NOTICE OF PRIVACY PRACTICES
The U S Department of Health and Human Services (HHS) Office for Civil Rights (OCR), enforces federal civil rights laws, conscience and religious freedom laws, the Health Insurance Portability and Accountability Act (HIPAA) Privacy Security, and Breach Notification Rules, and the Patient Safety Act Rule, which together protect your fundamental rights of non-discrimination, conscience, religious freedom, and health information privacy at covered entities.
HIPAA PRIVACY NOTICE: THIS PRIVACY 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.
INTRODUCTION:
When it comes to your health information, you have certain rights. The Privacy Notice is being provided to you on behalf of Azura Palliative Care and Hospice WI, LLC and the practitioners with clinical privileges that work with Azura Palliative Care and Hospice WI, LLC. Azura Palliative Care and Hospice WI, LLC , acknowledges that your medical information is private and confidential. Azura Palliative Care and Hospice WI, LLC is required by law to maintain the privacy of “protected health information.” “Protected Health Information” or “PHI” includes any individually identifiable information that we obtain from you or others that relates to your past, present or future physical or mental health, the health care you have received, or payment for your health care. Azura Palliative Care and Hospice WI, LLC may share protected health information with one another, as necessary, to carry out treatment, payment or health care operations relating to the hospice services to be rendered by Azura Palliative Care and Hospice WI, LLC.
As required by law, this notice provides you with information about your rights and Azura Palliative Care and Hospice WI, LLC’s legal duties and privacy practices with respect to the privacy of PHI. This notice also discusses the uses and disclosures we will make of your PHI. Azura Palliative Care and Hospice WI, LLC must comply with the provisions of this notice as currently in effect, although we reserve the right to change the terms of this notice from time to time and make revised notice available.
YOUR RIGHTS UNDER HIPAA:
- Ask us to limit the information we share
- Get a copy of the privacy notice
- Request Confidential Communication
- Get a copy of your paper or electronic medical record
- Get a list of those of whom we share your information
- Choose someone to act for you
- Correct your paper or electronic medical record
- Get a list of whom we have shared information with
- File a complaint if you believe your privacy rights have been violated:
Azura Palliative Care and Hospice WI, LLC
Attn: Privacy Officer
1233 North Mayfair Road, Ste 308
Milwaukee, WI 53226
Phone: 1 (414) 455-6800
U S Department of Health and Human Services Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 1 (877) 696-6775
Azura Palliative Care and Hospice WI, LLC will not retaliate against you for filing a complaint.
PERMITTED USES AND DISCLOSURES:
Azura Palliative Care and Hospice WI, LLC can use or disclose you PHI for purposes of treatment, payment and health care operations. For each of these categories of uses and disclosures, we have provided a description and an example below. However, not every use or disclosure in every category will be listed.
- Treatment: means the provision, coordination or management of your health care, including consultations between health care providers relating to your care and referrals for health care from one health care provider to another. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In addition, the doctor may need to contact a physical therapist to create the exercise regimen appropriate for your treatment.
- Health Care Operations: means our support functions, related to treatment and payment, such as quality assurance activities, case management, receiving and responding to patient comments and complaints, physician reviews, compliance programs, audits, business planning, development, management and administrative activities. For example, Azura Palliative Care and Hospice WI, LLC may need to use your PHI to evaluate the performance of our staff when caring for you. We may also combine PHI about many patients to decide what additional services we should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose PHI for review and learning purposes. In addition, Azura Palliative Care and Hospice WI, LLC may remove information that identifies you so that others can use the information for educational purposes without learning who you are.
- Payment: means the activities undertaken to obtain reimbursement for the health care provided to you, including billing, collections, claims management, determinations of eligibility and coverage and other utilization review activities. For example, Azura Palliative Care and Hospice WI, LLC may need to provide PHI to Third Party Payor to determine whether the proposed course of treatment will be covered or if necessary to obtain payment. Federal or state law may require Azura Palliative Care and Hospice WI, LLC to obtain written release from you prior to disclosing certain specifically protected PHI for payment purposes, and we will ask you to sign a release, when necessary, under applicable law.
- National Security and Intelligence Activities. Azura Palliative Care and Hospice WI, LLC may release PHI about you to authorized federal officials for intelligence, counterintelligence, other national security activities authorized by law or to authorized federal officials so they may provide protection to the President or foreign heads of state.
- Serious Threats. As permitted by applicable law and standards of ethical conduct, Azura Palliative Care and Hospice WI, LLC may use and disclose PHI is, in good faith, believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public or is necessary for law enforcement authorities to identify or apprehend an individual.
NOTE: Incidental uses and disclosures of PHI sometimes occur and ae not considered to be violations of your rights. Incidental uses and disclosures are by-products of otherwise permitted uses or disclosures which are limited in nature and cannot be reasonably prevented.
