Hospice Care of the Northwest has established policies to guard against unnecessary disclosure of your medical information. This notice describes how medical information about you may be used and disclosed and how you can access this information. Please review it carefully. The following is a summary of the circumstances under which your medical information may be used and disclosed:

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

To Obtain Payment
Hospice Care of the Northwest will include your medical information in invoices to collect payment from third parties for the care you receive. For example, Hospice Care of the Northwest may be required by your health insurer to provide information regarding your health care status so that the insurer will reimburse the hospice. Hospice Care of the Northwest 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
Hospice Care of the Northwest may use and disclose medical information in order to operate 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;
• Procedure development, case management and care coordination;
• Professional review and performance evaluation;
• Training programs including those in which students, trainees, or practitioners in health care learn under supervision;
• Accreditation, certification, licensing or credentialing activities;
• Review and auditing, including compliance reviews, medical reviews, legal services and compliance programs;
• Business management and general administrative activities of Hospice Care of the Northwest;
• Fundraising for the benefit of Hospice Care of the Northwest; and
• Marketing information about Hospice Care of the Northwest.
• For example,Hospice Care of the Northwest may use your medical information to evaluate its staff performance, combine your health information with other hospice patients’ information in evaluating how to more effectively serve all hospice patients, disclose your medical information toHospice Care of the Northwest staff and contracted personnel for training purposes, use your medical information to contact you as a reminder regarding a visit to you, or contact you as part of general fundraising and community information mailings.

Business Associates
We provide some services through other persons or companies that need access to your medical information to carry out these services. The law refers to these persons or companies as our Business Associates. Examples of these Business Associates include the accreditation programs and medical records storage facility. We may disclose your medical information to our Business Associates so that they can do the job we have contracted with them to do. We require that they use appropriate safeguards to ensure the privacy of your medical information.

Health Oversight Activities and Specialized Government Functions
We may disclose your medical information to an agency that oversees healthcare systems and ensures compliance with the rules of government health programs, such as Medicare or Medicaid, and under certain circumstances to the U.S. Military or U.S. Department of State.

Law Enforcement Officials, Medical Examiners and Coroners, and Court or Administrative Orders
We may disclose your medical information to the police, other law enforcement officials, medical examiners and coroners, and to the courts or administrative proceedings as allowed or required by law, or required by a court order or other legal process.

Notification and Other Communications with Your Relatives, Close Friends, or Caregivers
You or your legal representative must tell your physician, nurse, or other healthcare team members which of your relatives or other persons may or may not receive information about you. After learning who these persons are, we may, using our best judgment, use and disclose your medical information to notify these persons of what they need to know to care for you. In an emergency or other situation where you are not able to identify your chosen person to receive communications about you, we may exercise our professional judgment to determine whether such a disclosure is in your best interest, who is the appropriate person, and what medical information is relevant to their involvement with your healthcare.

Funeral Directors and Organ, Eye, and Tissue Organizations
We may disclose your medical information to funeral directors as necessary to carry out their duties and as allowed by law. We may also disclose your health information to organizations that facilitate organ, eye, or tissue procurement, banking, or transplantation.

Public Health Activities
We may report your identity and other medical information to: public health authorities for the purpose of controlling disease, injury, or disability; the U.S. Food and Drug Administration for regulating certain products or activities; governmental authorities about suspected or known child or elder abuse and neglect, or domestic violence; a person exposed to a contagious disease or has the risk of contracting or spreading disease; your employer and governmental agencies as required by federal and state laws regarding work-related illness or injury; to prevent or lessen a serious or imminent threat to a person’s or the public’s health or safety; or to a public or private entity that is authorized to assist in disaster relief efforts.

Research
With your authorization, we may use or disclose your medical information to identify you as a potential candidate for a research study that has been approved by an Institutional Review Board or for governmental research studies in which your identifiable information will not be released.

Workers’ Compensation
We may disclose your medical information as allowed or required by Illinois law relating to Workers’ Compensation or to other similar programs.

Other Communications With You
We may contact you to remind you of appointments with physicians or other healthcare team members and to follow up on the services you received. We may leave messages about appointments or other reminders on your telephone or with a person who answers the phone. Hospice Care of the Northwest may also use your medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

Your Rights with Respect to Your Medical Information
Other than as stated above, Hospice Care of the Northwest will not disclose your medical information without your written authorization. You have the following rights regarding your medical information contained in the medical record that Hospice Care of the Northwest keeps about you:

Right to Request Restrictions
You may request restrictions on certain uses and disclosures of your medical information. You have the right to request a limit on Hospice Care of the Northwest’s disclosure of your health information to someone who is involved in your care or the payment of your care. However, Hospice Care of the Northwest is not required to agree to your request. If you wish to make a request for restrictions, please contact the Hospice Care of the Northwest Privacy Officer at 562-989-5300.

Right to Receive Confidential Communications
You have the right to request that Hospice Care of the Northwest communicate with you in a certain way. For example, you may ask that we not leave phone messages for you at work. If you wish to receive confidential communications in a specific way, please contact the Hospice Care of the Northwest Privacy Officer at 562-989-5300. Hospice Care of the Northwest will not request that you provide any reasons for your request and will attempt to honor your reasonable requests regarding confidential communications.

Right to Inspect and Copy Your Medical Information
You have the right to inspect and copy your medical records, including billing records. If you request a copy of your medical information, Hospice Care of the Northwest may charge a reasonable fee for copying and assembling costs associated with your request.

Right to Amend Medical Information
You or your representative have the right to request that Hospice Care of the Northwest amend your records if you believe that your medical information is incorrect or incomplete. That request may be made as long as the information is maintained by the hospice.

Right to an Accounting
You or your representative have the right to request an accounting of disclosures of your medical information made by Hospice Care of the Northwest for certain reasons, including reasons related to public purposes authorized by law and certain research.

Right to a Paper Copy of this Notice
You or your representative have a right to a separate paper copy of this Notice at any time even if you or your representative have received this Notice previously.

Right to Revoke Consent
You have the right to revoke your written consent/authorization to use or disclose your medical information except when the disclosure has already happened.

Duties of the Hospice
Hospice Care of the Northwest is required by law to:

• Make sure that your medical information is protected;
• Give you this Notice, which describes your medical privacy rights and our duties to maintain the privacy of your medical information;
• Follow the terms of the Notice that is currently in effect; and
• Notify you if we are unable to agree to your requested restrictions on disclosure of your medical information.

You or your representative have the right to express complaints to Hospice Care of the Northwest and to the Secretary of the Department of Health and Human Services if you or your representative believe that your privacy rights have been violated. Hospice Care of the Northwest encourages you to express any concerns you may have regarding the privacy of your medical information. You will not be retaliated against in any way for filing a complaint.

Hospice Care of the Northwest reserves the right to change our privacy practices and to use a new Notice of Privacy Practices for all health information we maintain about you. Hospice Care of the Northwest will post the latest copy of its privacy practices at our offices and on our website. The Notice will contain an effective date and will be available upon request.