Arkansas Hospice | Privacy Policy

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.

USE AND DISCLOSURE OF HEALTH INFORMATION

Arkansas Hospice may use your health information for purposes of providing you treatment, obtaining payment for your care and conducting health care operations. Your health information may be used or disclosed only after the Hospice has obtained your written consent. The Hospice has established a policy 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. 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 medication. The Hospice also may disclose your health care information to individuals outside of the Hospice involved in your care including family members, clergy whom you have designated, pharmacists, suppliers of medical equipment or other health care professionals that the Hospice uses in order to coordinate your care.

To Obtain Payment. The Hospice may include your health information in invoices to collect payment from third parties for the care you may 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. The Hospice 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. The Hospice may use and disclose health care 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:

Performance improvement activities.
Activities designed to improve health or reduce health care costs.
Protocol development, case management and care coordination.
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 analysis and formulary development.
Business management and general administrative activities of the Hospice.
Fundraising for the benefit of the Hospice and certain marketing activities.

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 Arkansas 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 or family as part of general fundraising and community information mailings (unless you tell us you do not want to be contacted).

Arkansas Hospice may disclose certain information about you including your name, your general health status, your religious affiliation and where you are in the hospice inpatient facility. The Hospice may disclose this information to people who ask for you by name. Please inform us if you do not want your information disclosed.

For Fundraising Activities. Arkansas Hospice may use information about you including your name, address, phone number and the dates you received care at the Hospice in order to contact you or your family to support the hospice. The Hospice may also release information to Arkansas Hospice Foundation. No personal information will be released to any other health care entity.

However, Federal privacy rules also allow Arkansas Hospice to use or disclose your health information for other reasons as well:

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

To Report Abuse, Neglect or Domestic Violence. Arkansas Hospice is allowed or mandated to notify government authorities if the Hospice believes a patient is the victim of abuse, neglect or domestic violence. Arkansas 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. Arkansas Hospice may disclose your health information only when it relates to health oversight activities for activities including audits, or licensure. 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. Arkansas 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. Arkansas Hospice may disclose your health information to a law enforcement official for law enforcement purposes, for example in an emergency in order to report a crime or incident.

To Coroners and Medical Examiners. Arkansas Hospice may disclose your health information to coroners and medical examiners for purposes of determining the cause of death or for other reasons, as authorized by law.

To Funeral Directors. Arkansas Hospice may disclose your health information to funeral directors consistent with applicable law and if necessary, to carry out their duties with respect to funeral arrangements.

For Research Purposes. Arkansas Hospice may use your health information for research. The Hospice will ask your permission if any researcher will be granted access to your individual identifiable health information for example pain management.

In the Event of a Serious Threat to Health or Safety. Arkansas Hospice may disclose your health information consistent with applicable law, 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.

AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION

Other than is stated above, Arkansas 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 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.
Right to receive confidential communication. You have the right to request that the Hospice communicate with you in a certain way. For example, you may request Arkansas Hospice only conduct communications pertaining to your health information with you privately with no other family member present.
Right to inspect and copy your health information. You have the right to inspect and copy your health information, including billing records. 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.
Right to amend health care information. If you or your representative believes that your health information records are incorrect or incomplete, you may request that the Hospice amend the records. This request may be made as long as the information is maintained by Arkansas Hospice The following are applicable to the amendment of health care information:
- A request for an amendment of records must be made in writing.
  Arkansas Hospice may deny the request 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.
- If, in the opinion of the Hospice, the records containing your health information are accurate and complete.
Right to an explanation of Disclosure. You or your representative has the right to request an explanation of disclosure of your health information made by Arkansas Hospice. The request for an explanation must be made in writing and should specify the time period for the explanation.
Right to paper copy of this notice. You or your representative has a right to a separate paper copy of this Notice at any time.
Right to file a complaint. You or your representative have the right to express complaints to Arkansas Hospice and to the Secretary of Health and Human Services if you or your representative believes that your privacy rights have been violated.

Any complaints to Arkansas Hospice should be made in writing. 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.

DUTIES OF THE HOSPICE

Arkansas 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. Arkansas Hospice is required to abide by terms of this Notice, which may be amended from time to time. Arkansas Hospice reserved 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.

You or your representative has the right to express complaints to Arkansas Hospice and to the Secretary of Health and Human Services if you or your representative believes that your privacy rights have been violated.

CONTACT PERSON

Arkansas Hospice contact person for all issues regarding patient privacy and your rights under the Federal privacy standards is the privacy officer. All requests should be made to the Privacy Officer at 501-748-3333 or toll free at 877-257-3400.

Health Information Management Department
14 Parkstone Circle

North Little Rock, AR 72116

EFFECTIVE DATE

This Notice is effective April 14, 2003.

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