USE AND DISCLOSURE OF HEALTH INFORMATION
Delaware 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. Delaware Hospice has established a policy to guard against unnecessary disclosure of your health information.

To Provide Treatment.
Delaware Hospice may use your health information to coordinate care within Delaware Hospice and with others involved in your care, such as your attending physician, members of Delaware Hospice interdisciplinary team and other health care professionals who have agreed to assist Delaware Hospice in coordinating care. For example, physicians involved in your care will need information about your symptoms in order to prescribe appropriate medications. Delaware Hospice also may disclose your health care information to individuals outside of Delaware Hospice involved in your care including family members, pharmacists, suppliers of medical equipment or other health care professionals.

To Obtain Payment.
Delaware Hospice may include your health information in invoices to collect payment from third parties for the care you may receive from Delaware Hospice. For example, Delaware Hospice may be required by your health insurer to provide information regarding your health care status so that the insurer will reimburse you or Delaware Hospice. Delaware Hospice 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.
Delaware Hospice may use and disclose health care information for its own operations in order to facilitate the function of Delaware Hospice and as necessary to provide quality care to all of Delaware 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 Delaware Hospice.
• Fundraising for the benefit of Delaware Hospice.

For example Delaware Hospice 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 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 as part of general fundraising and community information mailings (unless you tell us you do not want to be contacted).

For Fundraising Activities.
Delaware Hospice may use information about you and your family including your name, address, phone number and the dates you received care at Delaware Hospice in order to contact you to raise money for Delaware Hospice. Delaware Hospice may also release this information to a related Hospice foundation. If you do not want Delaware Hospice to contact you or your family, notify the Performance Improvement Coordinator (302) 478-5707 and indicate that you do not wish to be contacted.

For Appointment Reminders.
Delaware Hospice 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.
The Hospice 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.
Delaware Hospice 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.
Delaware 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.
• 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.
Delaware Hospice is allowed to notify government authorities if Delaware Hospice believes a patient is the victim of abuse, neglect or domestic violence. Delaware 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.
Delaware Hospice may disclose your health information to a health oversight agency for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action. Delaware 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.
Delaware Hospice 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 Delaware Hospice 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 by state law, Delaware Hospice 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 Delaware Hospice has a suspicion that your death was the result of criminal conduct including criminal conduct at Delaware Hospice.
• In an emergency in order to report a crime.

To Coroners And Medical Examiners.
Delaware 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.
Delaware 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, Delaware Hospice may disclose your health information prior to and in reasonable anticipation, of your death.

For Organ, Eye Or Tissue Donation.
Delaware 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.
Delaware Hospice may, under very select circumstances, use your health information for research. Before Delaware Hospice discloses any of your health information for such research purposes, the project will be subject to an extensive approval process.

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

• 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 Delaware Hospice's disclosure of your health information to someone who is involved in your care or the payment of your care. However, Delaware Hospice is not required to agree to your request. If you wish to make a request for restrictions, please contact the Administrative Office.
  
  
• Right to receive confidential communications. You have the right to request that Delaware Hospice communicate with you in a certain way. For example, you may ask that Delaware 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 Administrative Office. Delaware 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 the Medical Records Office. If you request a copy of your health information, Delaware Hospice 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 the Hospice 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 Delaware Hospice. A request for an amendment of records must be made in writing to the Medical Records Office. Delaware 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 Delaware Hospice, if the records you are requesting are not part of Delaware 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 Delaware 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 Delaware Hospice 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 Medical Records Office. 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. Delaware 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 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 Administrative Office. A copy of the current version of Delaware Hospice's Notice of privacy practices is also available at its website (www.delawarehospice.org).
  
  

NC-221 4/03