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This
PRIVACY 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.
Use and disclosure of health information
Avalon Hospice & Palliative Care may
use your health information, information that constitutes protected
health information as defined in the Privacy Rule of the Administrative
Simplification provisions of the Health Insurance Portability and
Accountability Act of 1996, for purposes of providing you treatment,
obtaining payment for your care and conducting health care operations.
Avalon Hospice & Palliative Care has established policies to
guard against unnecessary disclosure of your health information.
The
following is a summary of the circumstances under which and purposes
for which your health information may be used and disclosed:
To provide
treatment. Avalon
Hospice & Palliative Care may use your health information to
coordinate care within Avalon Hospice & Palliative Care and
with others involved in your care, such as your attending physician,
members of Avalon Hospice & Palliative Care interdisciplinary
team and other health care professionals who have agreed to assist
Avalon Hospice & Palliative Care in coordinating care. For example,
physicians involved in your care will need information about your
symptoms in order to prescribe appropriate medications. Avalon Hospice
& Palliative Care also may disclose your health care information
to individuals outside of Avalon Hospice & Palliative Care involved
in your care including family members, clergy who you have designated,
pharmacists, suppliers of medical equipment or other health care
professionals.
To obtain
payment.
Avalon Hospice & Palliative Care may include your health information
in invoices to collect payment from third parties for the care you
receive from Avalon Hospice & Palliative Care. For example,
Avalon Hospice & Palliative Care may be required by your health
insurer to provide information regarding your health care status
so that the insurer will reimburse you or Avalon Hospice & Palliative
Care. Avalon Hospice & Palliative Care also may need to obtain
prior approval from your insurer and may need to explain to the
insurer your need for hospice care and the services that will be
provided to you.
To conduct
health care operations. Avalon
Hospice & Palliative Care may use and disclose health information
for its own operations in order to facilitate the function of Avalon
Hospice & Palliative Care and as necessary to provide quality
care to all of Avalon Hospice & Palliative Care's patients.
Health care operations includes 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 reviews, 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 Avalon
Hospice & Palliative Care.
* Fundraising for the benefit of Avalon Hospice & Palliative
Care.
For example Avalon Hospice & Palliative Care may use your health
information to evaluate its staff performance, combine your health
information with other Hospice patients in evaluating how to more
effectively serve all Hospice patients, disclose your health information
to Hospice staff and contracted personnel for training purposes,
use your health information to contact you as a reminder regarding
a visit to you, or contact you as part of general fundraising and
community information mailings (unless you tell us you do not want
to be contacted).
For Fundraising
Activities.
Avalon Hospice & Palliative Care may use information about you
including your name, address, phone number and the dates you received
care in order to contact you or your family to raise money for Avalon
Hospice & Palliative Care. If you do not want Avalon Hospice
& Palliative Care to contact you or your family, notify our
privacy officer to indicate that you do not wish to be contacted.
The privacy officer can be reached at (858) 751-0315.
For Appointment
Reminders.
Avalon Hospice & Palliative Care may use and disclose your health
information to contact you as a reminder that you have an appointment
for a home visit.
For Treatment
Alternatives.
Avalon Hospice & Palliative Care may use and disclose your health
information to tell you about or recommend possible treatment options
or alternatives that may be of interest to you.
When Legally
Required.
Avalon Hospice & Palliative Care will disclose your health information
when it is required to do so by any Federal, State or local law.
When There
Are Risks to Public Health. Avalon
Hospice & Palliative Care may disclose your health information
for public activities and purposes 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.
* Notify an employer about an individual who is a member of the
workforce as legally required.
To Report
Abuse, Neglect Or Domestic Violence. Avalon
Hospice & Palliative Care is allowed to notify government authorities
if Avalon Hospice & Palliative Care believes a patient is the
victim of abuse, neglect or domestic violence. Avalon Hospice &
Palliative Care 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. Avalon
Hospice & Palliative Care may disclose your health information
to a health oversight hospice for activities including audits, civil
administrative or criminal investigations, inspections, licensure
or disciplinary action. Avalon Hospice & Palliative Care, however,
may not disclose your health information if you are the subject
of an investigation and your health information are not directly
related to your receipt of health care or public benefits.
In Connection
With Judicial And Administrative Proceedings. Avalon
Hospice & Palliative Care may disclose your health information
in the course of any judicial or administrative proceeding in response
to an 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, but only when Avalon Hospice & Palliative
Care makes reasonable efforts to either notify you about the request
or to obtain an order protecting your health information.
For Law Enforcement
Purposes.
As permitted or required by State law, Avalon Hospice & Palliative
Care may disclose your health information to a law enforcement official
for certain law enforcement purposes as follows:
* As required by law for reporting of certain types of wounds or
other physical injuries pursuant to the court order, warrant, subpoena
or summons or similar process.
* For the purpose of identifying or locating a suspect, fugitive,
material witness or missing person.
* Under certain limited circumstances, when you are the victim of
a crime.
* To a law enforcement official if Avalon Hospice & Palliative
Care has a suspicion that your death was the result of criminal
conduct including criminal conduct at Avalon Hospice & Palliative
Care.
* In an emergency in order to report a crime.
To Coroners
And Medical Examiners. Avalon Hospice & Palliative Care
may disclose your health information to coroners and medical examiners
for purposes of determining your cause of death or for other duties,
as authorized by law.
To Funeral
Directors.
Avalon Hospice & Palliative Care may disclose your health information
to funeral directors consistent with applicable law and if necessary,
to carry out their duties with respect to your funeral arrangements.
If necessary to carry out their duties, Avalon Hospice & Palliative
Care may disclose your health information prior to and in reasonable
anticipation of your death.
