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THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
INTEGRIS Hospice of Oklahoma County, Inc. ("Hospice of Oklahoma County")
is required to maintain the privacy of your health information and provide you
with a notice of its legal duties and privacy practices. We call this information
"protected health information" or "PHI" for short. Hospice
of Oklahoma County and the individual members of its professional staff constitute
an organized health care arrangement ("OHCA") and have agreed to provide
you with one joint notice that explains how, when and why we use and disclose
your PHI. It is noted that independent members of the professional staffs are
neither employees nor agents of Hospice of Oklahoma County/INTEGRIS Health,
but are joined under this notice for the convenience of explaining how, when
and why we use and disclose your PHI. We will not use or disclose your PHI except
as described in this notice. With some exceptions, we may not use or disclose
any more of your PHI than is necessary to accomplish the purpose of the use
or disclosure. This notice applies to all PHI generated or maintained by us
at the listed facilities.
TREATMENT, PAYMENT & HEALTH CARE OPERATIONS.
- Treatment:
- We may use your PHI to provide you with medical treatment and services.
We may disclose your PHI to physicians, nurses, technicians, medical students,
and other health care personnel who need to know your PHI for your care
and continued treatment. Hospital departments within the INTEGRIS Health
network may share your PHI in order to coordinate services, such as prescriptions,
lab work, x-rays and other services. For example, your physician/hospice
nurse may need to tell the dietitian if you have diabetes so we can arrange
appropriate care to meet your needs. We may use and disclose your PHI
to tell you about or arrange for possible treatment options for your continued
care if you revoke hospice services, such as rehabilitation, home care
or nursing home services, family members, clergy or others.
- Payment:
- We may use and disclose your PHI for the purpose of determining coverage,
billing, collections, claims management, medical data processing, and
reimbursement. PHI may be released to an insurance company, third party
payer or other entity (or their authorized representatives) involved in
the payment of your medical bill and may include copies or excerpts of
your medical record that are necessary for payment of your account. For
example, a bill sent to a third party payer may include information identifying
you, your diagnosis, and procedures and supplies used. We may also tell
your health plan about a treatment you are going to receive to obtain
prior approval or determine whether your plan will cover the treatment.
- Routine Healthcare Operations:
- We may use and disclose your PHI during routine healthcare operations.
These uses and disclosures are necessary to run the hospice program and
make sure our patients receive quality care. Common examples include conducting
quality assurance, utilization review, medical review, internal auditing,
accreditation, certification, licensing, credentialing, medical research,
training and education. For example, we may use your PHI to contact you
for the purpose of conducting patient satisfaction services or we may
disclose your PHI to a pharmaceutical company in assessing your eligibility
for pharmaceutical assistance programs.
SPECIAL CIRCUMSTANCES.
- Emergencies:
- Your authorization is not required if you need emergency treatment.
We will try to get your authorization as soon as practicable after the
emergency.
- Communicable diseases:
- Authorization of such release may include information which may be considered
a communicable or venereal disease in nature to include, but not limited
to, such diseases as hepatitis, syphilis, gonorrhea and the human immunodeficiency
virus, also known as acquired immune deficiency syndrome (AIDS).
- Mental Health/Substance Abuse:
- In certain circumstances, we may not disclose your PHI, including psychotherapy
notes, to you without the written consent of your physician or to others
without your written authorization or a court order.
OTHER USES AND DISCLOSURES.
- Family/Friends:
- Unless you object, orally or in writing, we may disclose your PHI to
a friend or family member who is involved in your medical care or who
helps pay for your care. We may also tell your family or friends your
condition and that you are enrolled in the hospice program. We may disclose
your PHI to an entity assisting in a disaster relief effort so that your
family can be notified about your condition, status and location. If you
are unable or unavailable to agree or object, we will use our best judgment
in communicating with your family and others.
- Inpatient Hospital Directories/Clergy:
- Unless you object, orally or in writing, we may include certain limited
information about you in a hospital directory while you are a patient
of Hospice of Oklahoma County and admitted to a hospital or a long term
care facility (such as, but not limited to nursing homes or assisted living
center) as directed by your physician. This information may include your
name, location in the hospital or long term care facility, your general
condition (e.g., fair, stable, etc.) and your religious affiliation. This
is so your family and friends can visit you and generally know how you
are doing. The directory information, except for your religious affiliation,
may also be released to people who ask for you by name. Your religious
affiliation may be given to a member of the clergy, such as a priest or
rabbi, even if they do not ask for you by name.
- Appointment Reminders:
- We may use and disclose your PHI to contact you as a reminder that you
have an appointment for treatment or medical care. This may be done through
an automated system or by one of our staff members. If you are not home,
we may leave a message on an answering machine or with the person answering
the telephone.
- Health Related Business and Services:
- We may use and disclose your PHI to tell you of health-related benefits/services
of interest to you.
- Business Associates:
- We may disclose your PHI to business associates with whom we contract
to provide services on our behalf. Examples of business associates, include,
copy services used to copy medical records, consultants, accountants,
lawyers, durable medical suppliers (DME) and third-party billing companies.
