Notice of Privacy Practices
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 Protected Health Information
Franklin Hospice may use your *Protected Health Information (PHI) for purposes of providing you treatment, obtaining payment for your care and conducting health care operations. Your PHI may be used or disclosed only after Franklin Hospice(FH) has obtained your written consent. FH has established a policy to guard against unnecessary disclosure of your PHI.
THE FOLLOWING IS A SUMMARY OF HOW YOUR PHI MAY BE USED AND DISCLOSED BY FRANKLIN HOSPICE AFTER YOU HAVE PROVIDED WRITTEN CONSENT:
To Provide Treatment Franklin Hospice(FH) may use your PHI to coordinate care within FHand with others involved in your care, such as your attending physician, members of the interdisciplinary team and other health care professionals who have agreed to assist FHin coordinating care. For example, physicians involved in your care will need information about your symptoms in order to prescribe appropriate medications. FHalso may disclose your health care information to individuals outside of FHinvolved in your care including family members, clergy you have designated, pharmacists, suppliers of medical equipment or other health care professionals that FHuses in order to coordinate your care.
To Obtain Payment FH may include your PHI in invoices to collect payment from third parties for the care you receive. For example, FHmay be required by your health insurer to provide information regarding your health care status so that the insurer will reimburse you or FH. FHalso 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 FH may use and disclose health care information for its own operations in order to facilitate its function and as necessary to provide quality care to all of FHpatients. Health care operations include such activities as:
- Quality assessment and improvement activities;
- Activities designed to improve care 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 the Hospice; and
- Fundraising for the benefit of the Hospice and certain marketing activities.
For example, FH may use your PHI to evaluate its staff performance, combine your health information with other FHpatients in evaluating how to more effectively serve all FHpatients, disclose your health information to FHstaff and contracted personnel for training purposes, use your PHI to contact you as a reminder regarding a visit to you, or contact you or your family as part of general fundraising and community information mailings (unless you tell us you do not want to be contacted).
Health Information Exchange
We have chosen to participate in the Chesapeake Regional Information System for our Patients, Inc. (CRISP), a regional health information exchange serving Maryland and D.C. As permitted by law, your health information will be shared with this exchange in order to provide faster access, better coordination of care and assist providers and public health officials in making more informed decisions. You may “opt-out” and disable all access to your health information available through CRISP by calling 1-877-952-7477 or completing and submitting an Opt-Out form to CRISP by mail, fax or through their website at www.crisphealth.org. Public Health reporting and Controlled Dangerous Substances information, as part of the Maryland Prescription Drug Monitoring Program (PDMP), will still be available to providers.
Federal privacy rules allow Franklin Hospiceto use or disclose your PHI without your consent or authorization for a number of reasons:
When Legally Required FH will disclose your PHI when it is required to do so by any Federal, State or local law.
When There Are Risks to Public Health FH may disclose your PHI 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.
- To 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.
- To notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease.
- To an employer about an individual who is a member of the workforce as legally required.
To Report Abuse, Neglect Or Domestic Violence FH is allowed to notify government authorities if FH believes a patient is the victim of abuse, neglect or domestic violence. FH will make this disclosure only when specifically required or authorized by law or when the patient agrees to the disclosure.
To Conduct Health Oversight ActivitiesFH may disclose your PHI to a health oversight agency for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action. FH,however, may not disclose your PHI if you are the subject of an investigation and your PHI is not directly related to your receipt of health care or public benefits.
In Connection With Judicial And Administrative Proceedings FH may disclose your PHI 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 FHmakes reasonable efforts to either notify you about the request or to obtain an order protecting your health information.
For Law Enforcement Purposes FHmay disclose your PHI to a law enforcement official for 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 FHhas a suspicion that your death was the result of criminal conduct; and
- In an emergency in order to report a crime.
To Coroners And Medical Examiners FH may disclose your PHI to coroners and medical examiners for purposes of determining your cause of death or for other duties, as authorized by law.
To Funeral Directors FHmay disclose your PHI 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, FH may disclose your PHI prior to and in reasonable anticipation, of your death.
For Organ, Eye or Tissue Donation FH may use or disclose your PHI 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 FH may, under very select circumstances, use your PHI for research. Before the Hospice discloses any of your PHI for such research purposes, the project will be subject to an extensive approval process. The Hospice will ask your permission if any researcher will be granted access to your individually identifiable health information.
In the Event of A Serious Threat To Health Or Safety FH may, consistent with applicable law and ethical standards of conduct, disclose your PHI if FH, 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 FH to use or disclose your PHI 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 FH may release your PHI for worker's compensation or similar programs.
AUTHORIZATION TO USE OR DISCLOSE PHI
Other than as stated above, FH will not disclose your PHI without your written authorization. If you or your representative authorizes FH to use or disclose your PHI, you may revoke that authorization in writing at any time.
YOUR RIGHTS WITH RESPECT TO YOUR PHI
You have the following rights regarding your PHI that FH maintains:
- Right to request restrictionsYou may request restrictions on certain uses and disclosures of PHI. You have the right to request a limit on FH’s disclosure of your PHI to someone who is involved in your care or the payment of your care. However, FH is not required to agree to your request. If you wish to make a request for restrictions, please contact FH.
- Right to receive confidential communicationsYou have the right to request that FH communicate with you in a certain way. For example, you may ask that FHonly conduct communications pertaining to your PHI with you privately with no other family members present. If you wish to receive confidential communications, please contact FH. FH 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 informationYou have the right to inspect and copy your PHI, including billing records. A request to inspect and copy records containing your PHI may be made toFH. If you request a copy ofyour PHI, FH may charge a reasonable fee for copying and assembling costs associated with your request.
- Right to amend health care informationIf you or your representative believes that your PHI records are incorrect or incomplete, you may request that FH amend the records. That request may be made as long as the information is maintained by FH. A request for an amendment of records must be made in writing to FH. FH 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 FH,if the records you are requesting are not part of FH’s records, if the PHI 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 FH, the records containing your PHI are accurate and complete.
- Right to an accounting of disclosuresYou or your representative have the right to request an accounting of disclosures of your PHI made byFH for any reason other than for treatment, payment or health operations. The request for an accounting must be made in writing to FH.
The request should specify the time period for the accounting starting on April 14, 2003.
Accounting requests may not be made for periods of time in excess of six years. FH 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 noticeYou 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 FH. [You or your legal representative may also obtain a copy of the current version of FH’s Notice of privacy practices at its website, www.franklinhospice.org
- HITECH Notification Requirements– Under HITECH,FH is required to notify a patient whose protected health information, PHI, has been breached within 60 days of the event.
DUTIES OFFRANKLIN HOSPICE
FH is required by law to maintain the privacy of your PHI and to provide to you and your representative this Notice of its duties and privacy practices. FH is required to abide by terms of this Notice as may be amended from time to time. FH 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 FH changes its Notice, FH 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 FH and to the Secretary of Health and Human Services if you or your representative believe that your privacy rights have been violated. Any complaints to FH should be made as outlined under the Patient Complaint Processissued at the time of enrollment.
This Notice is effective April 14, 2003. Amended March 16, 2010. Amended July 16, 2013. Amended November 15, 2018.
IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT
209 Grant St., Chambersburg, PA 17201
*PHI-Any health information relating to: past, present or future physical or mental health or condition; provision of health care; past, present or future payment for healthcare. Information created or received by a provider, plan, employer or clearinghouse. Information that is individually identifiable or that provides a reasonable basis to believe the information can be used to identify the individual, in any medium: written, verbal or electronic.]