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Hospice of Salina Notice of Privacy Practices/Health Information Rights

This Notice is effective April 14, 2003. Revised & new effective date September 23, 2013

Use and Disclosure of Your Health Information

Hospice of Salina, Inc. may use and disclose your health information for the purpose of providing you treatment, obtaining payment for your care, conducting health care operations, or as permitted by law. Your health information may be used or disclosed only after Hospice of Salina has obtained your written authorization, or as authorized by state or federal law. Hospice of Salina has established a policy to guard against unnecessary disclosure of your health information. The following is a summary of the circumstances under which your health information may be used and disclosed:

Hospice of Salina may disclose your health information to another health care provider for the health care operations of that health care provider if Hospice of Salina and that health care provider has or had a relationship with you. The information disclosed will relate to that relationship and is for very limited purposes as permitted by law.

Hospice of Salina may use your health information to evaluate 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 or your family as part of general fundraising and community information mailings. Please inform us if you do not want to be contacted.

Use and Disclosure of Your Protected Health Information without Your Permission

Federal privacy rules allow Hospice of Salina to use or disclose your health information without your permission or authorization for the following reasons:

Authorization to Use or Disclose Health Information

Other than what is stated above, Hospice of Salina will not disclose your health information without your written authorization. If you, or your representative, authorize Hospice of Salina to use or disclose your health information, you may revoke that authorization in writing at any time.

Covered entities must agree to restrict disclosure to a health plan if the individual pays out of pocket in full for healthcare service.

Your Rights with Respect to Your Health Information

You have the following rights regarding your health information that Hospice of Salina maintains:

BREACH OF PRIVATE HEALTH INFORMATION: To receive notice of breach in private health information, you will be notified by phone, email or mail upon discovery of breach by Hospice of Salina or any business associate.

Duties of Hospice of Salina

Hospice of Salina is required by law to maintain the privacy of your health information and to provide to you and your representative this Notice of its duties and privacy practices. Hospice of Salina is required to abide by terms of this Notice, as may be amended from time to time. Hospice of Salina reserves the right to change the terms of its Notice and to make the new Notice provisions effective for all health information that it maintains. If Hospice of Salina changes its Notice, Hospice of Salina will provide a copy of the revised Notice to you or your appointed representative if you request a copy. A copy of our current notice is also posted in each of our operating facilities. You, or your personal representative, have the right to express complaints to Hospice of Salina and to the Secretary of Health and Human Services if you, or your representative, believe that your privacy rights have been violated. Any complaints to Hospice of Salina should be made in writing to our contact person identified at the end of this document. Hospice of Salina encourages you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way for filing a complaint.

Hospice of Salina reserves the right to change the terms of the Notice of Patient Privacy (NPP) and will make provisions effective for all private health information.