Privacy Notice

NOTICE OF PRIVACY PRACTICES

As required by the Privacy Regulations outlined in the Health Insurance Portability and Accountability Act of 1996 (HIPAA)

Effective Date of Notice: April 14, 2003

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

A. OUR COMMITMENT TO YOUR PRIVACY

HomeCare & Hospice is dedicated to maintaining the privacy of the identifiable health information of the patients we serve. In providing care to you, we will create records regarding you and the treatment and services we provide to you. The law requires that HomeCare & Hospice maintain confidentiality of health information that identifies you, and has established policies to protect against unnecessary disclosure of your health information. The law also requires that our organization provide you with this written notice of our duties and responsibilities under that law concerning how HomeCare & Hospice may use and disclose your identifiable health information. By law, we must follow the terms of the notice of privacy practices that we have in effect at the time we are serving you.

The purpose of this notice is to provide you with important information regarding:

v How we may use and disclose your identifiable health information

v Your privacy rights in relation to your identifiable health information

v Our obligations concerning the use and disclosure of your identifiable health information.

The terms of this notice apply to all records containing your identifiable health information that are created or maintained by HomeCare & Hospice. We reserve the right to revise or amend our Notice of Privacy Practices. Any change in this notice will be effective for all of your records that HomeCare & Hospice has created or maintained in the past, and for any of your records we may create or maintain in the future. You will be notified when changes occur in the conditions described in this notice and be provided with a copy of the revised notice. A copy of the most current privacy notice will be posted in a prominent location in each of our Regional Offices, on our web site at www.communitycarewny.org and/or a paper copy will be made available to you upon request.

SHOULD YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE OR ANY ISSUE REGARDING PATIENT PRIVACY AND YOUR RIGHTS UNDER THE FEDERAL PRIVACY LAWS, PLEASE CONTACT THE PRIVACY OFFICER AT 1-800-339-7011.

B. YOUR HEALTH INFORMATION MAY BE USED BY HomeCare & Hospice IN THE FOLLOWING WAYS

1. To Provide Treatment: HomeCare & Hospice may use your identifiable health information to establish and carry out an appropriate plan of care for you. For example, your health information may be used to obtain services essential for your health and well being, such as obtaining medical equipment, arranging for transportation, or lab testing, or providing your physician with information so that he can order the appropriate medications. Your health information may also be disclosed to others who may assist in your care, such as your doctor, family members or privately paid caregivers; or, in an emergency, when your health and safety require treatment intervention.

2. To Obtain Payment: HomeCare & Hospice may use and disclose your identifiable health information in order to bill and collect payment for services and supplies you may receive from us. For example, we may contact your health insurer to certify you are eligible for benefits (and for what range of benefits) and we may provide your insurer with details regarding your treatment to determine if your insurer will pay for your treatment. We may use and disclose your identifiable health information to obtain payment from third parties, such as family members or friends that may be responsible for paying for your health care costs. We may also use your identifiable health information to bill you directly for services and supplies you may receive from us. We may also use your identifiable health information to assist you in obtaining a coverage source for services or supplies you receive from us.

3. To Conduct Health Care Operations: Our organization may use and disclose your identifiable health information to operate our business and provide quality care to all HomeCare & Hospice patients. Health care operations include such activities as:

v Quality improvement activities, including satisfaction survey activities

v Activities designed to promote health or reduce health care costs

v Protocol development, case management, care coordination

v Professional review and employee performance evaluations

v Training programs or internships including those in which students, trainees, or practitioners in health care learn under supervision

v Accreditation, certification, licensing, or credentialing activities

v Business planning and development including cost management

v Business management and general administration activities

v Fundraising activities

v Management of requests for identifiable health information from other health care providers with which you have or had a treatment relationship, providing the information requested pertains to that

relationship.

For example, HomeCare & Hospice may use your health information to evaluate the performance

of its staff, combine your information with other individuals it serves to evaluate how to better serve

our patient, use your health information to train agency staff and contracted personnel, or contact

you as part of general fundraising and community information mailings.

4. For Appointment Reminders: HomeCare & Hospice may use and disclose your identifiable health information to contact you and remind you of visits/deliveries.

5. For Treatment Alternatives: Our organization may use or disclose your identifiable health information to inform you of health-related benefits or services that may be of interest to you.

