HELIOS CARE
297 River Street Service Road, Oneonta NY 13820

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO YOUR INDIVIDUAL IDENTIFIABLE HEALTH INFORMATION.
PLEASE REVIEW IT CAREFULLY.

Helios Care may use your protected health information (PHI) as defined in the Privacy Rule of the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996, for the purposes of providing you treatment, obtaining payment for your care and conducting health care operations. Helios Care has established policies to guard against unnecessary disclosure of your health information.

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

To Provide Treatment: Helios Care may use your health information to coordinate care within Hospice and with others involved in your care such as your attending provider, members of Hospice interdisciplinary groups and other health care professionals who have agreed to assist Hospice in coordinating care. For example, providers involved in your care will need information about your symptoms in order to prescribe appropriate medications. Hospice also may disclose your health care information to individuals outside of Hospice involved in your care including family members, clergy who you have designated, pharmacists, suppliers of medical equipment, or other health care professionals.

To Obtain Payment: Helios Care may include your health information in invoices to collect payment from third parties for the care you receive from Hospice. For example – Hospice may be required by your health insurer to provide information regarding your health care status so that the insurer will reimburse you or Hospice. 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: Helios Care may use and disclose health information for its own operations in order to facilitate the function of Hospice and as necessary to provide quality care to all 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, case management and care coordination.
• Contacting health care providers and patients with information about treatments 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 Hospice.
• Fundraising for the benefit of Hospice.

For example, Helios Care may use your health information to evaluate its staff performance, combine your health information with information of 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, or contact you as part of general fundraising and community information mailings (unless you tell us you do not want to be contacted.)

For Fundraising Activities: Helios Care may use your name to acknowledge donations made to hospice in your honor. Hospice may release your name and address to the Hospice Foundation. If you do not want Hospice to contact you or your family, notify the Privacy Officer at 297 River Street Service Road, Oneonta, NY 13820 or (607) 432-6773 and indicate that you do not wish to be contacted.

Federal Privacy Rules and State Laws allow Helios Care to use or disclose your health information without your authorization in the following circumstances or purposes:

By Law. We will disclose health information about you when required to do so by federal, state or local law.

National Security and Military and Veterans. We may release health information about you to authorized officials for national security activities authorized by law. We may disclose health information about you to authorized officials so they may provide protection to the President, other authorized persons or foreign heads of state. If you are a member of the armed forces, we may release health information about you as required by military command authorities. We may release health information about foreign military personnel to the appropriate foreign military authority.

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

Worker’s Compensation. We may release health information about you for worker’s compensation or similar programs. These programs provide benefits for work-related injuries or illness.

Public Health Risks. We may disclose health information about you for public health activities. These activities generally include, but are not limited to, the following:

• to prevent or control disease, injury or disability;
• to report deaths;
• to report child or elder abuse or neglect;
• to report elder exploitation;
• to report reactions to medications or problems with products;
• to notify people of recalls of products they may be using;
• to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
• to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required by law.

Health Oversight Activities. We may disclose health information to a health oversight agency for activities authorized by law for audits, investigations, inspections, and licensure.

Lawsuits and Disputes. If you are involved in a lawsuit, we may disclose health information about you in response to a court or administrative order; in response to a subpoena, discovery request or other lawful process by someone else other than you involved in the dispute.

Law Enforcement. As permitted or required by State law, 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 a law enforcement official if Hospice has a suspicion that your death was the result of criminal conduct including criminal conduct at Hospice.
• In an emergency in order to report a crime.

Organ, Eye and Tissue Donation. If you are an organ donor, we may release health information to organizations that handle organ procurement for organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.

Coroners, Medical Examiners and Funeral Directors. We may release health information to a coroner or medical examiner. We may also release health information about patients of Hospice to funeral directors as necessary to carry out their duties.

Research. Under certain circumstances, we may use and disclose health information about you for research purposes. All research projects are subject to a special approval process. This process evaluates a proposed research project and its use of health information. We will ask for your specific permission if the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care with us.

Informing family and friends. We may disclose your health information to family, friends, or caregivers who are involved in your care.

Disaster Assistance/Relief Efforts. We may disclose health information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.

Fundraising Activities. We may use information about you to contact you in an effort to raise money for Helios Care. If you do not want Helios Care to contact you for fundraising efforts, you must notify the Privacy Officer at 297 River Street Service Road, Oneonta, NY 13820 or by telephone at (607)432-6773.

Business Associates. There may be some services provided by our business associates, such as durable medical equipment providers, pharmacies, or legal or accounting consultants. We may disclose your protected health information to our business associates so that they can perform the services we have asked them to do. To protect your health information, we require our business associates to enter into a written contract that requires them to appropriately safeguard your information.

Special Rules Regarding Disclosure of Psychiatric, Substance Abuse, and HIV-Related Information. Special restrictions apply to the the disclosure of protected health information relating to care for psychiatric conditions, substance abuse, or HIV-related testing and treatment.

Authorization To Use or Disclose Health Information:

Other than stated above, Helios Care will not disclose your health information other than with your written authorization. Uses or disclosures not described in this notice, such as marketing purposes or sale of PHI, will be made only with your authorization. If you authorize Helios Care to use or disclose your health information, you may revoke that authorization in writing any time.

