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COVENANT HOSPICE’S

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 HEALTH INFORMATION

 

Covenant Hospice, Inc., hereinafter referred to as “Covenant,” may use your health information for purposes of providing your treatment, obtaining payment for your care, and conducting health care operations. Your health information may be used or disclosed only after Covenant Hospice has obtained your written consent. In many cases written consent is obtained upon admission to our services. Covenant 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 AFTER YOU HAVE PROVIDED YOUR WRITTEN CONSENT:

 

To Provide Treatment

 

Covenant may use your health information to coordinate care with physician(s), members of the Covenant Interdisciplinary Group (nurses, social workers, chaplains, hospice aides and volunteers), and other health care professionals who have agreed to assist Covenant in coordinating the care and services we provide. For example, a physician involved in your care may need to know your current medications and information about your symptoms in order to prescribe appropriate treatment. Covenant may also disclose your health care information to individuals outside of the organization who are involved in your care. These individuals may include pharmacists, suppliers of medical equipment, or other health care professionals that Covenant uses in order to provide the full range of services and coordinate your care. Covenant may also disclose your health care information to those most closely involved in your care, such as family members or clergy whom you have designated, unless you request that we do not do so. 

 

To Obtain Payment

 

Covenant may include certain health information in invoices to collect payment for the care you receive from third parties, such as Medicare/Medicaid or other health insurance providers. For example, Covenant may be required by your insurer to provide information regarding your health care status for reimbursement to you or to Covenant. We may also need to obtain prior approval from your health insurance provider and may need to explain your need for hospice care and for the services we will be providing to you.

 

 

To Conduct Health Care Operations

 

Covenant may use and disclose health care information within the organization to facilitate internal hospice functions and as necessary to provide quality care to you and other patients. Internal functions include, but are not limited to activities such as:

 

·        Performance Improvement Activities.

 

·        Activities designed to improve healthcare overall or to 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 issues that do not include treatment.

 

·        Professional review and performance evaluation.

 

·        Training programs, including those in which students, trainees, or other 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 Covenant.

 

·        Fundraising for the benefit of the Hospice with certain marketing activities.

 

For example, Covenant may use your health information in combination with other Covenant patients’ information during a survey by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO); in the evaluation process to see if Covenant is providing the quality of care we expect from our staff;  to evaluate the care and services we provide in order to decide how to serve all Covenant patients more effectively; to contact you to schedule visits according to your needs; or to 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).

 

Inpatient & Palliative Care Center

 

While you are in one of Covenant’s Inpatient Care Centers they may disclose certain information about you, including your name, your general health status, your religious affiliation, and your location to people who ask for you by name. Please inform us if you do not want such information disclosed.

 

For Fundraising And Outreach Activities

 

Covenant may use minimal information about you, including your name, to acknowledge donations from you or your family, or donations made on your behalf. The list of contributors and memorial gifts may be released to our Foundation. Covenant only sends generic mailings requesting donations. If you or your family do not wish to be contacted, please notify our Development Department, at (850) 438-9714, and we will remove this information from our listings.

 

For Bereavement Services/Remembrance Celebrations

 

At your request, Covenant may use your name to recognize you as part of our Memorials and Remembrance Celebrations. If you do not wish to be recognized, please notify our Bereavement Department, at (850) 433-2155.

 

When Legally Required

 

Covenant will disclose your health information when it is required to do so by any Federal, State or local laws. 

 

When There Are Risks to Public Health

 

Covenant may disclose your health information in order to:

 

·        Prevent or control disease, injury or disability; report disease, injury, and vital events such as birth or death; and for the conduct of public health surveillance, investigations, and interventions.

 

·        To report adverse events and 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

 

Covenant is mandated by law to notify government authorities if we believe you are a victim of abuse, neglect, or domestic violence. Covenant will make this disclosure only when specifically required or authorized by law or when you agree to the disclosure. 

