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.

What Is This Notice About and Why Is It Important?

Harbor Light Hospice and it’s affiliates:  Hospice Community Care, Heartlite Hospice Care, Hospice Care of the Northwest, Hospice Care of the Rockies (“Hospice”) is required by law to maintain the privacy of protected health information (“PHI” or “health information”) and to provide you with this Notice describing its legal responsibilities and privacy practices regarding PHI.  State and federal laws require Hospice to: maintain the privacy of your health information; provide you with this Notice about its legal duties and privacy practices and your legal rights pertaining to health information it collects and maintains about you; notify you following a breach of unsecured PHI; follow the privacy practices described in this Notice while it is in effect;  notify you if it is unable to agree to a requested restriction pertaining to your health information; and accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations. Hospice reserves the right to change its information practices and to make the changes effective for all PHI it maintains. Should its information practices change, it will change its Notice of Privacy Practices and make the new Notice available to you.  When it changes this Notice, it will be posted in its offices, and on its website (www.harborlighthospice.com).

Use and Disclosure of Health Information

Hospice may use your health information for purposes of providing you treatment, obtaining payment for your care services and conducting health care operations.  Harbor Light Hospice has established a policy to guard against unnecessary disclosure of your health information.

Federal privacy rules allow the Hospice to use or disclose your health information without your authorization for a number of reasons.  The following is a summary of the circumstances under which, and purposes for which, your health information may be used and disclosed without the need for your authorization.

To Provide Treatment

The Hospice may use your health information to coordinate care within the hospice team 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/services.

For example, information about your symptoms will need to be reported to the physician in order to obtain appropriate prescriptions for symptom management.

The Hospice may also disclose your health care information to individuals outside the hospice team in an effort to coordinate your care.  This may include family members, clergy whom you have designated, pharmacists, suppliers of durable medical equipment and/or other health care professionals that the Hospice uses in order to coordinate your care.

The Hospice will send out weekly appointment reminders to contract nursing homes to notify them of scheduled staff visits to see their hospice patients.

Information may be disclosed to community Social Service Agencies in an effort to provide linkage tor care resources desired by the patient or representative.

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 to provide health care information regarding your health status so that your insurer will reimburse the Hospice for services rendered.

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 includes the following activities:

• Quality assessment and improvement activities;

• Activities designed to improve health care delivery or reduce health care costs

• Case management and care coordination

• Professional review and performance evaluation

• Training programs including those in which trainees or practitioners in health care learn under supervision

• Volunteer training

• Memorial services for Hospice families

• Certification, accreditation, licensing or credentialing activities

• Review and auditing for purpose of compliance programs and legal services

• Business planning and development including cost management and planning related analyses

• Business management and general administrative activities of the Hospice

For example, your health information may be used to evaluate the performance of Hospice staff, combine your health information with other Hospice patients to determining how to more effectively meet the needs of all patients served by the Hospice and disclose your health information to train the Hospice staff.

When Legally Required

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

To Inform Individuals Involved In Your Care or Payment For Your Care

During times of treatment, we disclose your health information only to you, a family member, personal representative, or another person responsible for your care.  We may use or disclose your health information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, regarding your general condition.  We may also contact you to notify you of any breach of unsecured PHI.

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 a birth or death and the conduct of public health surveillance, investigations and interventions.

• To report adverse events, product defects, to 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

The Hospice is mandated to notify government authorities if the Hospice believes a patient is the victim of abuse, neglect or domestic violence.

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 is 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 hearing as expressly authorized by such order or in response to a subpoena, discovery request or other legal process.  The Hospice must make all efforts to either notify you about the request or to obtain an order protecting your health information before disclosing the information.

For Law Enforcement Purposes

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

• As required by law for reporting of certain types of 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

• For the purpose of preventing or lessening a serious and imminent threat to your health or safety or to the health and safety of the public, in accordance with applicable law and ethical standards of conduct

• Under certain limited circumstances, when you are the victim of a crime or the Hospice believes that disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or to the safety of the public

• To a law enforcement official if the Hospice has a suspicion that your death was the result of criminal conduct including criminal conduct on the part of the Hospice

• In an emergency situation where a crime must be reported

To Coroners and Medical Examiners

The Hospice may disclose your health information 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.

