Medical privacy policy

This Notice of Privacy Practices (Notice) describes how medical information about you may be used and disclosed, and how you can access this information. Please review it carefully.

A. Use and Disclosure of Health Information
Hospice of Dubuque may use your personal health information for purposes of providing treatment to you, obtaining payment for your care and conducting health care operations. Your personal health information refers to 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. Hospice of Dubuque has established a policy to guard against unnecessary disclosure of your personal health information.

The following is a summary of the circumstances under which, and purposes for which, your health information may be used and disclosed.

A.1. To Provide Treatment: Hospice of Dubuque may use your personal health information to coordinate care within the hospice and with others involved in your care. These individuals may include your attending physician(s), members of the Hospice Interdisciplinary Team and other health care professionals who have agreed to assist Hospice of Dubuque in coordinating care. For example, physicians involved in your care will need information about your symptoms in order to prescribe appropriate medications. Hospice of Dubuque may also disclose your personal health information to other individuals involved in your care, including family members, designated clergy, pharmacists, suppliers of medical equipment and other health care professionals.

A.2. To Obtain Payment: Hospice of Dubuque may include your personal health information on statements sent to your insurance company when collecting payment from third parties for the care provided to you. For example, Hospice of Dubuque may be required by your health insurer to provide information regarding your health care status or the services provided. Hospice of Dubuque may need to obtain prior approval from your insurance carrier to explain your need for hospice care and the services.

A.3. To Conduct Health Care Operations: Hospice of Dubuque may use and disclose your personal health information for its own operations in order to facilitate the function of the hospice and, as necessary, to provide quality care to all Hospice of Dubuque patients. Operations include, but are not limited to:

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
referrals may be made with your consent, or the consent of your legal representative, to other social service agencies to assist in the provision of care for you and/or your caregiver(s)
professional review and performance evaluation
training and counseling programs for Hospice of Dubuque staff, and for programs in which students, non-health care professionals, trainees or practitioners in health care learn under supervision
provision of a security escort for staff safety
accreditation, certification, licensing or credentialing activities
program review and auditing, including compliance reviews, quality assessment/improvement activities, medical reviews, financial audits, legal services and any regulatory compliance programs
business management and general administrative activities of Hospice of Dubuque including planning, development, cost management/analysis and formulary development.

For example, Hospice of Dubuque may use your personal health information to evaluate staff and services, and to provide education.

A.4. For Fundraising Activities: Hospice of Dubuque will obtain written authorization prior to using any personal health information related to your illness or treatment for fundraising activities and/or education about hospice care and services. However, Hospice of Dubuque may use your name, phone number, address, age, gender, insurance status and the dates you received care from Hospice of Dubuque in order to contact you, or your family, when raising the funds necessary to continue its mission of care. Hospice of Dubuque may also disclose the aforementioned demographic information to the Hospice of Dubuque Foundation and/or a Business Associate. Your name may also be used to publicly acknowledge memorials or gifts made in your honor. If you, or your family, do not wish to be contacted regarding Hospice of Dubuque’s fundraising activities, submit a written request to the Hospice of Dubuque Fund Development Dept., 1670 JFK Road, Dubuque, IA 52002.

A.5. For Bereavement Activities: Bereavement care will be individualized and based upon an assessment of bereavement needs.

Bereavement services, which may include a personal contact, mailings, or bereavement support groups, will be made available to identified family members who have indicated a desire for such services.
Your name will be included in agency materials used for an annual memorial event for families who have been served by Hospice of Dubuque unless you, your family, or representative request exclusion.

The following is a summary of the circumstances under which, and purposes for which, your personal health information may also be used and disclosed.

B. Protected Health Information
B.1. State Protected Health Information (personal health information specifically protected by state law) includes information on substance abuse, HIV infection, and mental health information. This information will be kept strictly confidential unless it meets state-mandated criteria for release of information (eg, risk to public health). Hospice of Dubuque will obtain authorization prior to using state-protected health information for reasons other than those mandated by state criteria. Hospice of Dubuque will also comply with federal and local laws regarding release of personal health information.

