NOTICE OF PRIVACY PRACTICES
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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.
I. USE AND DISCLOSURE OF HEALTH INFORMATION
Hospice of Nation, Inc [“Hospice”] 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. The Hospice 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 THE LAW PERMITS YOUR HEALTH INFORMATION TO BE
USED AND DISCLOSED:
*Please note that phone numbers collected with verbal or written consent for SMS will
NOT be shared with third parties or affiliates for marketing purposes under any
circumstances*
To Provide Treatment. The Hospice may use your health information to coordinate care within
the Hospice and with others involved in your care, such as your attending physician, members of
the Hospice interdisciplinary team and other health care professionals who have agreed to assist
the Hospice in coordinating care. For example, physicians involved in your care will need
information about your symptoms in order to prescribe appropriate medications. The Hospice
also may disclose your health care information to individuals outside of the Hospice involved in
your care including family members, caregivers, clergy who you have designated, pharmacists,
suppliers of medical equipment or other health care professionals.
To Obtain Payment. The Hospice may use and disclose your health information to collect
payment from third parties for the care you receive from the Hospice. For example, the Hospice
may be required by your health insurer to provide information regarding your health care status
so that the insurer will reimburse you or the Hospice. For this purpose, your health information
may be used and disclosed on invoices, correspondence and other communications with your
health insurer. The Hospice also may need to obtain prior approval from your insurer and may
need to use and disclose health information to explain to the insurer your need for hospice care
and the services that will be provided to you.
To Conduct Health Care Operations. The Hospice may use and disclose health information
for its own operations in order to facilitate the function of the Hospice and as necessary to
provide quality care to all of its patients. Health care operations include 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, volunteers, trainees or practitioners in
health care learn under supervision.
• Training of non-health care professionals.
• Accreditation, certification, licensing or credentialing activities (including, but not limited to
activities of the Joint Commission and California Department of Health Services.)
• 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 the Hospice.
For example the Hospice 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, the need for medication or supply refills and community
information mailings (unless you tell us you do not want to be contacted).
For Appointment Reminders. The Hospice may use and disclose your health information to
contact you as a reminder that you have an appointment for a visit.
For Treatment Alternatives. The Hospice 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.
THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND
PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY ALSO BE USED AND
DISCLOSED WITHOUT YOUR PRIOR AUTHORIZATION OR CONSENT, UNLESS
SUCH DISCLOSURE IS FURTHER RESTRICTED OR LIMITED BY CALIFORNIA LAW:
When Legally Required. The Hospice 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. The Hospice 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. The Hospice is allowed to notify
government authorities if the Hospice believes a patient is the victim of abuse, neglect or
domestic violence. The Hospice 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. The Hospice may disclose your health information to
a health oversight hospice for activities including audits, civil administrative or criminal
investigations, inspections, licensure or disciplinary action. The Hospice, however, may not
disclose your health information if you are the subject of an investigation and your health
information is not directly related to your receipt of health care or public benefits.
In Connection with Judicial and Administrative Proceedings. The Hospice 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 the Hospice 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, the Hospice 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 the Hospice has a suspicion that your death was the result of
criminal conduct including criminal conduct at the Hospice.
• In an emergency in order to report a crime.
To Coroners and Medical Examiners. The Hospice 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. The Hospice 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, the Hospice may disclose your
health information prior to and in reasonable anticipation of your death.
For Organ, Eye or Tissue Donation. The Hospice may use or disclose your health information
to organ procurement organizations or other entities engaged in the procurement, banking or
transplantation of organs, eyes or tissue for the purpose of facilitating the donation and
transplantation.
For Research Purposes. The Hospice may, under very select circumstances, use your health
information for research. Before the Hospice 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. The Hospice may, consistent with
applicable law and ethical standards of conduct, disclose your health information if the Hospice,
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 the Hospice 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. The Hospice may release your health information for worker’s
compensation or similar programs.
THE FOLLOWING IS A SUMMARY STATEMENT OF CIRCUMSTANCES UNDER
WHICH YOUR AUTHORIZATION IS NEEDED TO USE OR DISCLOSE HEALTH
INFORMATION:
Except as described and stated above, the Hospice will not disclose your health information other
than with your written authorization. For example, we will not share your information for
marketing purposes or sell you information, unless you give us written permission. If you or your
representative authorizes the Hospice to use or disclose your health information, you may revoke
that authorization in writing at any time.
II. YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION
You have the following rights regarding your health information that the Hospice 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 the Hospice ‘s disclosure of
your health information to someone who is involved in your care or the payment of your care.