We will only make these disclosures if we have received satisfactory assurance
that the business associate will properly safeguard your PHI.
- Research:
- Under certain circumstances, we may use and disclose your PHI to researchers
whose clinical research studies have been approved by an Institutional Review
Board ("IRB"). While most clinical research studies require patient
consent, there are some instances where your PHI may be used or disclosed
pursuant to IRB waiver or as allowed by law. For example, a research project
may involve comparing the health and recovery of all patients with the same
medical condition who received one medication to those who received another.
PHI may be disclosed to researchers preparing to conduct a research study,
for example, to help them look for patients with specific medical needs,
so long as the PHI they review does not leave the hospital. PHI regarding
people who have died may be disclosed without authorization in certain circumstances.
- Marketing:
- We may use your PHI to provide marketing materials you. For example,
we may utilize your photo or image to raise money for indigent care.
- Fundraising:
- We may use and disclose your PHI to raise funds for Hospice of Oklahoma
County and its operations. We may disclose certain PHI to a foundation
related to INTEGRIS Health or Hospice of Oklahoma County so that it may
contact you to raise funds. If you do not want to be contacted for fundraising
efforts, you must notify the President of INTEGRIS Health Foundation,
3433 N.W. 56th Street, Oklahoma, City, OK, 73112, in writing.
- Workers Compensation:
- We may disclose your PHI for workers' compensation or similar programs
in order to comply with workers' compensation and similar laws.
- Other Uses:
- We must obtain a separate authorization from you to use or disclose
your PHI for situations not described in this Notice.
SPECIAL SITUATIONS.
- Organ Procurement Organizations:
- If you are an organ donor, we may disclose your PHI to organ procurement
organizations and other entities engaged in the procurement, banking or
transplantation of organs for the purpose of tissue donation and transplant
to assist them in organ, or tissue donations and transplants.
- Regulatory Agencies:
- We may disclose your PHI to a health oversight agency for activities
authorized by law, including, but not limited to, licensure, certification,
audits, investigations, inspections and medical device reporting. We may
provide your PHI to assist the government when it conducts an investigation
or inspection of a healthcare provider or organization.
- Law Enforcement:
- We may disclose your PHI if asked to do so by law enforcement official:
- (i) in response to a court order, warrant, summons or other similar
process;
- (ii) to identify or locate a suspect, fugitive, material witness,
or missing person;
- (iii) about the victim of a crime, if under limited circumstances,
we are unable to obtain the person's agreement;
- (iv) about a death we believe may be the result of criminal conduct;
- (v) about criminal conduct at the hospital; and
- (vi) in emergency circumstances to report a crime; the location
of a crime or victims, or the identity, description or location of
the person who committed the crime.
- Lawsuits and Disputes:
- If you are involved in a lawsuit or dispute, we may disclose your PHI
in response to a valid court or administrative order. In limited circumstances,
we may disclose PHI in response to a subpoena, discovery request or other
lawful process, but only if efforts have been made to inform you about the
request or to obtain an order protecting the information requested.
- Public Health:
- As required by law, we may disclose your PHI to public health or legal
authorities charged with preventing or controlling disease, injury or
disability. For example, we are required to report births, deaths, birth
defects, abuse, abortions, tumors, reactions to medications, device recalls,
and various diseases and/or infections to government agencies in charge
of collecting that information.
- Judicial and Administrative Proceedings.
- We may disclose your PHI in the course of any administrative or judicial
proceeding.
- Specific Government Functions.
- We may disclose your PHI to military personnel and veterans in certain
situations. We may disclose your PHI for national security purposes, such
as protecting the president of the United States or conducting intelligence
operations.
- Military/Veterans:
- We may disclose your PHI as required by military command authorities,
if you are a member of the armed forces.
- Inmates:
- If you are an inmate of a correctional institute or under the custody
of a law enforcement officer, we may release your PHI to the correctional
institute or law enforcement official.
- To Avoid Harm:
- In order to avoid a serious threat to the health and safety of a person
or the public, we may disclose PHI to law enforcement personnel or persons
able to prevent or lessen such harm. We may notify a person who may have
been exposed to a disease or may be at risk for contracting or spreading
a disease or condition as ordered by public health authorities or allowed
by state law.
- Required by Law:
- We will disclose your PHI when required to do so by federal, state or
law. For example, we are required to report criminally injurious conduct
.
- Coroners, Medical Examiners, Funeral Directors:
- We may release your PHI to a coroner or medical examiner. This may be
necessary, for example, to identify a deceased person or to determine
a cause of death. We may also release your PHI to funeral directors as
necessary to carry out their duties.
THE INFORMATION AUTHORIZED FOR RELEASE MAY INCLUDE RECORDS WHICH MAY
INDICATE THE PRESENCE OF A COMMUNICABLE OR VENEREAL DISEASE WHICH MAY INCLUDE,
BUT ARE NOT LIMITED TO, DISEASES SUCH AS HEPATITIS, SYPHILIS, GONORRHEA AND
THE HUMAN IMMUNO-DEFICIENCY VIRUS, ALSO KNOWN AS ACQUIRED IMMUNE DEFICIENCY
SYNDROME (AIDS).
