Privacy Notice

Iowa City Hospice may use your health information for purposes of providing you treatment, obtaining payment for your care and conducting health care operations. Your health information may be used or disclosed only after Iowa City Hospice has obtained your written consent. Iowa City Hospice has established a policy 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 after you have provided your written consent:

• • To Provide Treatment
    Iowa City Hospice may use your health information to coordinate care within Iowa City Hospice and with others involved in your care, such as your attending physician, members of Iowa City Hospice Interdisciplinary Team and other health care professionals who have agreed to assist Iowa City Hospice in coordinating care. For example, physicians involved in your care will need information about your symptoms in order to prescribe appropriate medications. Iowa City Hospice may also disclose your health care information to individuals outside of Iowa City Hospice involved in your care including family members, clergy whom you have designated, pharmacists, suppliers of medical equipment or other health care professionals that Iowa City Hospice uses in order to coordinate your care.
  • To Obtain Payment
    Iowa City Hospice may include your health information in invoices to collect payment from third parties for the care you may receive from the Iowa City Hospice. For example, Iowa City Hospice may be required by your health insurer to provide information regarding your health care status so that the insurer will reimburse you or Iowa City Hospice. Iowa City Hospice also may need to obtain prior approval from your insurer and may need to explain to the insurer your need for Iowa City Hospice care and the services that will be provided to you.
  • To Conduct Health Care Operations
    Iowa City Hospice may use and disclose health information for its own operations in order to facilitate the function of Iowa City Hospice and as necessary to provide quality care to all of the Iowa City Hospice’s patients. Health care operations include 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 Iowa City Hospice.

• Fundraising for the benefit of Iowa City Hospice and certain marketing activities
  For example Iowa City Hospice may use your health information to evaluate its staff performance, combine your health information with other Iowa City Hospice patients in evaluating how to more effectively serve all Iowa City Hospice patients, disclose your health information to Iowa City Hospice 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 or your family as part of general fundraising and community information mailings (unless you tell us you do not want to be contacted).Federal privacy rules allow Iowa City Hospice to use or disclose your health information without your consent or authorization for a number of reasons:
• • When Legally Required
    Iowa City Hospice will disclose your health information when it is required to do so by any Federal, State or local law.
  • When There is Risk to Public Health
    Iowa City Hospice 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.
• To report adverse events, product defects, to track products or enable product recall, repairs and replacements and to conduct post-marketing surveillance and compliance with requirements of the Food and Drug Administration.
• To notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease.
• To an employer about an individual who is a member of the workforce as legally required.

• • To Report Abuse, Neglect or Domestic Violence
    Iowa City Hospice is allowed to notify government authorities if Iowa City Hospice believes a patient is the victim of abuse, neglect or domestic violence. Iowa City Hospice 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
    Iowa City Hospice may disclose your health information to a health oversight agency for activities including audits, civil administration or criminal activities, inspections, licensure or disciplinary action. The Iowa City Hospice, 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
    Iowa City Hospice may disclose your health information in the course of any judicial or administrative proceedings 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 Iowa City Hospice makes reasonable efforts to either notify you about the request or to obtain an order protecting your health information.
  • For Law Enforcement Purposes
    Iowa City Hospice may disclose your health information to a law enforcement official for 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 Iowa City Hospice has a suspicion that your death was the result of criminal conduct including criminal conduct at the Iowa City Hospice.
• In an emergency in order to report a crime.

• To Coroners and Medical Examiners
  Iowa City 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.
• To Funeral Directors
  Iowa City Hospice 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, Iowa City Hospice may disclose your health information prior to and in reasonable anticipation, of your death.
• For Organ, Eye or Tissue Donation
  Iowa City Hospice 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.
• For Research Purposes
  Iowa City Hospice may, under very select circumstances, use your health information for research. Before Iowa City Hospice discloses any of your health information for such research purposes, the project will be subject to an extensive approval process. Iowa City Hospice will ask your permission if any researcher will be granted access to your individually identifiable health information.
• In the Event of a Serious Threat to Health or Safety
  Iowa City Hospice may, consistent with applicable law and ethical standards of conduct, disclose your health information if the Iowa City 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.
• For Specified Government Functions
  In certain circumstances, the Federal regulations authorize Iowa City Hospice 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
  Iowa City Hospice may release your health information for worker’s compensation or similar programs.

Authorization To Use Or Disclose Health Information

Other than is stated above, Iowa City Hospice will not disclose your health information other than with your written authorization. If you or your representative authorizes Iowa City 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 Iowa City Hospice 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 the Iowa City Hospice’s disclosure of your health information to someone who is involved in your care or the payment of your care. However, Iowa City Hospice is not required to agree to your request. If you wish to make a request for restrictions, please contact a member of the Interdisciplinary Team.
• Right to receive confidential communications
  You have the right to request that Iowa City Hospice communicate with you in a certain way. For example, you may ask that Iowa City 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 a member of the Interdisciplinary Team. Iowa City Hospice 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 319-351-5665. If you request a copy of your health information, Iowa City Hospice may charge a reasonable fee for copying and assembling costs associated with your request.
• Right to amend health care information
  If you or your representative believes that your health information records are incorrect or incomplete, you may request that Iowa City Hospice amend the records. A request for an amendment of records must be made in writing to the Executive Director. Iowa City Hospice 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 Iowa City Hospice, if the records you are requesting are not part of the Iowa City 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 Iowa City 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 Iowa City Hospice for any reason other than for treatment, payment or health operations. The request for an accounting must be made in writing to the Compliance Officer. The request should specify the time period for the accounting starting on April 14, 2003. Accounting requests may not be made for periods of time in excess of six years. Iowa City Hospice 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 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. To obtain a separate paper copy, please contact 319-351-5665.

Duties Of Iowa City Hospice

Iowa City 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. Iowa City Hospice is required to abide by terms of this Notice as may be amended from time to time. Iowa City Hospice 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 Iowa City Hospice changes its Notice, Iowa City Hospice 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 Iowa City Hospice and to the Secretary of Health and Human Services if you or your representative believes that your privacy rights have been violated. Any complaints to Iowa City Hospice should be made in writing to the Executive Director. Iowa City 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

If you have any questions about this notice, please contact us:

Privacy/Compliance Officer
Iowa City Hospice
1025 Wade Street
Iowa City, IA 52240

Phone: 319-351-5665
Email: info@iowacityhospice.org

This Notice is effective April 14, 2003.