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 transplantation of organs, eyes or tissue for the purpose of facilitating the donation and transplantation, according to your specific wishes.

For Research Purposes

At present the Hospice does not participate in any research activities that would require disclosure of Patient Health Information (PHI). If this would change, the Hospice would amend or develop standards to meet research requirements and notify our patients and families of such change.

For Specified Government Functions

In certain circumstances, Federal Regulations authorize the Hospice to use and disclose the protected 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 Workers’ Compensation

The Hospice may disclose your health information for Workers’ Compensation or other similar programs established by law.

Authorizations to Use and Disclose Health Information

Other than those instances stated above, your health information may be used or disclosed only after the Hospice has obtained your written authorization.  For example, a specific authorization will be required for use or disclosure of your health information 1) if it involves certain psychotherapy notes, 2) for marketing (except if the communication is face-to-face, or is for a promotional gift of nominal value) or for any marketing that involves financial remuneration; or 3) for any sale of your PHI.  In these situations, you may withdraw your authorization at any time and must do so in writing to Hospice. Your withdrawal may not be effective in certain situations where we have already taken action in reliance on your authorization.

Your Rights with Respect to Your Health Information

You have the following rights regarding your health information that the Hospice maintains.

The right to request restrictions (or limits) on certain uses and disclosures of PHI.  You have the right to request a restriction or limitation on the health information we use or disclose for treatment, payment, or health care operations and to others involved in your care.  We are not required to agree to your request. If we do agree, we will comply with your request unless the use or disclosure is needed to provide emergency treatment or otherwise allowed or required by law.  Also, if you request, we must agree to restrict disclosures to health plans if you pay out of pocket in full for any service we provide. Any request for restrictions must be in writing and sent to the Hospice Administrator/Privacy Officer, contact information provided at the end of this Notice.

The right to receive health information by alternative means.  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 without other family members present.  Hospice will attempt to accommodate reasonable requests. The request must be in writing and sent to the Hospice Administrator/Privacy Officer.

Right to inspect and copy your health information.  You have the right to inspect and copy your health information, including billing records.  Exceptions include psychotherapy notes or related information; information that may be used in a civil, criminal or administrative action or proceeding; or where prohibited by law.  The Hospice will charge a fee for the cost of copying, assembling, handling, mailing or other supplies associated with your request, and the Hospice may take a reasonable time to fulfill your request.  A request to inspect and copy records containing your health information may be made to the Hospice Administrator/Privacy Officer.

Right to amend health care information.

If you or your representative believe that your health information records are incorrect or incomplete, you may request that the Hospice amend the records.  That request may be made so long as the information is maintained by the Hospice. A request for an amendment of records must be made, in writing, to the Hospice Administrator.  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, are not part of the Hospice’s records, 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 any reason other than for treatment, payment or health operations.  The request for an accounting must be made, in writing, to the Hospice Administrator/Privacy Officer. The request should specify the time period for the accounting. Accounting requests may not be made for periods of time in excess of six years from the date of your request.  The Hospice 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 a paper copy of this notice.  You or your representative has a right to a separate paper copy of this Notice at any time, even if you or your representative has received this Notice previously.  To obtain a separate paper copy, please contact the Hospice Administrator/Privacy Officer.

How To Make A Complaint.

You or your personal representative has the right to express complaints to the Hospice if you or your representative believe that your privacy rights have been violated.  Any complaints to the Hospice should be made, in writing, to the Hospice Administrator/Privacy Officer. You also may send a complaint to the U.S. Department of Health and Human Services (“DHHS”).  Further information may be found at  We support your right to protect the privacy of your medical information. We will not retaliate in any way if you choose to file a complaint with the Hospice or with DHHS.

Contact Person

The Hospice Administrator has been designated as the contact person for all issues regarding patient privacy and your rights under the Federal privacy standards.  You may reach the Corporate Compliance Officer/Privacy Officer at [1N131 County Farm Road, Winfield, IL 60190 or at (800) 419-0542.]

Effective Date

This Notice is effective April 14, 2003.