PATIENT HEALTH INFORMATION RIGHTS:
Although all records concerning your hospitalization and treatment at an INTEGRIS
facility or while under the care of Hospice of Oklahoma County are the property
of INTEGRIS Health, you have the following rights concerning your PHI.
Right to Confidential Communications:
You have the right to receive confidential communications of your PHI by alternative
means or at alternative locations. For example, you may request that we only
contact you at work or by mail. You must submit your request in writing and
identify how or where you wish to be contacted. We will accommodate all reasonable
requests.
Right to Inspect and Copy:
You have the right to inspect and copy your PHI as provided by law. This right
does not apply to psychotherapy notes. A request must be made in writing. We
have the right to charge you the amounts allowed by state or federal law for
such copies. We may deny your request to inspect and copy in certain circumstances.
If you are denied access, you may requested that the denial be reviewed. A licensed
healthcare professional chosen by us will review your request and the denial.
The person conducting the review will not the be person who denied your request.
We will comply with the outcome of the review.
Right to Amend:
If you feel that the PHI we have about you is incorrect or incomplete, you
have the right to request an amendment of your PHI. You must submit your request
in writing and state the reason(s) for the amendment. We may deny your request
for an amendment if it is not in writing, does not include a reason to support
the request; or the information
(i) was not created by us (unless the person or entity that created the information
is not available to make the amendment;
(ii) is not part of the medical record that we maintain;
(iii) is not part of the information that you would be permitted to inspect
or copy; or
(iv) is accurate and complete.
Right to an Accounting:
You have the right to obtain a statement of certain disclosures of your PHI
to third parties, except those disclosures made for treatment, payment or healthcare
operations or authorized pursuant to this Notice. To request this list, you
must submit your request in writing and state a time period no longer than six
(6) months which may not include dates prior to April 14, 2003. If you request
more than one (1) accounting in a 12-month period, we may charge you for the
costs of providing the list. We will notify you of the cost involved and you
may choose to modify or withdraw your request before any costs are incurred.
Right to Request Restrictions:
You have the right to request restrictions or limitations on PHI we use or
disclose about you unless our use or disclosure is required by law. We are not
required to honor your request. To request restrictions, you must make your
request in writing and tell us
(i) what information you want to limit;
(ii) whether you want to limit our use, disclosure or both; and
(iii) to whom you want the limits to apply. If we agree, we will comply with
your request unless the information is needed to provide emergency treatment
to you.
Right to Receive Copy of this Notice:
You have the right to a paper copy of this notice. If you have received this
notice in electronic form and would like a paper copy, please contact the INTEGRIS
Privacy Security Officer at the number listed below. You may obtain a copy at
our website: www.integris-health.com or www.hospiceokcounty.com
.
Right to Revoke Authorization:
You have the right to revoke your authorization to use or disclose your PHI,
EXCEPT to the extent that action has already been taken by us in reliance on
your authorization.
FOR MORE INFORMATION OR TO REPORT A PROBLEM:
If you have questions and would like additional information, you may contact
the INTEGRIS Privacy/Security Officer. If you believe your privacy rights have
been violated, you may file a complaint with (i) INTEGRIS by contacting the
INTEGRIS Privacy/Security Officer; or (ii) the Secretary of the Department of
Health and Human Services. To file a complaint with DHHS the address is 200
Independence Avenue, S.W., Washington, D.C. 20201, HHS.Mail@hhs.gov. All complaints
must be in writing and filed within 180 days of when you knew or should have
known that the act or omission complained of occurred. You will not be penalized
for filing a complaint.
CHANGES TO THIS NOTICE: We will abide by the terms of the
notice currently in effect. We reserve the right to change the terms of its
notice and to make the new notice provisions effective for all PHI we maintain.
OWNERSHIP CHANGE. In the event that an INTEGRIS hospital/facility
is sold or merged with another organization, your PHI may become property of
the new owner.
NOTICE EFFECTIVE DATE: April 14, 2003.
CONTACT: INTEGRIS Privacy/Security Officer (405) 951-2450.
INTEGRIS HOSPITALS/FACILITIES/SERVICES related to Hospice
of Oklahoma County, Inc.:
INTEGRIS Baptist Medical Center
3300 Northwest Expressway
Oklahoma City, Oklahoma 73112
INTEGRIS Canadian Valley Regional Hospital
1201 Health Center Parkway
Yukon, Oklahoma 73099
INTEGRIS Southwest Medical Center
4401 S. Western
Oklahoma City, Oklahoma 73109
INTEGRIS Samaritan Home Health Services
3500 Northwest 56th Street Suite 201
Oklahoma City, Oklahoma 73112
INTEGRIS Pro Health Plaza Pharmacy
3433 Northwest 56th Street Suite 140B
Oklahoma City, Oklahoma 73112
INTEGRIS Southwest Medical Center Plaza Pharmacy
4221 S. Western
Oklahoma City, Oklahoma 73109
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