Privacy Notice

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.

Home Hospice, Home Nursing and/or Home Healthcare Equipment, Ltd. may use your health information, information that constitutes protected health information as defined in the Privacy Rule of the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1966, for purposes of providing you treatment obtaining payment for your care and conducting health care operations. We have established policies to guard against unnecessary disclosure of your health information. We are required to abide by the terms of this Notice as are currently in effect.

THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED:

Treatment.

Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. may use your health information to coordinate care within our hospice and with others involved in your care, such as your attending physician, members of the Home Hospice interdisciplinary team and other health care professionals who have agreed to assist us in coordinating care. For example, Home Hospice may disclose health information to physicians involved in your care will need information about your symptoms in order to prescribe appropriate medications. Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. may disclose your heath care information to individuals outside of our hospice, including family members, clergy who you have designated, pharmacists, suppliers of medical equipment or other health care professionals.

Payment.

Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. may use and disclose your health information to receive payment for the care you receive. For example, Home Hospice may be required by your health insurer to provide information regarding your health care status so that the insurer will provide reimbursement for services rendered. Home 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.

Health Care Operations.

Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. may use and disclose health information for its own operations in order to facilitate the function of this hospice and as necessary to provide quality care to all of the hospice patients. Health care operations includes 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 treatment 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 to analyses and formulary development, and business management and general administrative activities.

For example, Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. may use your health information to evaluate its staff performance, combine your health information with that of other patients in evaluating how to more effectively serve our patients, disclose your health information to 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 community information mailings (unless you tell us you do not want to be contacted).

In-Patient Facility (Hospice House).

Home Hospice may disclose certain information about you, including your name, your general health status, your religious affiliation and where you are in the Hospice House, in the hospice directory while you are in the facility. Home Hospice may disclose this information to people who ask for you by name. Please inform us if you do not want your information to be included in the directory.

Fundraising Activities.

Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. may use information about you, including your name, address, telephone number and the dates you received care, in order to contact you to raise money for the Hospice House Foundation. If you do not want Home Hospice to contact you, notify Skip Hedgpeth, Program Administrator, 432-550-7970 and indicate that you do not wish to be contacted.

Appointment Reminders.

Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. may use and disclose your health information to contact you as a reminder that you have an appointment for a home visit.

Treatment Alternatives.

Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. may use and disclose your health information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

When Required by Law.

Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. will disclose your health information when it is required to do so by any Federal, State or local law.

Public Health Risks. Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. may disclose your health information for public activities and purposed 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.

Abuse, Neglect or Domestic Violence.

Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. are allowed to notify government authorities if we believe a patient is the victim of abuse, neglect or domestic violence. Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. will make this disclosure only when specifically required or authorized by law.

Health Oversight Activities.

Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. may disclose your health information to a health oversight organization for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action. Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. 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.

Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. 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 Home Hospice makes reasonable efforts to either notify you about the request or to obtain an order protecting your health information.

Law Enforcement Purposes.

As permitted or required by State law, Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. 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 Home Hospice has a suspicion that your death was the result of criminal conduct, including criminal conduct at our hospice.

In an emergency in order to report a crime.

Coroners and Medical Examiners.

Home 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.

Funeral Directors.

Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. 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, Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. may disclose your health information prior to and in reasonable anticipation of your death.

Organ, Eye or Tissue Donation.

Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. 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.

Research Purposes.

Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. may, under very select circumstances, use your health information for research. Before Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. discloses any of your health information for such research purposes, the project will be subject to an extensive approval process.

Limited Data Set.

Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. may use or disclose a limited data set of your health information, that is, a subset of your health information for which all identifying information has been removed, for purposed of research, public health, or health care operations. Prior to our release, any recipient of that limited data set must agree to appropriately safeguard your health.

Serious Threat to Health or Safety.

Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. may, consistent with applicable law and ethical standards of conduct, disclose your health information if we, in good faith, believe 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.

Specified Government Functions.

In certain circumstances, the Federal regulations authorize Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. 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.

Worker’s Compensation.

Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. may release your health information for worker’s compensation or similar programs.

AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION

Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. will not use or disclose your health information without your written authorization except as otherwise permitted or required by this Notice. If you or your representative authorize Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. to use or disclose your health information, you may revoke that authorization in writing at any time. You understand that Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. are unable to take back any disclosures it has already made under the authorization, and that Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. are required to retain our records of the care that it has provided you.

YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION

You have the following rights regarding your health information that Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. maintains:

Right to request restrictions.

You may request restrictions on certain uses and disclosures of your heath information. You have the right to request a limit on Home Hospice ,Home Nursing, and/or Home Healthcare Equipment, Ltd.’s disclosure of your health information to someone who is involved in your care or the payment of your care. However, Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. are not required to agree to your request. If you wish to make a request for restrictions, please contact Skip Hedgpeth, Program Administrator, 432-550-7970.

Right to receive confidential communications.

You have the right to request that Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. communicate with you in a certain way. For example, you may ask that we 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 Skip Hedgpeth, Program Administrator at 550-7970. Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. 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 Skip Hedgpeth, Program Administrator at 550-7970. If you request a copy of your health information, Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. may charge a reasonable fee for copying and assembling costs associated with your request.

Right to amend health care information.

You or your representative has the right to request that Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. amend your records, if you believe that your health information is incorrect or incomplete. That request may be made as long as the information is maintained by this hospice. A request for an amendment of records must be made in writing to Skip Hedgpeth, Program Administrator, Home Hospice, 6010 E. Hwy 191, Ste. 235, Odessa, Texas 79762.

Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. 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 Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd., if the records you are requesting are not part of Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. 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 Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd., 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 Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. 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 Skip Hedgpeth, Program Administrator, Home Hospice, 6010 E. Hwy 191, Ste 235, Odessa, Texas 79762. The request should 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. Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. 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 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. To obtain a separate paper copy, please contact Skip Hedgpeth, Program Administrator, Home Hospice, 6010 E. Hwy 191, Ste 235, Odessa, Texas 79762.

DUTIES OF HOME HOSPICE

Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. are required by law to maintain the privacy of your health information and to provide to you and your representative this Notice of its duties and privacy practices. Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. are required to abide by the terms of this Notice as may be amended from time to time. Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. reserve 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 Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. change its Notice, we will provide a copy of the revised Notice to you or your appointed representative. You or your representative have the right to express complaints to Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. and to the Secretary of DHHS if you or your representative believe that your privacy rights have been violated. Any complaints to Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. should be made in writing to Skip Hedgpeth, Program Administrator. Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. encouragesyou to express any concerns you have regarding the privacy of your information. You will not be retaliated against in any way for filing a complaint.

CONTACT PERSON

Home Hospice, Home Nursing, and/or Home Healthcare Equipment, Ltd. has designated the Program Administrator, Skip Hedgpeth, as its contact person for all issues regarding patient privacy and your rights under the Federal privacy standards. You may contact him at Home Hospice, 6010 E. Hwy 191, Ste 235, Odessa, Texas 79762 or telephone at 432-550-7970.

EFFECTIVE DATE

This Notice is effective April 14, 2003.

IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT SKIP HEDGPETH, PROGRAM ADMINISTRATOR, 6010 E. Hwy 191, Ste 235, ODESSA, TEXAS 79762, 432-550-7970.