patient privacy
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.
HOH is required by law to maintain the privacy of your protected health information and will use and disclose it for the following purposes:
To Provide Care: HOH may use your health information to coordinate care within Hospice and with health care professionals and community resources involved in your care. For example, physicians involved in your care need information about your symptoms in order to prescribe appropriate medications. Some other examples are family members and designated caregivers (for instance to schedule a visit), pharmacists, and suppliers of medical equipment and others whom you have designated such as clergy, funeral directors, and organ donation agencies.
To Obtain Payment: HOH may use and disclose information so that the care you receive can be properly reimbursed. For example, HOH may need to obtain 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: HOH may use and disclose health care information for its own operations. For example, HOH may contact you or your family through mailings such as newsletters and fundraising. HOH discloses the patient name and year of death during our annual memorial service. HOH also discloses the patient name in our Hospice quarterly newsletter under the section "Individuals Honored by Donation". If you do not want the above communications, please notify us at 616-396-2972. If you reside at Hospice House, HOH may disclose your name, your general health status, your religious affiliation and your room to visitors. Please inform the Hospice House Director at 616-396-2972 if you do not want this information shared.
When Legally Required: HOH will disclose your health information when it is required to do so by any Federal, State or local law. Examples of such releases would be for law enforcement or national security purposes, subpoenas, or other court orders, communicable disease reporting, disaster relief, review of our activities by government agencies, to avert a serious threat to health or safety, to report abuse and neglect or in other kinds of emergencies.
Exceptions: HOH may request additional authorization from you to release information that falls under more stringent laws.
When Authorized: Other than is stated above, HOH will not disclose your health information without your written authorization that may be revoked in writing at any time.
Your Privacy Rights
You have the following rights regarding your health information that HOH maintains. All requests must be made using HOH forms that are available through the Privacy Official at the address listed below. HOH is required to maintain records for no longer than 7 years.
Right To Request Restrictions: You have the right to ask for limits on how your information is used or disclosed. We are not required to agree to your request and may not be able to provide services under the requested restriction.
Right To Receive Confidential Communications: You have the right to request that HOH communicate with you in a certain way. For example, you may ask that Hospice conduct communications with you privately. HOH will not require that you provide any reasons for your request and will attempt to honor your reasonable requests.
Right To Inspect And Copy: You have the right to inspect and copy your health information, including billing records. HOH may charge a reasonable fee for copying and assembling costs associated with your request. The chart will remain in the possession of HOH, and the HOH staff will copy the chart for you.
Right To Amend: If you or your representative believes that your health information records are incorrect or incomplete, you may request that HOH amend your records. HOH may have to deny your request under certain circumstances, but HOH must give you a written reason for the denial.
Right To An Accounting: You or your representative have the right to request an accounting of disclosures of your health information made by HOH on or after April 14, 2003 for reasons other than for care, payment, or health care operations. The first accounting is provided without charge. Subsequent accounting requests may be subject to a reasonable cost-based fee.
Privacy Notice and Revisions: 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. HOH is required to abide by the terms of this notice. HOH may revise this Notice and make the changes effective for all health information that it maintains. If HOH revises its Notice, the new Notice will be posted on our website at www.hollandhospice.org. If the changes are material, you will receive a revised Notice of Privacy. To obtain a paper copy, please contact the Privacy Official.
Complaint Procedure: You or your authorized representative have the right to express complaints to HOH and/or to the Secretary of Health and Human Services if you or your representative believe that your privacy rights have been violated. Any complaints against HOH should be made in writing to the Privacy Official. Expressing concerns or filing a complaint will not in any way jeopardize your relationship with Hospice.
Contact Person:
Privacy Official
Hospice of Holland
270 Hoover Blvd,
Holland, MI 49423
(616) 396-2972.
Effective 4/14/2003, Updated 3/09/2009