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
HCI Care Services may use your health information for purposes of:

• Providing you treatment
• Obtaining payment for your care
• Conducting health care operations
• The following are examples of times under which your health information may be used or disclosed after you sign the written consent.

For Treatment
To coordinate care within HCI Care Services. This includes sharing your health information with your attending physician, the interdisciplinary group and other health care professionals who assist HCI Care Services in providing your care. HCI Care Services may also share your health information with individuals outside of HCI Care Services such as family members, clergy whom you designate, pharmacists, medical equipment suppliers and other health care professionals who are used in the coordination of your care.

To Obtain Payment
HCI Care Services may include your health information in invoices to insurers (private insurance, Medicare and/or Medicaid) to collect payment for services you have received. HCI Care Services may need prior approval from your insurer and may need to explain to them your need for hospice care and the services that will be provided to you.

To Conduct Health Care Operations
HCI Care Services may use and disclose your health information for our own operations and as necessary to provide quality care to all of HCI Care Services’ patients. These include functions like: quality improvement activities, protocol development, professional review and performance evaluation, training programs for students, accreditation, licensing, medical review, legal services, business planning, cost management, administrative activities of HCI Care Services, fundraising for the benefit of HCI Care Services and certain marketing activities (unless you tell us you do not want to be contacted).

If you are a patient at one of the Kavanagh Houses, certain information about you (name, general health status, religious affiliation, and room number) may be disclosed while you are receiving care in that facility. HCI Care Services may disclose this information to people who ask for you by name. Please inform us if you do not want this information disclosed.

For Fund Raising
HCI Care Services may use information about you (name, address, phone number, and dates of care) to contact you or your family to raise money for HCI Care Services. This information may be released to HCI Care Services’ Foundation. If you do not want HCI Care Services to contact you or your family, notify the Development Director at 515-271-1309 and indicate that you do not wish to be contacted.

For Marketing
HCI Care Services may send to you or your family members event notifications and newsletters informing you of HCI Care Services activities. If any personal health information and/or photos are to be included in this material, HCI Care Services will obtain an authorization from you before using your information/photos.

When Legally Required
HCI Care Services will disclose your health information when it is required to do so by any Federal, State or local laws. HCI Care Services may release your health information in response to a court order or other valid legal processes. In addition, HCI Care Services may release your health information to identify or locate a missing person, fugitive or suspect, if HCI Care Services suspects your death was the result of criminal conduct, in order to report a crime or when you are the victim of a crime

When There Are Risks to Public Health
HCI Care Services may disclose your health information for public health activities such as:  prevention or controlling a disease, reporting death, reporting of adverse events or product defects. HCI Care Services may disclose your health information, in good faith, if we believe that such disclosure is needed to prevent an imminent threat to your health or safety or to the health and safety of the public.

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

To Coroners and Medical Examiners
HCI Care Services 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
If necessary to carry out their duties with respect to your funeral arrangements.

For Organ, Eye or Tissue Donation
To organ procurement organizations or those involved in procuring, banking or transplanting to comply with patient or family wishes.
 
For Research Purposes
Before HCI Care Services discloses any of your health information for research purposes; the project will be subject to an extensive approval process. HCI Care Services will ask your permission if any researcher will be granted access to your individually identifiable health information.

For Worker’s Compensation
HCI Care Services may release your health information to worker’s compensation or similar programs.

Your Rights with Respect to Your Health Information
You have the following rights regarding your health information that HCI Care Services maintains:

Right to Request Restriction
You may request restrictions to certain uses and disclosures of your health information. You may request a limit on HCI Care Services’ disclosure of your health information to someone involved in your care or in the payment of your care. HCI Care Services is not required to agree to your request. If you wish to make a request for restriction, please contact the Privacy Officer at 515-333-4253.

Right to Receive Confidential Communications
You may request that HCI Care Services communicate with you in a certain way. For example, you can request that HCI Care Services communicate health information to you privately with no family members present. If you wish to receive confidential communications in an alternative manner, please contact the Privacy Officer at 515-333-4253. HCI Care Services will not request that you provide any reasons for your request and will attempt to honor your reasonable request for confidential communications.

Right to Inspect and Copy Your Health Information
A request to inspect and copy your health records or your billing records may be made to the Privacy Officer at 515-333-4253. If you request a copy of your health information, HCI Care Services may charge a reasonable fee for copying and assembling costs associated with your request.

Right to Amend Health Care Information:
If you or your personal representative believes that your health records are incorrect or incomplete, you may request that HCI Care Services amend the record. This request applies to information maintained by HCI Care Services. A request for amendment must be made in writing to the Privacy Officer at 515-333-4253. HCI Care Services may deny the request if it is not in writing or does not include a reason for the amendment. The request may also be denied if your records were not created by HCI Care Services or are not a part of HCI Care Services’ records, if the health information you wish to amend is not part of the health information you are permitted to inspect and copy, or if in the opinion of HCI Care Services, the records containing your health information are accurate and complete.

Right to an Accounting:
You or your personal representative may request an accounting of disclosures of your health information made by HCI Care Services for any reason other that for treatment, payment or health operations. The request must be made in writing to the Privacy Officer. The request must include the time period for the accounting starting no sooner than April 14, 2003. Accounting requests may not be made for periods of time in excess of six years. HCI Care Services will provide the first accounting during any 12-month period without charge. Subsequent accounting requests are subject to a reasonable cost-based fee.

Right to a Paper Copy of this Notice:
You or your personal representative has a right to a separate paper copy of this notice at any time even if you or your representative received this notice previously. To obtain a separate paper copy, please contact the Privacy Officer at 515-333-4253.

Duties of HCI Care Services
HCI Care Services is required by law to maintain the privacy of your health information and to provide to you and your personal representative this notice of its duties and privacy practices. HCI Care Services is required to abide by the terms of this notice as may be amended from time to time. HCI Care Services reserves the right to change the terms of its notice to make the new notice provisions effective for all health information that its maintains. If HCI Care Services changes its notice, HCI Care Services will provide a copy of the revised notice on their web site or by request to the Privacy Officer at 515-333-4253. You or your personal representative has the right to express complaints to HCI Care Services and to the Secretary of Health and Human Services if you believe that your privacy rights have been violated. Any complaint to HCI Care Services should be made in writing to the Privacy Officer. HCI Care Services encourages you to express any concerns you may have regarding privacy of your information. You will not be retaliated against in any way for filing a complaint.

Contact Person
HCI Care Services’ contact person for all issues regarding patient privacy and your rights under the State and Federal Privacy Standards is:  Privacy Officer, HCI Care Services, 2910 Westown Parkway, Suite 200, West Des Moines, Iowa 50266-1332     515-333-4253