AVIANT Hospice Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

 

USE AND DISCLOSURE OF HEALTH INFORMATION AVIANT Hospice, herein referred to as AH, 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 1996, EPHI 2005 and HITECH 2009 Acts for purposes of providing you treatment, obtaining payment for your care arid conducting health care operations. AH has established policies to guard against unnecessary disclosure of your health information.

The following is a summary of the circumstances and purposes for which your health information may be used and disclosed:

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

To Obtain Payment. AH may include your health information in invoices to collect payment from third parties for the care you receive from AH. For example, AH may be required by your health insurer to provide information regarding your health care status so that the insurer will reimburse you or AH. AH 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.
YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION
The following details your rights regarding your health Information that AVIANT Hospice maintains:

THE RIGHT TO REQUEST RESTRICTIONS

You may request restrictions on certain uses and disclosures of your health information. You have the right to request a limit on AH’s disclosure of your health information to someone who is involved in your care or the payment of your care. However, AH is not required to agree to your request.

RIGHT TO RECEIVE CONFIDENTIAL COMMUNICATIONS

 

You have the right to request that AH communicate with you in a certain way. For example, you may ask that AH only conduct communications pertaining to your health information with you privately with no other family members present. AH 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 YOU HEALTH INFORMATION

You have the right to inspect and copy your health information, including billing records. If you request a copy of your health information, AH may charge a reasonable fee for copying and assembling costs associated with your request.

RIGHT TO AMEND HEALTHCARE INFORMATION

 

You or your representative has the right to request that AH 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 AH. AH 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 AH, if the records you are requesting are not part of AH’s records, if the withheld 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 AH, 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 AH for certain reasons, including reasons related to public purposes authorized by law and certain research. The request should specify the time period for the accounting starting on or after April 14, 2014. Accounting requests may not be made for periods of time in excess of six (6) years. AH would provide the first 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.
AH 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. AH is required to abide by the terms of this Notice may be amended from time to time. AH reserves 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 AH changes its Notice, AH will provide a copy of the revised Notice to you or your appointed representative. You or your personal representative has the right to express complaints to AH and to the Secretary of DHHS if you or your representative believes that your privacy rights have been violated. Any complaints to AH should be made in writing; AH encourages you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way for filing a complaint.

CONTACT PERSON

AH has designated a contact person for all issues regarding patient privacy and your rights under the Federal privacy standards.

EFFECTIVE DATE

This Notice is effective April 14. 2003. If you believe your privacy rights have been violated, you can file a complaint with the AH Privacy Officer, or with the Office for Civil Rights, U.S. Department of Health and Human Services, There will be no retaliation for filing a complaint with either the Privacy Officer or the Office for Civil Rights. Contact information for both is listed below.

 

AVIANT Hospice Privacy Officer

7000 E. Belleview Ave. Suite 130
Greenwood Village, CO 80111
Phone: 928.425.5400
Fax: 303.953.7271