Notice of Privacy Practices

Your rights to privacy are important to Seacoast Hospice. Careful review of this document will help you understand ways in which we may use and share your health information.

HOW YOUR PRIVATE INFORMATION IS USED BY OUR ORGANIZATION
The use of your private health information is required for three areas of the work that the Hospice does:

providing treatment to you,

obtaining payment for the services we provide,

performance of other activities that are necessary to support the direct care we provide (activities required to maintain our organization)

For providing treatment to you
1. To coordinate your Hospice care with others, such as:

your attending physician

members of the Hospice Interdisciplinary Team

other health care professionals involved in your care

your family members

clergy who you have designated

pharmacists

suppliers of medical equipment

2. To tell you about or recommend treatment options or other choices that may be of interest to you.

To obtain payment for your care
We provide information about your medical condition and the care that you receive to those who pay for
your hospice care.

To Conduct Health Care Operations
Health care operations includes such activities as:

evaluating our staff performance

combining your health information with other Hospice patients in evaluating how to more effectively serve all Hospice patients

training purposes

contacting you as a reminder regarding a visit to you

contacting you as part of general fundraising and community information mailings. (If you do not want the Hospice to contact you or your family, notify Mary Swanson, Director, Clinical Services, Privacy Official.)


ADDITIONAL REASONS FOR WHICH YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED
(When legally required by any Federal, State or local law)
1. When there are risks to public health, the Hospice may disclose your health information to:

prevent or control disease, injury or disability

report disease, injury, or death

participate in public health surveillance, investigations and interventions

report adverse events and product defects, or 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.

2. To report Abuse, Neglect Or Domestic Violence.

If the Hospice believes a patient is the victim of abuse, neglect or domestic violence (only when specifically required or authorized by law or when the patient agrees to the disclosure).

3. To Coroners And Medical Examiners for purposes of determining your cause of death or for other
duties, as authorized by law.
4. Other legal and regulatory reasons to share health information.

to conduct health oversight activities.

In connection with judicial and administrative proceedings.

For law enforcement purposes.

OTHER REASONS OR PERSONS WITH WHOM HEALTH INFORMATION
MAY BE SHARED
1. Funeral Directors.
Consistent with applicable law and if necessary, to carry out their duties related to your funeral arrangements.
2. Organ, eye or tissue donation and transplantation organizations.
For the purpose of facilitating your wishes related to the donation and transplantation or organs or tissues.
3. For Research Purposes.
Generally health information that can be linked to a specific individual is not disclosed for research. Before the Hospice discloses any of your health information for research purposes, the project will be subject to an extensive approval process and information will not be shared without your consent.
4. In the event of a serious threat to health or safety
The Hospice may, consistent with applicable law and ethical standards of conduct, disclose your health information if the Hospice, in 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.
5. For specific government functions
Government functions may be related to military and veterans, national security and intelligence activities, Presidential and other protective services, medical suitability determinations and inmate and law enforcement custody.
6. For Worker's Compensation
The Hospice may release your health information for worker's compensation or similar programs.


AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION
Other than for the reasons indicated above, the Hospice will not disclose your health information without your written authorization. Of course, if you or your representative choose, you may revoke your authorization in writing at any time.


YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION
You have several rights related to your health information that the Hospice maintains:
1. Right to request restrictions.

You have the right to request a limit on the disclosure of your health information to others involved in your care or the payment of your care. However, the Hospice is not required to agree to your request. If you wish to make a request for restrictions, please contact Mary Swanson, Director Clinical Services.

2. Right to receive confidential communications.

You may ask that the Hospice 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 Mary Swanson, Director Clinical Services.

3. 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 Mary Swanson, Director Clinical Services.

4. Right to make changes to health care information.

You or your representative have the right to request that the Hospice make changes to your records, if you believe that your health information is incorrect or incomplete.

A request for a change of records must be made in writing to Mary Swanson, Director Clinical Services.

The hospice follows specific criteria to amend or change records and will only be able to honor your request if these criteria are met.

5. Right to an accounting.

You have the right to request a report of disclosures of your health information made by the Hospice for certain reasons, including reasons related to public purposes authorized by law and certain research.

The request for a report must be made in writing to Mary Swanson, Director Clinical Services.

The request should specify the time period for the accounting starting on or after April 14, 2003.

6. Right to a paper copy of this notice.

You or your representative have a right to a separate paper copy of the Seacoast Hospice Notice of Privacy Practices even if you or your representative have received this Notice previously.

A separate paper copy can be obtained by contacting Mary Swanson, Director Clinical Services, Privacy Official.

A copy of the current version of Seacoast Hospice's Notice of Privacy Practices can also be
obtained on our website at: www.seacoasthospice.org.


DUTIES OF THE HOSPICE

The Hospice is 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

If the Hospice changes its Notice, the Hospice will provide a copy of the revised Notice to you or your appointed representative.

The Hospice encourages you to express any concerns you may have regarding the privacy of your information. Your care will not be impacted in any way for filing a complaint or for registering a concern.

CONTACT PERSON
Seacoast Hospice, Director of Clinical Services, Privacy Official, is the contact person for issues regarding patient privacy and rights under the Federal privacy standards. You may contact us at the address and phone number below:

10 Hampton Road
Exeter, NH 03833
Telephone: 800 416-9207, 603-778-7391,
TTY/Voice #: 1-800-735-2964
Fax: 603 772-7692
www.seacoasthospice.org

EFFECTIVE DATE
This Notice is effective April 14, 2003.