B.2. In the Event of Risk or Serious Threat to Health or Safety:

Hospice of Dubuque may disclose your personal health information when there are risks to public health (eg, disease control, product defects, exposure to a communicable disease).
Consistent with applicable law and ethical standards of conduct, Hospice of Dubuque may disclose your personal health information if it is believed 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 others.

B.3. After Your Death:

Your personal health information will only be provided to the executor or administrator of your estate or, if there is no estate proceeding, to your spouse or legal representative. Such information will be provided only upon written request to Hospice of Dubuque and only if there is valid need for the person to receive such information. An example in which it would be appropriate for Hospice of Dubuque to release such information would be, if a dispute exists as to the patient’s mental capacity at the time of the signing of his/her will or codicil.
Hospice of Dubuque will obtain authorization from your legal representative before releasing, or using, any of your personal health information for purposes other than the purposes identified in this Notice.

B.4. To Conduct Health Oversight Activities: Hospice of Dubuque may disclose your personal health information to a health oversight agency for activities including audits, civil administrative or criminal investigations, inspections, licensure, or disciplinary action. For example, for Medicare or OSHA site reviews. However, Hospice of Dubuque may not disclose your personal health information if you are the subject of an investigation and your personal health information is not directly related to your receipt of health care or your receipt of public benefits.

B.5. In Connection with Judicial and Administrative Proceedings: Hospice of Dubuque may disclose your personal health information in the course of any judicial or administrative proceeding in response to a valid order of a court or administrative tribunal having jurisdiction, as directed or authorized by such order, or in response to a valid discovery request, or other lawful process.

B.6. When Legally Required or for Law Enforcement Purposes: Hospice of Dubuque may disclose your personal health information 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 a 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 circumstances, when there is a suspicion that you are the victim of a crime
to a law enforcement official if Hospice of Dubuque has a suspicion that your death was the result of criminal conduct
in an emergency in order to report a crime.

B.7. To Coroners and Medical Examiners: Hospice of Dubuque may disclose your personal health information to coroners and medical examiners for purposes of determining your cause of death or for other duties, as authorized by law. If necessary, Hospice of Dubuque may disclose your personal health information prior to, and in reasonable anticipation of, your death.

B.8. To Funeral Directors: Hospice of Dubuque may disclose your personal health information to funeral directors consistent with applicable law, and if necessary, to carry out its duties with respect to your funeral arrangements. If necessary, Hospice of Dubuque may disclose your personal health information prior to, and in reasonable anticipation of, your death.

B.9. If Organ, Eye or Tissue Donation is Desired: At your request, Hospice of Dubuque may disclose your personal health information to organ procurement organizations or other entities engaged in procurement, banking or transplantation of organs, eyes or tissue for the purpose of facilitating the donation and transplantation.

B.10. For Research Purposes: Hospice of Dubuque may, under very select circumstances, use your personal health information for research. Before Hospice of Dubuque discloses any of your personal health information for such research purposes, the project will be subject to an extensive approval process. Hospice of Dubuque will ask your permission, or that of your personal representative, before any researcher will be granted access to your individually identifiable personal health information.

B.11. For Specified Government Functions: In certain circumstances, federal regulations authorize Hospice of Dubuque to use or disclose your personal health information to facilitate specified government functions relating to veterans, national security and intelligence activities, protective services for the President and others, medical suitability determinations and law enforcement.

B.12. For Worker's Compensation: Hospice of Dubuque may release your personal health information for worker's compensation or similar programs.

C. Authorization to Use or Disclose Health Information
Other than as stated above, Hospice of Dubuque will not disclose your personal health information without your written authorization. If you, or your representative, authorize Hospice of Dubuque to use or disclose your personal health information, you may revoke that authorization in writing at any time.

D. Your Rights with Respect to Your Health Information
You have the following rights regarding your personal health information:

D.1. Right to Request Restrictions: You have the right to request a limit on Hospice of Dubuque’s disclosure of your personal health information to someone who is involved in your care, or the payment of your care. Hospice of Dubuque is not required, however, to agree to your request. You have the right to request restrictions on your personal health information that pertains solely to a health care item or service for which you paid the health care provider out of pocket in full, in which case, Hospice of Dubuque cannot refuse the request for privacy. If you wish to request restrictions, submit the request, in writing, to the Hospice of Dubuque Privacy Official.

