Privacy Policy

Notice of Privacy Practices

This notice describes how health information about you may be used and disclosed and how you may have access to this information. Please review it carefully.

Understanding Your Health Record/Information

A medical record is started upon your admission to Montgomery Hospice. Typically, this record contains your symptoms, examination and test results, diagnoses and care. This information, often referred to as your medical record or medical chart, serves as a:

• basis for planning your care
• means of communication among the many health professionals who contribute to your care
• legal document describing the care you received
• means by which you or a third-party payer can verify that services billed were actually provided

Montgomery Hospice may use the information contained in your medical record, while maintaining your anonymity, as a

• tool to educate heath professionals
• source of data for medical research
• source of information for public health officials charged with improving the health of the nation
• source of data for facility planning and marketing
• tool with which we can assess and continually work to improve the care we render

Understanding what is in your record and how your health information is used helps you to:

• ensure its accuracy
• better understand who, what, when, where, and why others may access your health information
• make more informed decisions when authorizing disclosure to others

Your Health information Rights

Although your medical record is the physical property of Montgomery Hospice, the information belongs to you. You have the right to:

• request a restriction on certain uses and disclosures of your information (If you wish to make a request for restrictions, let your nurse or social worker know and they can give you a request form to complete or contact the Manager of the Medical Record Department. This request must be in writing.)
• obtain a paper copy of the Montgomery Hospice Notice of Information Practices upon request
• inspect and copy your health record (A request to inspect and copy health information may be made in writing to the Manager of the Medical Record Department.)
• amend your health record (A request for amendment of health information created by Montgomery Hospice must be made in writing and sent to the Manager of the Medical Record Department. The request must contain the reason for the amendment.)
• obtain an accounting of disclosures of your health information (The request is to be in writing to the Manager of the Medical Record Department and should specify the time period for the accounting starting on April 14, 2003.)
• receive confidential communications (You can request that we communicate with you in a certain way. For example, you may ask that communications pertaining to your health information be conducted in private with no other family members present. If you wish to receive confidential communications, please contact the Manager of the Medical Record Department. Montgomery Hospice will attempt to honor your reasonable requests for confidential communications.)
• revoke your authorization to use or disclose information except to the extent that action has been taken

Our Responsibilities

Montgomery Hospice is required to:

• maintain the privacy of your health information
• provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you
• abide by the terms of this notice
• notify you if we are unable to agree to a requested restriction
• accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will mail to you a revised notice to the address you've supplied us. We will not use or disclose your health information without your authorization, except as described in this notice.

For More Information or to Report a Problem

If have questions and would like additional information, you may contact the Privacy Officer/Manager of the Medical Record Department at 301 921 4400. If you believe your privacy rights have been violated, you can file a complaint with the Privacy Officer/Manager of the Medical Record Department or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.

Examples of Disclosures for Treatment, Payment and Health Operations

• We will use your health information for treatment.
• We will fax or mail your health information to your physician.
• We will use your health information for payment.
• We will use your health information for regular operations.
• We may use your health information to obtain services from business associates and support agencies.
  
  For example: There are some services provided by our organization through contracts with business associates. Examples include Roberts Medical Supply and Bradley Care Drugs. Examples of support agencies include Food and Friends, Hospice Caring, and the ALS Association.
• Your health information may be communicated through E-mail to family members.
• We may include your health information in a Directory.
• We may use your health information for notification and communication purposes.
  
  For example: We may use or disclose information to notify or assist in notifying a family member, personal representative, or other people responsible for your care, your location and general condition. Team members, using their best judgement, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person's involvement in your care or payment related to your care.
• Your health information may be used in research data.
• We will provide health information to funeral directors.
• We may provide your health information to organ procurement organizations.
• Your demographic information and dates of service may be used for marketing and fundraising.
• We may share your health information when there are risks to public health.
• For example: Health information may be disclosed for public activities and purposes as required by law:
  1. Montgomery Hospice may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
  2. In order 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.
  3. In order to notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease.
• We may share your health information to report abuse, neglect or domestic violence.
• Your health information may be shared with law enforcement and/or the court system.

Authorization to use or disclose health information.

Other than is stated above, Montgomery Hospice will not disclose your health information other than with your written authorization.

Contact Person

Montgomery Hospice's contact person for all issues regarding patient privacy and you rights under the Federal privacy standards is the Manager of the Medical Record Department (301-921-4400).

Effective Date: This Notice is effective April 14, 2003.