Prohibition of Sale of Protected Health Information:

Helios Care is prohibited from selling patient lists to third parties and from disclosing Protected Health Information to a third party for the independent marketing activities of the third party, without obtaining an authorization from every patient on the list. The authorization must state that the disclosure will result in remuneration to the hospice.

Your rights as a patient regarding privacy of your health information and our duties in protecting your health information

You have the following rights regarding health information we maintain about you:

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 Helios Care’s disclosure of your health information to someone who is involved in your care or the payment of your care. You have the right to restrict disclosure of PHI to a health plan with respect to treatment for which you have paid fully out of pocket. However, Helios Care is not required to agree with your request. If you wish to make a request for restrictions, please contact the Privacy Officer at 297 River Street Service Road, Oneonta, NY 13820 or by telephone at (607)432-6773.

Right to Receive Confidential Communications. You have the right to request that Helios Care communicate with you in a certain way. For example, you may ask that Helios Care only conduct communications pertaining to your health information with you privately with no other family members present. Helios Care will not request that you provide any reasons for your request and will attempt to honor your reasonable request for confidential communications. If you wish to receive confidential communications, please contact the Privacy Officer at 297 River Street Service Road, Oneonta, NY 13820 or by telephone at (607)432-6773.

Right to a Paper Copy of This Notice. You may ask us to give you a copy of this Notice at any time. To obtain a separate paper copy, please contact the Privacy Officer at 297 River Street Service Road, Oneonta, NY 13820 or by telephone at (607)432-6773.

Right to be notified following a breach of your unsecured protected health information. We will notify you if your medical information has been “breached,” which means that your medical information has been used or disclosed in a way that is inconsistent with law and results in it being compromised.

Right to Inspect and Receive a Copy Your Health Information. You may inspect and receive a copy of health information that we have produced, while caring for you. Usually, this includes medical and billing records. To inspect and/or receive a copy of health information you must submit your request in writing to the Privacy Officer at 297 River Street Service Road, Oneonta, NY 13820 or by telephone at (607)432-6773. If you request a copy of the information, we will charge a fee for the costs of copying, mailing or other supplies associated with your request.

Right to Request Electronic Copy of Protected Health Information. You may request an electronic copy of your electronic health record as maintained by Hospice in a form and format that is mutually agreed upon. You must submit your request in writing to the Privacy Officer at 297 River Street Service Road, Oneonta, NY 13820 or by telephone at (607)432-6773. The rule allows for a 30-day period to comply with an access request and allows Hospice to charge reasonable fees to produce the information.

Right to Amend. If you feel that health information we have about you is incorrect or incomplete, you may ask us to correct the information. You have the right to request an amendment for as long as we keep the information. To request an amendment, your request must be made in writing and submitted to the Privacy Officer at 297 River Street Service Road, Oneonta, NY 13820 or by telephone at (607)432-6773. You must provide a reason and documentation that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

• Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
• Is not part of the health information kept by us;
• Is not part of the information which you would be permitted to inspect and copy; or
• Is accurate and complete.

Right to an Accounting of Disclosures. You have the right to request an accounting of disclosures of your health information made by Hospice for certain reasons including reasons related to public purposes authorized by law. The request for an accounting must be made in writing to the Privacy Officer at 297 River Street Service Road, Oneonta, NY 13820 or by telephone at (607)432-6773. The request should be specify the time period for the accounting starting on or after April 14, 2003. Accounting requests may not be made for periods of time in excess of six (6) years. Helios Care 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.

Right to Opt Out of Receiving Fundraising Communications. You have the right to opt out of communications for purposes of fundraising. To opt out of fundraising communications, please contact Privacy Officer at 297 River Street Service Road, Oneonta, NY 13820 or by telephone at (607)432-6773.

DUTIES OF HELIOS CARE

Helios Care 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. Helios Care is required to abide by the terms of this Notice as may be amended from time to time. Helios Care 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 Helios Care changes the Notice, Helios Care will provide a copy of the revised Notice to you or your appointed representative. You or your personal representative has the right to express complaints to Helios Care and to the Secretary of the Department of Health and Human Services if you or your appointed representative believe your rights have been violated. Any complaint to Helios Care should be made in writing to the Privacy Officer at 297 River Street Service Road, Oneonta, NY 13820 or by telephone at (607) 432-6773, New York State Department of Health at 1-800-628-5972 or you may contact the Office of Civil Rights at
U.S. Department of Health and Human Services Jacob Javits Federal Building, 26 Federal Plaza – Suite 3312, New York, NY 10278
Voice Phone (800) 368-1019
FAX (212) 264-3039
TDD (800) 537-7697. Helios Care 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

Helios Care has designated the Privacy Officer as its contact person for all issues regarding patient privacy and your rights under the Federal Privacy Standards. You may contact this person at Helios Care at 297 River Street Service Road, Oneonta, NY 13820 or (607)432-6773.

EFFECTIVE DATE

This Notice is effective April 14, 2003.