HIPAA 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.

Hospice and Palliative Care of Iredell County, Inc. (the "Hospice") may use your health information for purposes of providing you treatment. Information that constitutes protected health information as defined in the Privacy Rule of the Administrative Simplification provisions of the health and insurance Portability and Accountability Act of 1996, 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. This Notice includes updated information regarding privacy practices required by the Health Information Technology for Economic and Clinical Health (HITECH) Act (Final Rule).

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 medications. The Hospice also may disclose your health care information to individuals outside of the Hospice involved in your care including family members, pharmacists, suppliers of medical equipment or other health care professionals.

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:

• Quality assessment and improvement activities.
• Activities designed to improve health or reduce health care costs.
• Protocol development, care management and care coordination.
• Contacting health care providers and patients with information about treatment 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. 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 Hospice staff and contracted personnel for training purposes, use your health information to contact you as a reminder regarding a visit to you.
• For Fundraising/Marketing Activities. The Hospice will not use any information about you including your name, address, phone number and the dates you received care for any fundraising/marketing activities without your written permission. You have the right to opt out of receiving fundraising communications by notifying Hospice & Palliative Care of Iredell County staff and requesting that you be removed from fundraising communications.

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

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

When There Are Risks to Public Health
The Hospice may disclose your health information 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.
• 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.
• Notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease.
• Notify an employer about an individual who is a member of the workforce as legally required.

To Report Abuse, Neglect or Domestic Violence
The Hospice is allowed to notify government authorities if the Hospice believes a patient is the victim of abuse, neglect or domestic violence. The Hospice will make this disclosure only when specifically required or authorized by law or when the patient requests the disclosure.

To Conduct Health Oversight Activities
The Hospice may disclose your health information to a health oversight agency for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action. The Hospice, however, may not disclose your health information if you are the subject of an investigation and your health information are not directly related to your receipt of health care or public benefits.

In Connection With Judicial and Administrative Proceedings
The 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
As permitted or required by State law, the Hospice may disclose your health information to a law enforcement official for certain 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 law enforcement officials if the Hospice has a suspicion that your death was the result of criminal conduct at the Hospice.
• In an emergency in order to report a crime.

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

To Funeral Directors
The Hospice 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, the Hospice may disclose your health information prior to and in reasonable anticipation of your death.

For Organ, Eye or Tissue Donation
The Hospice may use or disclose your health information to organ procurement organizations or other entities engaged in the procurement, banking or transplantations of organs, eyes or tissue for the purpose of facilitating the donation and transplantation.

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

In the Event of a Serious Threat to Health or Safety
The Hospice may, consistent with applicable law and ethical standards of conduct, disclose your health information 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.

For Specified Government Functions
In certain circumstances, the Federal regulations authorize the Hospice to use or disclose your health information 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
The Hospice may release your health information for worker's compensation or similar programs.

Authorization To Use or Disclose Health information

Other than what is stated above, the Hospice will not disclose your health information without 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. Disclosures of your protected health information for marketing purposes require authorization from you. Disclosures that constitute the sale of your protected health information (PHI) will require your authorization. In addition, most uses and disclosures of psychotherapy notes require authorization prior to release.

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. If you wish to make a request for restrictions, please contact the Privacy Officer. Hospice agrees to restrict the disclosure of PHI (for payment or health care operations) to a health plan when the patient paid for the service or item in question out of pocket in full.
• Right to receive confidential communications. You have the right to request that the Hospice communicate with you in a certain way. For example, you may ask that the Hospice 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 the Privacy Officer. The Hospice 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 the Privacy Officer. 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. You or your representatives do not have the right to alter your medical records. You may however request an amendment to your records. Amending records does not mean that original information will be deleted. Rather, an amendment adds information to the record to insure that it is accurate and complete. The amendment request may be made as long as the information is maintained by the Hospice. A request for an amendment of records must be made in writing to the Privacy Officer. The Hospice 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 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, or if, in the opinion of the Hospice, the records containing your health information are accurate and complete.
• Right to an accounting. You or your representative have the right to request an accounting of disclosures of your health information made by the Hospice for certain reasons, including reasons related to public purposes authorized by law and certain research. The request for an accounting must be made in writing to the Privacy Officer. 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. The Hospice 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 representatives have a 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 the Privacy Officer. You may also access a copy of the current version on our website at www.HOIC.org.
• Right to be notified when a breach of your unsecured PHI has occurred.

Duties of the Hospice

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

Contact Person

Please contact the Privacy Officer at 2347 Simonton Road, Statesville, NC 28625, (704) 873-4719 for all issues regarding patient privacy and your rights under the Federal Privacy Standards. The Hospice Privacy Officer is Charles Ashe, MBA, CHPCA at 704-873-4719.

EFFECTIVE DATE
This Notice is effective August 2013. Revisions made September 2013 to comply with HITECH Act (Final Rule).