 

To Conduct Health Oversight Activities

 

Covenant may disclose your health information to a health oversight agency for activities including audits, civil administrative or criminal investigations, inspections, licensure, or disciplinary action. Covenant, 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

 

Covenant 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 Covenant makes reasonable efforts to either notify you about the request or to obtain an order protecting your health information.

 

For Law Enforcement Purposes

 

Covenant may disclose your health information to a law enforcement official for law enforcement purposes as follows:

 

·        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 Covenant has a suspicion that your death        was the result of criminal conduct, including criminal conduct at Covenant.

 

·        In an emergency in order to report a crime.

 

To Coroners And Medical Examiners

 

Covenant may disclose your health information to coroners and medical examiners for the purpose of determining your cause of death or for other duties, as authorized by law.

 

To Funeral Directors

 

Covenant 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, Covenant may disclose your health information prior to and in reasonable anticipation, of your death.

 

For Organ, Eye Or Tissue Donation

 

Covenant may 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

 

Covenant may, under very select circumstances, use your health information for research. Before Covenant discloses any of your health information for such research purposes, the project will be subject to an extensive approval process. Covenant 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

 

For Specified Government Functions

 

For Worker’s Compensation

 

Covenant may release your health information for worker’s compensation or similar programs.

 

Authorization To Use Or Disclose Health Information

 

Other than is stated above, Covenant will not disclose your health information other than with your written authorization. If you or your legal representative authorizes Covenant 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 Covenant 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 Covenant’s disclosure of your heath information to someone who is involved in your care or the payment of your care. However, Covenant is not required to agree to your request. If you wish to make a request for restrictions, please contact our Privacy Official.

 

Right To Receive Confidential Communications

 

You have the right to request that Covenant communicate with you in a certain way. For example, you may ask that Covenant only conduct communications pertaining to your health information with you privately with no other family members present. If you wish to receive confidential communications, please contact our Privacy Official.

 

Covenant 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 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 our Privacy Official. If you request a copy of your health information, Covenant may charge a reasonable fee for copying and assembling costs associated with your request as allowable by law.

 

Right To Amend Health Care Information

 

If you or your legal representative believes that your health information records are incorrect or incomplete, you may request that Covenant amend the records. That request may be made as long as the information is maintained by Covenant. A request for an amendment of records must be made in writing to Covenant Hospice’s Privacy Official. The Privacy Official 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 Covenant, 

 

·        the records you are requesting are not part of Covenant’s records,

 

·        the health information you wish to amend is not part of the health information you or your legal representative are permitted to inspect and copy, or

 

·        in the opinion of Covenant the records containing your health information are accurate and complete.

 

 

Right To An Accounting

 

You or your legal representative have the right to request an accounting of disclosures of your health information made by Covenant for any reason other than for providing care and services to you, receiving payment for the services we provided to you, or as part of our normal business functions (treatment, payment, or health operations.) The request for an accounting must be made in writing to Covenant Hospice’s Privacy Official. The request should specify the time period for the accounting, starting on April 14, 2003. Accounting request may not be made for periods of time in excess of six years. Covenant 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 Notice

 

You or your legal representative, have the right to a separate paper copy of this Notice at any time, even if you or your representatives have received this Notice previously. To obtain a separate paper copy, please contact our Privacy Official. You or your legal representative may also obtain a copy of the current version of Covenant’s Notice of Privacy Practices at its website, www.covenanthospice.org.

 

Duties Of Covenant

 

Covenant is required by law to maintain the privacy of your health information and to provide to you and your legally-appointed representative this Notice of its duties and privacy practices. Covenant is required to abide by terms of this Notice, as may be amended from time to time. Covenant 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 Covenant changes its Notice, Covenant will provide a copy of the revised Notice to you or your legally- appointed representative. You or your legally-appointed personal representative have the right to express complaints to Covenant and to the Secretary of Health and Human Services if you or your legally-appointed representative believe that your privacy rights have been violated. Any complaints to Covenant should be made in writing to our Privacy Official. Covenant 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

 

You can contact our Privacy Official at our Pensacola Office, 5041 North 12th Avenue, Pensacola, FL 32504, or by telephone at (800) 541-3072.