6. For Fundraising or Community Information Mailings: HomeCare & Hospice may use information about you including your name, address, phone number and the dates you received care in order to contact you regarding fundraising and community information mailings. If you do not wish to receive fundraising information and/or community information mailings, notify the Development Coordinator OR Agency Relations Coordinator at 1-800-339-7011.

C. YOUR IDENTIFIABLE HEALTH INFORMATION MAY BE USED OR DISCLOSED IN

CERTAIN SPECIAL CIRCUMSTANCES. These circumstances may include the following:

1. For Disclosures Required by Law: Our organization will use and disclose your identifiable health information when we are required to do so by federal, state, and local law.

2. When There is A Risk to Public Health: HomeCare & Hospice may disclose your health information for public health activities and purposes in order to:

v Prevent or control disease, injury, or disability; report disease, injury, and vital events, such as birth or death; and to conduct public health surveillance activities, investigations, and interventions.

v 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.

v Notify a person who has been exposed to a communicable disease or who may be at risk for contracting or spreading the disease.

v Notify an employer about an individual who is a member of the work force as legally required.

3. To Report Abuse, Neglect, or Domestic Violence: Our organization is allowed to notify government authorities if we believe a patient, regardless of age, is the victim of abuse, neglect, or domestic violence. HomeCare & Hospice will make this disclosure only when specifically required or authorized by law or if we believe that disclosure is necessary to prevent serious harm to you or other potential victims or when you agree to the disclosure.

4. To Conduct Health Oversight Activities: Your health information may be disclosed by HomeCare & Hospice to a health oversight agency for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action. Our organization may not disclose your health information if you are the subject of the investigation and your health information is not directly related to your receipt of health care or claims for public benefits related to health.

5. In Connection With Judicial and Administrative Proceedings: HomeCare & Hospice may disclose your identifiable health information in the course of any judicial or administrative proceeding in response to an order of the court or administrative tribunal as expressly authorized by such order. HomeCare & Hospice may disclose your identifiable health information in response to a subpoena, discovery request, or other lawful process. These disclosures will only occur when HomeCare & Hospice has made reasonable efforts to either notify you about the request or to obtain an order protecting your health information.

6. For Law Enforcement Purposes: HomeCare & Hospice may disclose your health information when asked to do so by a law enforcement official, as permitted or required by law, for the following law enforcement purposes:

v Regarding a crime victim in certain situations, if we are unable to obtain the person’s consent.

v Concerning a death we believe may have resulted from criminal conduct.

v Regarding criminal conduct in our offices.

v In response to a court order, warrant, subpoena, or summons or similar legal process.

v For the purpose of identifying or locating a suspect, fugitive, material witness or missing person.

v In an emergency, to report a crime (including location or victim(s) of the crime or description, identity, or location of the perpetrator).

v To coroners and medical examiners for the purposes of determining your cause of death or other duties as authorized by law.

7. To Funeral Directors: HomeCare & Hospice may disclose your identifiable health information to funeral directors consistent with applicable law and if necessary to carry out their duties in respect to your funeral arrangements. Your health information may be disclosed prior to and in reasonable anticipation of your death to permit the funeral director to carry out his duties.

8. For Organ, Eye, and/or Tissue Donation: HomeCare & Hospice may use or disclose your health information to organ procurement centers or other entities engaged in procurement, banking, or transplantation of organs, eye or tissue for the purpose of facilitating the donation and transplantation. The record maintained by HomeCare & Hospice must contain a written statement from you, indicating that you wish to donate your organs, eye(s) or tissue and the identification of the procurement center or entity that is to be the recipient.

9. In the Event of a Serious Threat to Health and Safety: HomeCare & Hospice may use or disclose your identifiable health information when our organization, in good faith, believes that such disclosure is necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. For example, your health information may be disclosed to emergency response teams during a natural disaster in order to obtain assistance for you. This disclosure will be limited to the person or organization able to help prevent the threat.

10. For Specified Government Functions: Federal regulations authorize HomeCare & Hospice to use or disclose your identifiable health information if you are a member or veteran of U.S. or foreign military forces and if required by the appropriate military authority. Your identifiable health information may also be disclosed for national security and intelligence activities, protective services for the President, government officials, and/or heads of state, or to conduct investigations. HomeCare & Hospice may also disclose your identifiable information to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure would occur for the following purposes: (a) for the institution to provide health care services to you; (b) for the safety and security of the institution, and/or (c) to protect your health and safety or the health and safety of other individuals.

11. For Workers Compensation: HomeCare & Hospice may disclose your health information for worker’s compensation or similar programs.

D. AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION

Other than those reasons stated above, HomeCare & Hospice will not disclose your health information without your written authorization. You may revoke that authorization in writing at any time.

E. YOUR RIGHTS REGARDING YOUR IDENTIFIABLE HEALTH INFORMATION

You have the following rights regarding the identifiable health information that we create and maintain about you:

1. You have the right to confidential communications: This means you have the right to request that HomeCare & Hospice communicate with you about your health and related issues in a specific manner or at a certain location. For instance, you may ask that we contact you at your home, rather than at work OR that we do not leave messages on your answering machine, but talk to you directly OR that communication pertaining to your health information be conducted privately, without family members present. You must make the request for confidential communications in writing. For further information, contact the Privacy Officer at 1-800-339-7011. The written request must specify the requested method of contact or the location where you wish to be contacted. You do not need to give a reason for your request. Our organization will accommodate any reasonable request for confidential communication.

2. You have a right to request restrictions: You may request restrictions on certain uses and disclosures of your health information for treatment, payment, or health care operations. For example, you may request that your health information not be disclosed to someone who is involved in your care OR the payment for your care. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise bound by law, in emergencies, or when the information is necessary to treat you. You must submit your request in writing to restrict our use or disclosure of your identifiable health information. For further information, contact the Privacy Officer at 1-800-339-7011. Your written request must provide clear directions as to (a) what information you wish to restrict (b) whether you are requesting to limit HomeCare & Hospice’s use, disclosure, or both and (c) to whom the limits apply.

3. You have a right to inspect and copy your health information: You have the right to inspect and obtain a copy of the identifiable health information that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes. You must submit your request in writing to inspect and/or obtain a copy of your identifiable health information. Contact the Privacy Officer at 1-800-339-7011 for further information. Our organization may charge a fee to cover the costs of copying, mailing, labor and supplies associated with your request. HomeCare & Hospice may deny your request to inspect and/or copy under certain limited circumstances. You may, however, request a review of the denial by another licensed health care professional chosen by HomeCare & Hospice. Instructions for the denial review process will be sent to you with the notice of denial.

4. You have a right to amend your health care information: You have a right to request that the information created and maintained by HomeCare & Hospice be amended, if you believe that your health information is incorrect or incomplete. You may make this request at any time, for as long as the information is kept by our organization. Your request to amend your record must be submitted in writing and include the reason why you believe the record needs to be amended. Contact the Privacy Officer at 1-800-339-7011 for further information.

HomeCare & Hospice will deny your request if your request is not submitted in writing or if

the request does not include the reason you are requesting your record be amended. Our

organization will also deny your request if you ask us to amend information that is: (a) accurate

and correct; (b) not part of the identifiable health information kept by or for the organization; (c)

not part of the identifiable health information which you would be permitted to inspect or copy; (d)

not created by our organization, unless the individual or entity that created the information is not

available to amend the information.

5. You have a right to an accounting of the disclosures of your health information: You have a right to request an accounting of the certain types of disclosures of your health information made by HomeCare & Hospice. Your request must be submitted in writing. Contact the Privacy Officer at 1-800-339-7011 for further information. All requests for an accounting must state the time period, which may not be longer than six years and may not include dates prior to April 14, 2003. HomeCare & Hospice will provide the first list you request in a 12-month period free of charge. Our organization may charge you a reasonable cost-based fee for any additional lists requested in the same 12-month period. You may withdraw your request before you incur any costs.

6. You have a right to a paper copy of this notice: You have a right to request a paper copy of HomeCare & Hospice’s Notice of Privacy Practices at any time, even if you have received this notice previously. To receive a copy, contact the Privacy Officer at 1-800-339-7011. A copy of our current notice may also be obtained from our website, www.HomeCare-Hospice.org.

7. You have a right to file a complaint: If you believe your privacy rights have been violated, you have a right to file a complaint with our organization or the Secretary of the Department of Health and Human Services. To file a complaint with HomeCare & Hospice, contact the Privacy Officer at 1-800-339-7011. The Privacy Officer will provide you with the information you need to file a written complaint. Our organization encourages you to express any concerns you may have about the privacy of your information and its management by our organization. You will not be retaliated against for filing a complaint.

This is an Equal Opportunity Program. Discrimination is prohibited by Federal law. Complaints of discrimination may be filed with the USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building, 1400 Independence Avenue, SW, Washington, DC, 20250-9410 or call (202) 720-5964 (voice and TDD).