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.  IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE PLEASE CONTACT OUR AGENCY.

YOUR RIGHTS
When it comes to your health information you have certain patient rights.  This section explains your rights and some of our responsibilities to help you.

PROCESS TO RECEIVE AN ELECTRONIC OR PAPER COPY OF YOUR MEDICAL RECORD
You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you by contacting our office and signing a release form.

We will provide a copy or a summary of your health information, usually within 30 days of your request.

PROCESS TO REQUEST AN AMENDMENT TO YOUR MEDICAL RECORD

  • You have the right to make a request to your physician to amend your protected health information.
  • In certain cases, we may deny your request for an amendment.
  • Should your request be denied you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and provide you a copy with such rebuttal.
  • Please contact our Privacy Officer if you have any questions amending your medical record.

PROCESS TO REQUEST CONFIDENTIAL COMMUNICATION

  • You have the right to request to receive confidential communications from us by alternative means or at an alternative location.
  • We will not request an explanation from you as to the basis for the request.
  • Please make this request in writing and or by email to our Privacy Officer.

ASK US TO “LIMIT” WHAT WE USE OR SHARE

  • You have the right to request a restriction of your protected health information.
  • You may request us not to use, share, or disclose certain health information for treatment, payment, or health care operations.
  • You may also request that any part of your protected health information not be disclosed to family members and or friends who may be involved in your care for notification purposes as described in this Notice of Privacy Practices.
  • We are not required to agree to your request, and we may say “no” if it may affect your care.
  • If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer.  We will say “yes” unless a law requires us to share that information.

GET A LIST OF THOSE WITH WHOM WE’VE SHARED INFORMATION

  • You have the right to receive an accounting (list) of certain disclosures we have made, if any, of your protected health information.
  • We will include all the disclosures except for those about treatment, payment, and health care operations, as described in this Notice of Privacy Practices.
  • It excludes disclosures we may have made to you if you authorized us to make the disclosure for a facility directory, to family members or friends involved in your care.

GET A COPY OF THIS PRIVACY NOTICE
You may ask for a printed paper copy of this Notice of Privacy Practices at any time, even if you have agreed to receive the notice electronically.

CHOOSE SOMEONE TO ACT FOR YOU
If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.

We will make sure the person has this authority and can act for you before we take any action.

FILE A COMPLAINT IF YOU FEEL YOUR RIGHTS ARE VIOLATED
You may complain if you feel we have violated your rights by contacting our office and our Privacy Officer.

You may file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to:
200 Independence Avenue, S.W.
Washington, D.C. 20201
calling 1-877-696-6775, or visiting hhs.gov/ocr/privacy/hipaa/complaints/.
We will not retaliate against you for filing a complaint.

YOUR CHOICES
FOR CERTAIN HEALTH INFORMATION, YOU CAN TELL US YOUR CHOICES ABOUT WHAT WE SHARE.

If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

IN THESE CASES, YOU HAVE BOTH THE RIGHT AND CHOICE TO TELL US TO:

  • Share information with your family, close friends, or others involved in your care
  • Share information in a disaster relief situation
  • Contact you for fundraising efforts

If you are not able to tell us your preference, for example, if you are unconscious, we may go ahead and share your information if we believe it is in your best interest.

We may also share your information when needed to lessen a serious and imminent threat to health or safety.

IN THESE CASES, WE NEVER SHARE YOUR INFORMATION UNLESS YOU GIVE US WRITTEN PERMISSION:

  • Marketing purposes
  • Sale of your information
  • Most sharing of psychotherapy notes

IN THE CASE OF FUNDRAISING
We may contact you for fundraising efforts, but you can tell us not to contact you again.

OUR USES AND DISCLOSURES

HOW DO WE TYPICALLY USE OR SHARE YOUR HEALTH INFORMATION?
We typically use or share your health information in the following ways.

TO TREAT YOU
We can use your health information and share it with other professionals who are treating you. Example: A doctor treating you for an injury asks another doctor about your overall health condition.

TO RUN OUR ORGANIZATION
We can use and share your health information to provide our services, improve your care, and contact you when necessary. Example: We use health information about you to manage your treatment and services.

TO BILL FOR YOUR SERVICES
We can use and share your health information to bill and get payment from health plans or other entities. Example: We give information about you to your health insurance plan so it will pay for your services.

HOW ELSE CAN WE USE OR SHARE YOUR HEALTH INFORMATION?
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research.

WE MUST MEET MANY CONDITIONS IN THE LAW BEFORE WE CAN SHARE YOUR INFORMATION FOR THESE PURPOSES.

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html

HELP WITH PUBLIC HEALTH AND SAFETY ISSUES
We can share health information about you for certain situations such as:

  • Preventing disease
  • Helping with product recalls
  • Reporting adverse reactions to medications
  • Reporting suspected abuse, neglect, or domestic violence
  • Preventing or reducing a serious threat to anyone’s health or safety

DO RESEARCH
We can use or share your information for health research.

COMPLY WITH THE LAW
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

RESPOND TO ORGAN AND TISSUE DONATION REQUESTS
We can share health information about you with organ procurement organizations.

WORK WITH A MEDICAL EXAMINER OR FUNERAL DIRECTOR
We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

ADDRESS WORKERS’ COMPENSATION, LAW ENFORCEMENT, AND OTHER GOVERNMENT REQUESTS

We can use or share health information about you:

  • For law enforcement purposes or with a law enforcement official
  • With health oversight agencies for activities authorized by law
  • For special government functions, such as military, national security, and presidential protective services.For workers’ compensation claims

RESPOND TO LAWSUITS AND LEGAL ACTIONS
We can share health information about you in response to a court or administrative order, or in response to a subpoena.

OUR RESPONSIBILITIES:
We are required by law to maintain the privacy and security of your protected health information.

We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

We must follow the duties and privacy practices described in this notice and give you a copy of it.

We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Please contact our office and or our Privacy Officer to let us know in writing if and when you change your mind.

For more information visit: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

CHANGES TO THE TERMS OF THIS NOTICE:

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.

THIS NOTICE OF PRIVACY PRACTICES APPLIES TO BUENA VIDA HOSPICE AND PALLIATIVE CARE SERVICES ACROSS TEXAS AND THE UNITED STATES.

Contact Information:
Buena Vida Hospice
810 Hwy. 6 South Ste. 102
Houston, Tx 77079

Office: (281) 888-1499
Fax: (346) 204-4455
Email: admin@buenavidahospice.com