SPECIAL CIRCUMSTANCES: Subject to the requirements of applicable law, we will make the following uses and disclosures to your PHI:
- Help with public and health safety issues
- Work with Medical Examiner or Funeral Director
- Respond to lawsuits and legal actions
- Compliance with the Law
- Respond to organ and tissue donation requests
- To prevent or control disease, injury or disability;
- To report births or deaths;
- To report abuse or neglect;
- To persons’ subject to the jurisdiction of the Food and Drug Administration (FDA) for activities related to quality, safety, or effectiveness of FDA-regulated products or services and to report reactions to medications or problems with products;
- To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
- To notify the appropriate government authority if we believe that an adult patient has been the victim of abuse, neglect or domestic violence. Azura Palliative Care and Hospice WI, LLC, will only make the disclosure if the patient agrees or when required or authorized by law.
- Health Oversight Activities. Azura Palliative Care and Hospice WI, LLC may disclose PHI to federal or state agencies that oversee our activities (e.g., providing health care, seeking payment, and civil rights).
- Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose PHI subject to certain limitations.
- Law Enforcement. Azura Palliative Care and Hospice WI, LLC may release PHI if asked to do so by a law enforcement official:
- In response to a court order, warrant, summons or similar process;
- To identify or locate suspect, fugitive, material witness, or missing person;
- About the victim of a crime under certain limited circumstances;
- About a death, we believe may be a result of criminal misconduct;
- About criminal conduct on our premises; or
- In emergency circumstances, to report a crime, the location of the crime or the victims, or the identity, description or location of the person who committed the crime.
NOTE: HIV related information, genetic information, alcohol and/or substance abuse records, mental health records and other specially protected health information may have certain special confidentiality protections under applicable state and federal law. Any disclosures of these types or records will be subject to these special protections.
OTHER USES OF YOUR HEALTH INFORMATION: Certain uses and disclosures of PHI will be made only with your written authorization, including uses and/or disclosures: (a) of psychotherapy notes (where appropriate); (b) for marketing purposes; (c) that constitute a sale of PHI under the Privacy Rule. Other uses and disclosures of PHI not covered by this notice or the laws that apply to use will be made only with your written authorization. You have the right to revoke that authorization at any time provided that the revocation is in writing, except to the extent that we already have taken action in reliance on your authorization.
In order to inspect or obtain a copy of your PHI, you may submit a request in writing to Azura Palliative Care and Hospice WI, LLC.
If you request a copy, Azura Palliative Care and Hospice WI, LLC may charge you a fee for the costs of copying and mailing your records, as well as other costs associated with your request.
Azura Palliative Care and Hospice WI, LLC may also deny a request for access to PHI under certain circumstances if there is a potential for harm to yourself or others. If we deny a request for access for this purpose, you will have a right to have our denial reviewed in accordance with the requirements of applicable law:
- You have the right to request an amendment to your PHI but we may deny your request for amendment, if we determine that the PHI record that is subject of the request is:
- Was not created by us, unless you provide a reasonable basis to believe that the originator of PHI is no longer available to act on the requested amendment;
- Is not part of your medical or billing records or other records used to make decisions about you;
- Is not available for inspection as set forth above; or
- Is accurate and complete.
- In the event, any agreed upon amendment will be included as an addition to, and not a replacement of, already existing records. In order to request an amendment to your PHI, you must submit your request in writing to Azura Palliative Care and Hospice WI, LLC, along with a description of the reason for your request.
- You have the right to receive an accounting of disclosures of PHI made by us to individuals or entities other than to you for the six years prior to your request, except for:
- To carry out treatment, payment and health care operations as provided above;
- Incidental to a use or disclosure otherwise permitted or required by applicable law;
- Pursuant to your written authorization;
- For the directory or to persons involved in your care or for other notification purposes a provided by law;
- The National Security or intelligence purposes as provided by law;
- To correctional institutions or law enforcement officials as provided by law;
- As part of limited data set as provided by law.
- To request an accounting of disclosures of your PHI, you must submit your request in writing to Azura Palliative Care and Hospice WI, LLC’s Privacy Officer. You request must state a specific time period.
- You have the right to receive a notification, in the event that there is a breach of your unsecured PHI, which requires notification under the Privacy Rule.
COMPLAINTS:
If you believe that your privacy rights have been violated, you should immediately contact Azura Palliative Care and Hospice WI, LLC’s Privacy Officer.
Azura Palliative Care and Hospice WI, LLC
Attn: Privacy Officer
1233 North Mayfair Road, Ste 308
Milwaukee, WI 53226
Phone: 1 (414) 455-5800
You may also file a complaint with Bureau of Quality Assurance (BQA) as well.
Department of Health Services
Division of Quality Assurance/Bureau of Health Services
ATTN: Hospice Complaint Coordinator
PO Box 2969
Madison, WI 53701-2969
Phone: 1 (608) 266-8481
THIRD PARTY:
Azura Palliative Care and Hospice WI, LLC does/will not sell or share personal information with third parties for marketing/promotional purposes.
CONTACT PERSON:
If you have any questions or would like further information about this practice, please contact Azura Palliative Care and Hospice WI, LLC.
Azura Palliative Care and Hospice WI, LLC
1233 North Mayfair Road, Ste 308
Milwaukee, WI 53226
Phone: 1 (414) 455-6800