However, the Hospice is not required to agree to your request. If you wish to make a request for
restrictions, please contact Hospice of Nation, Inc Privacy Officer at Hospice of Nation, Inc,
11835 W Olympic Blvd. STE 830E Los Angeles, California, 90064, (424)535-3355, email:
hospiceofnation@gmail.com
Right to receive confidential communications. You have the right to request that the Hospice
communicate with you in a certain way. For example, you may ask that the Hospice 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
Hospice of Nation, Inc Privacy Officer at Hospice of Nation, Inc, 11835 W Olympic Blvd STE
830E, Los Angeles, CA 90064, (424) 535-3355, email: hospiceofnation@gmail.com. The
Hospice 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. A request to inspect and copy records containing your health
information may be made to Hospice of Nation, Inc Privacy Officer at Hospice of Nation, Inc.
11835 W Olympic Blvd Suite 830E, Los Angeles, CA 90064, (424) 535-3355, email:
hospiceofnation@gmail.com. If you request a copy of your health information, the Hospice may
charge a reasonable fee for copying and assembling costs associated with your request. You can
request a copy of your records to be provided in paper or electronic format, or both, depending
on how Hospice generates and stores your records.
Right to amend health care information. You or your representative have the right to request
that the Hospice amend your records, whether paper or electronic, if you believe that your health
information is incorrect or incomplete. That request may be made as long as the information is
maintained by the Hospice. A request for an amendment of records must be made in writing to
Hospice of Nation, Inc Privacy Officer at Hospice of Nation, Inc, 11835 W Olympic Blvd.,
Suite 830E, Los Angeles, CA 90064, (424) 535-3355, email: hospiceofnation@gmail.com. The
Hospice 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 the Hospice, if the records you are requesting are not part of the Hospice‘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 the Hospice, the records
containing your health information are accurate and complete. We will advise you within 60
days if your request is denied.
Right to a paper copy of this notice. You or your representative have 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 Hospice of Nation Privacy Officer
at Hospice of Nation, Inc, 11835 W Olympic Blvd. STE 830E, Los Angeles, CA 90064,
(424)535-3355, email: hospiceofnation@gmail.com. The patient or a patient’s representative
may also obtain a copy of the current version of the Hospice’s Notice of Privacy Practices at its
website: www.hospice-of-nation.com
Right to choose someone to act for you. If you have given someone medical power of attorney
or if someone is your legal guardian, that person can exercise your rights and make choices about
your health information. We will need to be provided with information to confirm that this
person has authority and can act on your behalf.
Right to instruct us how to use your information. For certain health information, you can
inform Hospice of your choices about what information Hospice may share. If you have a clear
preference for how Hospice should share your information in the situations below, please inform
Hospice so Hospice can follow your instructions. These situations include, Hospice sharing
information with your family, close friends or others involved in your care; sharing information
in a disaster relief situation; and inclusion of your information in patient directory. If you are not
able to tell Hospice your preference, for example, if you are unconscious, Hospice may share
your information, if Hospice believes it is in your best interest. Hospice may also share your
information when needed to lessen a serious and imminent threat to health or safety.
III. DUTIES OF THE HOSPICE
The Hospice 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. Hospice will notify
you if a breach occurs that may have compromised the privacy or security of your protected
information. Hospice is required to abide by the terms of this Notice as may be amended from
time to time.
*Hospice 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 the Hospice changes its
Notice, the Hospice will provide a copy of the revised Notice to you or your appointed
representative. You or your personal representative have the right to express complaints to the
Hospice and to DHHS if you or your representative believe that your privacy rights have been
violated. Any complaints or concerns regarding the privacy of your information should be made
in writing to Hospice of Nation Privacy Officer / Administrator / DPCS at Hospice of Nation,
Inc, 11835 W Olympic Blvd. STE 830E, Los Angeles, CA 90064, (424)535-3355, email:
hospiceofnation@gmail.com. You can file a complaint with the U.S. Department of Health and
Human Services Office of Civil Rights by sending a letter to 200 Independence Avenue, S.W.
Washington, D.C. 20201, (877) 696-6775, www.hhs.gov/ocr/privacy/hipaa/complaints/ and
Hospice of Nation, Inc: DPCS (Director of Patient Care Services) or Administrator, Phone:
(424)535-3355. Hospice will not retaliate against you for filing a complaint.
IV. CONTACT PERSON
The Hospice has designated a Privacy Officer as its contact person for all issues regarding
patient privacy and your rights under the Federal privacy standards. You may contact the
Privacy Officer at Hospice of Nation, Inc, 11835 W Olympic Blvd., Suite 830E, Los Angeles,
CA 90064, (424) 535-3355, email: hospiceofnation@gmail.com.
IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT:
Hospice of Nation Privacy Officer or DPCS / Administrator at:
Mailing Address:
Hospice of Nation, Inc, 11835 W Olympic Blvd. STE 830E, Los Angeles, CA 90064
Telephone:(424)535-3355
Email: hospiceofnation@gmail.com.