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HIPAA 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.
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Understanding the Type of Information We Have: We receive medical information about you when you begin services with us. It includes your name, date of birth, sex, insurance information and other personal information. We also receive enrollment information from your health insurers and medical information from your other health care providers. When we visit you in your home, we also collect information about your condition, diagnosis and treatment. |
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Our Privacy Commitment to You: We care about your privacy. The information we collect about you is private. We are required to give you a notice of our privacy practices. Only people who have both the need and the legal right may see your information. Unless you give us permission in writing,we will only disclose your information as listed below: |
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Treatment |
We may use or disclose medical information about you to provide and coordinate your health care. For example, we may notify your regular doctor about changes in your health care status. |
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Payment |
We may use and disclose information so the care you are given can be properly billed and paid for. For example, we may be required for payment purposes to send your health insurer information that explains the physician ordered services we provided you. |
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Exceptions |
For certain kinds of records, your permission may be needed for release for treatment and/or payment. |
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As Required By Law and for Other Government Functions |
We will release information when we are required by law to do so or for other government functions. Examples of such releases would be for law enforcement or national security purposes, subpoenas or other court orders, communicable disease reporting, disaster relief, review of our activities by government agencies, to avert a serious threat to health or safety or in other kinds of emergencies. |
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Public Health
and Safety |
We may use or disclose information about you as required to prevent or reduce a serious threat to the health or safety of a person or the public.
For example, we may disclose information about immunizations and certain diseases to public health officials. |
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Family and Friends |
We may disclose your information to family members, friends or others that you identify in writing. |
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After Death |
We may disclose your information as required by coroners or medical examiners and funeral homes after you are deceased. |
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With Your Permission |
If you give us permission in writing, we may use and disclose your personal information for purposes you list. If you give us permission, you have the right to change your mind and revoke it. This must be in writing, too. We cannot take back any uses or disclosures already made with
your permission. |
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Our use and disclosure of your personal health information must comply not only with federal privacy regulations but also with applicable Oregon law. Oregon law provides certain additional protections to your personal health information. |
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Your Privacy Rights:
You have the following rights regarding the health information that we have about you.
Your requests must be made in writing to us at Central Oregon Home Health and Hospice | System Privacy Officer | 2698 NE Courtney Dr | Suite 101 | Bend, Oregon 97701 |
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Your Right
to Inspect
and Copy |
In most cases, you have the right to look at or get copies of your health records. You may be charged a fee to cover the cost of copying your records. (You may need to make an appointment to look at your records to assure that we will have it available for you.) |
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Your Right
to Amend |
You may ask us to change your records if you feel that there is
a mistake. We can deny your request for certain reasons, but we
must give you a written reason for our denial. |
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Your Right
to a List Of Disclosures |
You have the right to ask for a list of certain disclosures made after April 14, 2003. This list will not include the times that information was disclosed for treatment, payment, or health care operations. The list will not include information provided directly to you or your family, or information that was sent with your permission. It will not include information released without your name or other data that would identify you. |
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Your Right
to Request Restrictions
on Our Use
or Disclosure
of Information |
You can ask for limits on how your information is used or disclosed. We are not required to agree to such requests, but can if we believe it is reasonable to do so. |
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Your Right
to Request Confidential Communications |
You have the right to ask that we share information with you in
a certain way or in a certain place. For example, you may ask us
to send information to an alternate address instead of your home address. We will do our best to accommodate such a request. |
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Changes to this notice: We reserve the right to revise this notice. A revised notice will be effective for medical information we already have about you as well as any information we may receive in the future. We are required by law to comply with whatever notice is currently in effect. Any changes to our notice will be published on our web site. Go to www.cohhh.org. If the changes are material, a new notice will be given to you by our hospice staff before it
takes effect. |
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How to Use
Your Rights Under This Notice |
If you want to use your rights under this notice, you may call us or write to us at:
Central Oregon Home Health and Hospice | System Privacy Officer | 2698 NE Courtney Dr | Suite 101 | Bend, Oregon 97701 | (541) 382-5882
As your request to us must be in writing, we will help you prepare your written request, if you wish. |
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Complaints and Communications to Us |
If you want to exercise your rights under this notice or if you wish
to communicate with us about privacy issues or if you wish to file
a complaint, you can call us at (541) 382-5882 or write to:
Central Oregon Home Health and Hospice | System Privacy Officer | 2698 NE Courtney Dr | Suite 101 | Bend, Oregon 97701
You will not be penalized for filing a complaint. |
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Complaints
to the Federal Government |
If you believe that your privacy rights have been violated, you have the right to file a complaint with the federal government. You may write to:
Region X—Seattle (Alaska, Idaho, Oregon, Washington)
Linda Yuu Connor–Deputy Regional Manager | Office for Civil Rights
U.S. Department of Health and Human Services
2201 Sixth Ave | Mail Stop RX-11 | Seattle, WA 98121-1831
Voice Phone (206) 615-2290 | Toll Free (800) 368-1019
FAX (206) 615-2297 | TDY (206) 615-2296
You will not be penalized for filing a complaint with the federal government. |
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Additional Information |
More detailed versions of this notice can be found at our website at www.cohhh.org or by calling (541) 382-5882. You have the right to receive additional copies of the detailed notice at any time by contacting us. |
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This notice is available in other languages and alternate formats that meet
the guidelines for the Americans with Disabilities Act (ADA).
Esta notificación está disponible en otras lenguas y formatos diferentes que
satisfacen las normas del Acta de Americans with Disabilities (ADA). |
HH–H_HIPAANoticePriv_1-9-07 | App LD | P | ãCOHHH 2007. All Rights Reserved.