Use and Disclosure of Health Information
Abbey 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. Abbey 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 YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED:

To Provide Treatment. Abbey 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 you care will need information about your symptoms in order to prescribe appropriate medications. Abbey Hospice also may disclose your health care information to individuals outside of the hospice involved in your care including family members, pharmacists, suppliers of medical equipment, or other health care professionals.

To Obtain Payment. Abbey Hospice may include your health information in invoices to collect payment from third parties for the care you receive from the hospice. For example, Abbey 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. Abbey Hospice also may need to obtain prior approval from your insurer and may need to explain to the insurer your need for hospice and the services that will be provided to you.

To Conduct Health Care Operations. Abbey 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 the hospice’s 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, trainees, or practitioners in health care learn under supervision
• Training of non-health care professionals
• Accreditations, 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 Abbey Hospice
• Fundraising for the benefit of Abbey Hospice Foundation
  

For example, Abbey 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, or contact you as part of general fundraising and community information mailings (unless you tell us you do not want to be contacted).

For Appointment Reminders. Abbey Hospice 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. Abbey Hospice may use and disclose your health information to tell you about of recommend possible treatment options or alternatives that may be of interest to you.

When Legally Required. Abbey Hospice will disclose your health information when it is required to do so by and Federal, State, or local law.

When There are Risks to Public Health. Abbey 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 the disease.
• Notify an employer about an individual who is a member of the workforce as legally required.

To Report Abuse, Neglect, or Domestic Violence. Abbey 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. Abbey Hospice may disclose your health information to a health oversight agency 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 of public benefits.

In Connection with Judicial and Administrative Proceedings. Abbey 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 effort 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, Abbey Hospice may disclose your health information to a law enforcement official for certain law enforcement purposes as follows:

• As required by law for reporting 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. Abbey 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. Abbey 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. Abbey 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. Abbey 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 with be subject to an extensive approval process.

In the Event of A Serious Threat to Health or Safety. Abbey 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 heath 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. Abbey Hospice may release your health information for worker’s compensation or similar programs.

Authorization to Use or Disclose Health Information
Other than is stated above, Abbey Hospice will not disclose your health information other than with your written authorization. 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.

Your Rights with Respect to Your Health Information
You have the following rights regarding your health information that Abbey 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 Ellen Petry, Abbey Hospice Privacy Officer.
• 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 wit ho other family members present. If you wish to receive confidential communications, please contact Ellen Petry, Abbey Hospice Privacy Officer, at (770) 464-5858. Abbey Hospice will not request that your provide any reason 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 Ellen Petry at (770) 464-5858. If you request a copy of your health information, the hospice may charge a reasonable fee for copying assembling costs associated with your request.
• Right to amend health care information. You or your representative have the right to request that the hospice 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 the hospice. A request for an amendment of records must be made in writing to Ellen Petry, Abbey Hospice Privacy Officer, 215 Azalea Court, Social Circle, Georgia, 30025. The hospice may deny the request if it is not in writing or denied if your health information records were not created by the hospice, if health information you wish to amend is not part of the health information you or your representative are permitted to inspect an copy, or if, in the opinion of the hospice, 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 the hospice for certain reasons, including reasons related to public purposes authorized by law and certain research. The requests for an accounting must be mad in writing to Ellen Petry, Abbey Hospice Privacy Officer, 215 Azalea Court, Social Circle, Georgia, 30025. 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. The hospice would provide the fist accounting your 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 have the 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 Ellen Petry at (770)464-5858. You or your representative may also obtain a copy of the current version of Abbey Hospice’s Notice of Privacy Practices at our website, www.abbeyhospice.com.

Duties of Abbey Hospice
Abbey Hospice is required by law to maintain the privacy of our health information and to provide you and your representative this Notice of its duties and privacy practices. The hospice is required to abide by the terms of this Notice as may be amended from time to time. The 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 the Secretary of DHHS if you or your representative believe that your privacy rights have been violated. Any complaints to the hospice should be made in writing to Ellen Petry, Abbey Hospice Privacy Officer, 215 Azalea Court, Social Circle, Georgia, 30025. The hospice 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
Abbey Hospice has designated Ellen Petry, Privacy Officer, as its contact person for all issues regarding patient privacy and your rights under the Federal privacy standards. You may contact this person at 215 Azalea Court, Social Circle, Georgia, 30025 OR (770) 464-5858.

Effective Date
This Notice is effective April 14, 2003.

IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT ELLEN PETRY, ABBEY HOSPICE PRIVACY OFFICER, AT 215 Azalea Court, Social Circle, Georgia, 30025 OR (770) 464-5858.