other providers (business associates). Examples include certain tests and
treatments, and provision of medications. When these services are provided, we may
disclose your health information to our business associates so that they can provide the
services that we have requested, and so that they can bill Hospice, or your third party
payor, for these services. To protect your health information, we require the business
associate to maintain the privacy of your information.
Red Cross and Armed Forces. We may disclose PHI/ePHI to the Red Cross or Armed
Forces to assist them in notifying family members of your location, general condition, or
death.

Communication with Family: Hospice will request that you identify family members,
or other persons, to whom Hospice personnel may disclose your health information
when it is relevant to that person’s involvement in your care. Hospice personnel will use
their best professional judgment regarding disclosures to the identified person(s).
Research: We may disclose information for research purposes when the research has
been approved by the Hospice administration and Quality Improvement leadership.
Policies are followed to protect the privacy of your health information.
We will obtain a written authorization for disclosure of your health information for
research purposes.

Funeral Directors: We may disclose health information to funeral directors consistent
with applicable laws to carry out their duties.
Organ Procurement Organizations: If you have requested to participate in organ
donation, we may disclose health information, consistent with applicable law, to organ
procurement organizations or other entities engaged in the procurement, banking, or
transplantation of organs for the purpose of tissue donation and transplant.
Fundraising: We may disclose your demographic information to the Hospice
Foundation including name; address; other contact information; age; gender and date
of birth, for purposes of fundraising. We may contact you as part of fund-raising efforts
for Hospice. All fundraising communications will include information about how you may
opt out of future fundraising communications.

Food and Drug Administration (FDA): We may disclose to the FDA health information
relative to adverse events with respect to food, supplements, products and product
defects.
Workers Compensation: We may disclose health information to the extent authorized
by and to the extent necessary to comply with laws relating to workers compensation or
other similar programs established by law.

Public Health: As required by law, we may disclose your health information to public
health or legal authorities responsible for preventing or controlling disease, injury, or
disability. We may notify a person who has been exposed to, or is at risk of contracting
a communicable disease.

Correctional Institution: If you are an inmate of a correctional institution, we may
disclose to the institution or its agents, health information necessary for your health care,
and the health and safety of other individuals.
Law Enforcement: We may disclose health information for law enforcement purposes
as required by law or in response to a valid subpoena.

Reporting of Abuse, Neglect or Domestic Violence: We are allowed to notify
government authorities if we believe a patient is the victim of abuse, neglect or domestic
violence. We will make such a disclosure only when specifically required or authorized
by law or when the patient agrees to the disclosure.
Health Oversight Activities: We may disclose your health information to a health
oversight agency for activities including audits, inspections or licensure.
Judicial and Administrative Proceedings: We may disclose your health information
in the course of judicial or administrative proceedings in response to a court order or
subpoena.
Coroners and Medical Examiners: We may disclose your health information to
coroners and/or medical examiners as authorized by law.
Serious Health or Safety Threat: We may, consistent with legal and ethical standards,
disclose your health information if we believe that such disclosure is necessary to
prevent or minimize a serious threat to your health or safety, or to the public’s health or
safety.
Other Uses and Disclosures not described by this Notice will be made only with your
authorization.
YOUR HEALTH INFORMATION RIGHTS
Although your Hospice record is the physical property of Hospice, the information contained
in the record belongs to you. You have the following rights, as stated in the Federal Health
Insurance Portability and Accountability Act (HIPAA). You have the right to:
 Request a restriction on certain uses and disclosures of your health information.
However, we are not required to agree to your request.
 Request a restriction on disclosure of your health information related to services that
you have paid for out-of-pocket, in full, to a health plan. We must agree to the request
except when we are required by law to disclose.
 Review and obtain a copy of information in your Hospice record, including billing
records, in the form and format you request, as long as it is readily producible. We
may charge a reasonable fee for providing a copy of information in your record.
 Request an amendment to your Hospice record. A request to amend your record
must be made in writing, and must indicate a reason for the amendment. We are
not required to agree to your request.
 Obtain an accounting of disclosures of information in your Hospice record, for certain
reasons, including certain research. The request for an accounting must be made
in writing, and the time period requested may not be longer than 6 years prior to your
request. Accounting requests may be subject to a reasonable fee.

 Request communication of information in your Hospice record by alternative means
or at alternative locations.
 Revoke your authorization to use or disclose your health information except to the
extent that action has already been taken.
OUR RESPONSIBILITIES
Hospice is required to:
 Maintain the privacy of your health information, including genetic information.
 Provide you with a notice as to our legal responsibilities and privacy practices with
respect to your health information that we receive and maintain.
 Notify you if we are unable to agree to a requested restriction.
 Accommodate reasonable requests that you may have to communicate your health
information by alternative means or at alternative locations.
 Notify you of any breach of your unsecured health information.
 Obtain written permission to share your personal information for marketing purposes
or for the sale of your information.
 Abide by the terms of this notice.
We reserve the right to change our practices and to make the new provisions effective for all
protected health information that we maintain. If our information practices change, we will post
the revised notice to our website and provide you with a copy upon request.
OBTAINING MORE INFORMATION OR REPORTING A PROBLEM
If you have questions, would like additional information, or wish to request: restrictions, access
to your record, or an accounting of disclosures, you may contact our Corporate Compliance
Officer at 634-1100.
If you believe that your privacy rights have been violated, you can file a complaint with our
Corporate Compliance Officer at 315-634-1100 or with the Department of Health and Human
Services’ Office of Civil Rights. If you file a complaint, there will be no adverse consequences
affecting the care that we provide to you.

Effective Date: May 16, 2019

Created 2/21/10, revised 7/10; 2/13; 6/13, 8/15, 5/17, 6/17, (7/17), 4/19