D.2. Right to Receive Confidential Communications: You have the right to request that Hospice of Dubuque communicates with you in a manner or at a location that you designate. For example, you may ask that Hospice of Dubuque only conducts communications pertaining to your personal health information with you privately and without others present. If you wish to receive confidential communications, submit a written request to the Hospice of Dubuque Patient Care Director. Hospice of Dubuque will not require that you provide any reasons for your request and will attempt to honor your reasonable requests for confidential communications.

D.3. Right to Inspect and Copy Your Health Information: You have the right to inspect and copy your personal health information, including billing records. However, your request may be denied in very limited circumstances. A request to inspect and copy records containing your personal health information may be made, in writing, to the Hospice of Dubuque Privacy Official. If you request a copy of your personal health information, Hospice of Dubuque may charge a reasonable fee for copying requested information.

D.4. Right to Amend Health Care Information: If you, or your personal representative, believe that your personal health information records are incorrect or incomplete, you may request that Hospice of Dubuque amend the records. The request to amend your records may be made as long as the information is maintained by Hospice of Dubuque. A request for an amendment of records must be made, in writing, to the Hospice of Dubuque Privacy Official. Hospice of Dubuque may deny the request if it is not in writing, or if the request does not include a reason for the amendment. The request may also be denied if your personal health information records were not created by Hospice of Dubuque, or if the records you are requesting are not part of the Hospice of Dubuque medical record. The request may also be denied if the personal health information you wish to amend is not part of the personal health information you, or your representative, are permitted to inspect and copy, or if in the opinion of Hospice of Dubuque, the records containing your personal health information are accurate and complete.

D.5. Right to an Accounting of Disclosures: You, or your representative, have the right to request an accounting of disclosures of your personal health information made by Hospice of Dubuque for any reason other than for treatment, payment or health care operations. The request for an accounting must be made, in writing, to the Hospice of Dubuque Privacy Official. The request should specify the time period for the accounting. The right to request an accounting of disclosures of your personal health information will be effective April 14, 2003. Accounting requests may not be made for periods of time in excess of six years. Hospice of Dubuque will 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.

D.6. Right to a Paper Copy of this Notice: You, or your personal representative, have the right to a separate paper copy of this Notice at any time. To obtain a separate paper copy, please contact the Hospice of Dubuque Privacy Official, or obtain a copy of the current version of Hospice of Dubuque’s Notice of Privacy Practices at its website, www.hospiceofdubuque.org.

E. Duties of the Hospice
Hospice of Dubuque is required by law to maintain the privacy of your personal health information and to provide to you, or your personal representative, this Notice of its legal duties and privacy practices. Hospice of Dubuque is required to abide by the terms of this Notice which may be amended from time to time. Hospice of Dubuque reserves the right to change the terms of its Notice and to make the new Notice provisions effective for all personal health information that it maintains. If Hospice of Dubuque changes its Notice, Hospice of Dubuque will make a copy of the revised Notice available to you, or your appointed representative. You, or your personal representative, have the right to express complaints to Hospice of Dubuque 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 Hospice of Dubuque should be made, in writing, to the Hospice of Dubuque Privacy Official. Hospice of Dubuque 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.

F. Contact Person
This Notice has been provided to you as a summary of how your personal health information will be used and details your rights with respect to your protected information. If you have any questions, or desire more information regarding your personal health information, please contact the Hospice of Dubuque Privacy Official. For all issues and questions regarding this Notice, patient privacy and your rights under the federal privacy standards, contact the Hospice of Dubuque Privacy Official, 1670 JFK Road, Dubuque, IA 52002 or at 563.582.1220.

G. Effective Date
This Notice is effective February 17, 2010. Hospice of Dubuque reserves the right to revise this Notice at any time. Should this Notice be revised, you will be notified. In addition, a current Notice of Privacy Practices may be obtained from the Hospice of Dubuque Privacy Official at 563.582.1220 or at the Hospice of Dubuque website, www.hospiceofdubuque.org.