HOSPICE CARE OF CALIFORNIA
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. PLEASE REVIEW IT
CAREFULLY.

USE AND DISCLOSURE OF HEALTH INFORMATION

Hospice Care of California [“Hospice”] 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, for purposes of providing you treatment, obtaining payment for your care and conducting health care operations. Hospice Care of California has established policies to guard against unnecessary disclosure of your health information.

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

To Provide Treatment. Hospice Care of California may use your health information to coordinate care within the Hospice and with others involved in your care, such as your attending physician, members of the Hospice interdisciplinary team and other health care professionals who have agreed to assist the Hospice 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 California also may disclose your health care information to individuals outside of the Hospice 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. Hospice Care of California may include your health information in invoices to collect payment from third parties for the care you receive from Hospice Care of California. For example, the Hospice may be required by your health insurer to provide information regarding your health care status so that the insurer will reimburse you or the Hospice. Hospice Care of California 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 California may use and disclose health information for its own operations in order to facilitate the function of the Hospice and as necessary to provide quality care to all of the Hospice’s 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 analyses and formulary
  development.
• Business management and general administrative activities of the Hospice.

For example Hospice Care of California may use your health information to evaluate its staff performance, combine your health information with other Hospice patients in evaluating how to more effectively serve all Hospice patients, disclose your health information to Hospice Care of California staff and contracted personnel for training purposes, use your health information to contact you as a reminder regarding a visit to you.

For Appointment Reminders. Hospice Care of California may use and disclose your health information to contact you as a reminder that you have an appointment for a home visit.

For Treatment Alternatives. Hospice Care of California 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.

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

When Legally Required. Hospice Care of California will disclose your health information when it is required to do so by any Federal, State or local law.

When There Are Risks to Public Health. Hospice Care of California may disclose your health information for public activities and purposes 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.

To Report Abuse, Neglect Or Domestic Violence. Hospice Care of California is allowed to notify government authorities if Hospice Care of California believes a patient is the victim of abuse, neglect or domestic violence. Hospice Care of California will make this disclosure only when specifically required or authorized by law or when the patient agrees to the disclosure.

To Conduct Health Oversight Activities. Hospice Care of California may disclose your health information to a health oversight hospice for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action. Hospice Care of California, 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. Hospice Care of California 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 Hospice Care of California makes reasonable efforts to either notify you about the request or to obtain an order protecting your health information.

For Law Enforcement Purposes. As permitted or required by State law, Hospice Care of California 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 Hospice Care of California has a suspicion that your death was the result of
  criminal conduct including criminal conduct at Hospice Care of California.
• In an emergency in order to report a crime.

To Coroners And Medical Examiners. Hospice Care of California 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.

To Funeral Directors. Hospice Care of California 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, Hospice Care of California may disclose your health information prior to and in reasonable anticipation of your death.

For Organ, Eye Or Tissue Donation. Hospice Care of California 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.

In the Event of A Serious Threat To Health Or Safety. Hospice Care of California may, consistent with applicable law and ethical standards of conduct, disclose your health information if Hospice Care of California, 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.

For Specified Government Functions. In certain circumstances, the Federal regulations authorize Hospice Care of California 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.

For Worker's Compensation. Hospice Care of California may release your health information for worker's compensation or similar programs.

 
AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION

Other than is stated above, Hospice Care of California will not disclose your health information other than with your written authorization. If you or your representative authorizes the Hospice to use or disclose your health information, you may revoke that authorization in writing at any time.

 
YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION

You have the following rights regarding your health information that Hospice Care of California maintains:

• 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 Hospice Care of California ‘s disclosure of your health
  information to someone who is 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 the
  Privacy Official at Hospice Care of California
• Right to receive confidential communications. You have the right to request that Hospice Care of California
  communicate with you in a certain way. For example, 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 the Privacy Official,
  (714 577-9656). Hospice Care of California 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 the Privacy Official at (714 577-9656). If you request a copy of your health
  information, Hospice Care of California may charge a reasonable fee for copying and assembling costs
  associated with your request.
• Right to amend health care information. You or your representative have the right to request that Hospice
  Care of California 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 Hospice Care of California. A request
  for an amendment of records must be made in writing to the Privacy Official, 377 E. Chapman Ave.,
  Suite 280, Placentia, CA 92870. Hospice Care of California 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 the Hospice, if the records you are requesting are not part of the Hospice‘s
  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 the Hospice, 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 Hospice Care of California 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 the Privacy Official, 377 E. Chapman Ave., Suite 280, Placentia, CA 92870. 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. Hospice Care of California 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 the Privacy Official, Hospice Care of California.

    
DUTIES OF THE HOSPICE

Hospice Care of California 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. Hospice Care of California is required to abide by the terms of this Notice as may be amended from time to time. Hospice Care of California 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 Hospice Care of California changes its Notice, the Hospice will provide a copy of the revised Notice to you or your appointed representative. You or your personal representative have the right to express complaints to Hospice Care of California and to the Secretary of DHHS if you or your representative believe that your privacy rights have been violated. Any complaints to the Hospice should be made in writing to the Privacy Official, 377 E. Chapman Ave., Suite 280, Placentia, CA 92870. The Hospice 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

Hospice Care of California has designated the Privacy Official as its contact person for all issues regarding patient privacy and your rights under the Federal privacy standards. You may contact this person at 377 E. Chapman Ave, Suite 280, Placentia, Ca 92870, (714) 577-9656.

 
EFFECTIVE DATE

This Notice is effective April 14, 2003.