For Research
Purposes.
Avalon Hospice & Palliative Care may, under very select circumstances,
use your health information for research. Before Avalon Hospice
& Palliative Care discloses any of your health information for
such research purposes, the project will be subject to an extensive
approval process.
In the Event
of A Serious Threat To Health Or Safety. Avalon
Hospice & Palliative Care may, consistent with applicable law
and ethical standards of conduct, disclose your health information
if Avalon Hospice & Palliative Care, in good faith, believes
that such disclosure is necessary to prevent or lessen a serious
and imminent threat to your health or safety or to the health and
safety of the public.
For Specified
Government Functions. In
certain circumstances, the Federal regulations authorize Avalon
Hospice & Palliative Care to use or disclose your health information
to facilitate specified government functions relating to military
and veterans, national security and intelligence activities, protective
services for the President and others, medical suitability determinations
and inmates and law enforcement custody.
For Worker's
Compensation. Avalon Hospice & Palliative Care may release your
health information for worker's compensation or similar programs.
AUTHORIZATION
TO USE OR DISCLOSE HEALTH INFORMATION
Other
than is stated above, Avalon Hospice & Palliative Care will
not disclose your health information other than with your written
authorization. If you or your representative authorizes Avalon Hospice
& Palliative Care 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 your health information
that Avalon Hospice & Palliative Care maintains:
Right to
request restrictions. You
may request restrictions on certain uses and disclosures of your
health information. You have the right to request a limit on Avalon
Hospice & Palliative Care's disclosure of your health information
to someone who is involved in your care or the payment of your care.
However, Avalon Hospice & Palliative Care is not required to
agree to your request. If you wish to make a request for restrictions,
please contact our medical records supervisor at (858) 751-0315.
Right to
receive confidential communications. You
have the right to request that Avalon Hospice & Palliative Care
communicate with you in a certain way. For example, you may ask
that Avalon Hospice & Palliative Care only conduct communications
pertaining to your health information with you privately with no
other family members present. If you wish to receive confidential
communications, please contact our privacy officer at (858) 751-0315.
Avalon Hospice & Palliative Care will not request that you provide
any reasons for your request and will attempt to honor your reasonable
requests for confidential communications.
Right to
inspect and copy your health information. You
have the right to inspect and copy your health information, including
billing records. A request to inspect and copy records containing
your health information may be made to our medical records supervisor
at (858) 751-0315. If you request a copy of your health information,
Avalon Hospice & Palliative Care may charge a reasonable fee
for copying and assembling costs associated with your request.
Right to amend health care information.
You or your representative has the right to request that Avalon
Hospice & Palliative Care amend your records, if you believe
that your health information is incorrect or incomplete. That request
may be made as long as the information is maintained by Avalon Hospice
& Palliative Care. A request for an amendment of records must
be made in writing to our medical records supervisor at Avalon Hospice
& Palliative Care, 3914 Murphy Canon Road, Suite A226, San Diego,
Ca 92123. Avalon Hospice & Palliative Care may deny the request
if it is not in writing or does not include a reason for the amendment.
The request also may be denied if your health information records
were not created by Avalon Hospice & Palliative Care, if the
records you are requesting are not part of Avalon Hospice &
Palliative Care's records, if the health information you wish to
amend is not part of the health information you or your representative
are permitted to inspect and copy, or if, in the opinion of Avalon
Hospice & Palliative Care, 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 Avalon Hospice
& Palliative Care 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 our medical records
supervisor at Avalon Hospice & Palliative Care, 3914 Murphy
Canon Road, Suite A226, San Diego, Ca 92123. The request should
specify the time period for the accounting starting on or after
April 14, 2003. Accounting requests may not be made for periods
of time in excess of six (6) years. Avalon Hospice & Palliative
Care would provide the first accounting you request during any 12-month
period without charge. Subsequent accounting requests may be subject
to a reasonable cost-based fee.
Right to a paper copy of this notice. You
or your representative has a right to a separate paper copy of this
Notice at any time even if you or your representative, have received
this Notice previously. To obtain a separate paper copy, please
contact our privacy officer at (858) 751-0315.
DUTIES OF
AVALON HOSPICE & PALLIATIVE CARE
Avalon
Hospice & Palliative Care 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.
Avalon Hospice & Palliative Care is required to abide by the
terms of this Notice as may be amended from time to time. Avalon
Hospice & Palliative Care 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 Avalon Hospice &
Palliative Care changes its Notice, Avalon Hospice & Palliative
Care will provide a copy of the revised Notice to you or your appointed
representative. You or your personal representative has the right
to express complaints to Avalon Hospice & Palliative Care and
to the Secretary of DHHS if you or your representatives believe
that your privacy rights have been violated. Any complaints to Avalon
Hospice & Palliative Care should be made in writing to our privacy
officer at Avalon Hospice & Palliative Care, 3914 Murphy Canon
Road, Suite A226, San Diego, Ca 92123. Avalon Hospice & Palliative
Care 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 filing a complaint.
CONTACT PERSON
Avalon
Hospice & Palliative Care has designated the Quality Improvement
Manager as its contact person for all issues regarding patient privacy
and your rights under the Federal privacy standards. You may contact
this person at Avalon Hospice & Palliative Care, 3914 Murphy
Canon Road, Suite A226, San Diego, Ca 92123, (858) 751-0315
EFFECTIVE DATE
This Notice
is effective April 14, 2003.
IF YOU HAVE
ANY QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT our Quality
Improvement Manager at Avalon Hospice & Palliative Care, 3914
Murphy Canon Road, Suite A226, San Diego, Ca 92123, (858) 751-0315
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