This HEALTH INFORMATION PORTABILITY ACT (HIPAA) 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.
Samaritan is required by law to protect the privacy of your health information. We are required to provide you with this Notice of Privacy Practices to describe our legal duties and your rights with respect to your protected health information. We are also required to abide by the terms of this Notice which is currently in effect, and to notify you in the event of a breach of your unsecured health information.
The following is a summary of the circumstances under which and purposes for which your health information may be used and disclosed:
To Provide Treatment. We may use and disclose your health information to coordinate care within Samaritan and with others involved in your care, such as your attending physician, members of our interdisciplinary team and other health care professionals who have agreed to assist us in coordinating care. For example, physicians involved in your care will need information about your symptoms in order to prescribe appropriate medications. When appropriate, we may share your health information with a family member, other relative or any other person you identify if that person is involved in your care and the information is relevant to your care or the payment of your care. We also may notify your family about your location or general condition or disclose such information to an entity assisting in a disaster relief efforts.
You may ask us at any time not to disclose your health information to any person(s) involved in your care. We will agree to your request unless circumstances constitute an emergency or if the patient is a minor.
To Obtain Payment. We may include your health information in invoices to collect payment from third parties for the care you receive from Samaritan. For example, we may be required by your health insurer to provide information regarding your health care status so that the insurer will reimburse you or Samaritan. We 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. We may use and disclose health information for its own operations in order to facilitate the function of Samaritan and as necessary to provide quality care to all of our patients. Health care operations includes activities such 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 practitionersin health care learn under supervision.
•Training of non-health care professionals.
• Accreditation, certification, licensing or credentialing activities.
• Review and audit, including compliance reviews, medical reviews, legal service, and compliance programs.
• Business planning and development including cost management and planning related analyses and formulary development.
• Business management and general administrative activities of Samaritan.
Fundraising for the benefit of Samaritan.
For example, we may use your health information to evaluate its performance, combine your health information with other hospice patients in evaluating how to more effectively serve all hospice patients, or disclose your health information to hospice staff and contracted personnel for training purposes.
When Legally Required. We 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. We 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 and product defects; 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 employer’s workforce in certain limited situations, as authorized by law.
To Report Abuse, Neglect Or Domestic Violence. We are obligated to notify government authorities if we believe a patient is the victim of abuse, neglect, or domestic violence. We 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. We may disclose your health information to a health oversight agency for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action. However, we 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. We 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 we make reasonable efforts to either notify you about the request or to obtain an order protecting your health information.
For Law Enforcement Purposes. As permitted or required by State law, we 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 Samaritan has a suspicion that your death was the result of criminal conduct including criminal conduct at Samaritan.
• In an emergency in order to report a crime.
To Coroners and Medical Examiners. We 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. We 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, Samaritan may disclose your health information prior to and in reasonable anticipation of your death.
For Organ, Eye Or Tissue Donation We 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. We may, under very select circumstances, use your health information for research. Before we disclose any of your health information for such research purposes, the project will be subject to an extensive approval process. This process includes evaluating a proposed research project and its use of health information and trying to balance the research needs with your need for privacy. Before we use or disclose health information for research, the project will have been approved through this research approval process. Additionally, when it is necessary for research purposes and so long as the health information does not leave our organization, it may disclose your health information to researchers preparing to conduct a research project, for example, to help the researchers look for individuals with specific health needs. Lastly, if certain criteria are met, we may disclose your health information to researchers after your death when it is necessary for research purposes.
For Limited Data Set. We may use or disclose a limited data set of your health information, that is, a subset of your health information for which all identifying information has been removed, for purposes of research, public health, or health care operations. Prior to our release, any recipient of that limited data set must agree to appropriately safeguard your health information.
In the Event of A Serious Threat To Health Or Safety. We may, consistent with applicable law and ethical standards of conduct, disclose your health information if Samaritan, 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 us 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.
For Worker’s Compensation. We may release your health information for worker’s compensation or similar programs.
Other than what is stated above, we will not disclose your health information other than with your written authorization. If you or your representative authorizes Samaritan to use or disclose your health information, you may revoke that authorization in writing at any time. If you cancel your authorization, we will follow your instructions except to the extent that we have already relied upon your authorization and taken action.
The following uses and disclosures of your health information will only be made with
your signed authorization:
1. Uses and disclosures for marketing purposes;
2. Uses and disclosures that constitute a sale of health information;
3. Most uses and disclosures of psychotherapy notes, if we maintain psychotherapy notes; and
4. Any other uses and disclosures not described in this Notice.
YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION
You have the following rights regarding your health information that we maintain:
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 our disclosure of your health information to someone who is involved in your care or the payment of your care. However, we are not required to agree to your request, unless your request is for a restriction on a disclosure to a health plan for purposes of payment or health care operations (and is not for purposes of treatment) and the medical information you are requesting to be restricted from disclosure pertains solely to a health care item or service for which you have paid out-of-pocket in full. If you wish to make a request for restrictions, please contact our medical records supervisor at (856) 596-1600.
Right to receive confidential communications. You have the right to request that we communicate with you in a certain way. For example, you may ask that we 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 our privacy officer at (856) 596-1600. We 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 our medical records supervisor at (856) 596-1600. If you request a copy of your health information, we may charge a reasonable fee for copying and assembling costs associated with your request. You have the right to request that we provide you, an entity or a designated individual with an electronic copy of your electronic health record containing your health information, if we use or maintain electronic health records containing patient health information. We may require you to pay the labor costs incurred in responding to your request.
Right to amend health care information. You or your representative has the right to request that we 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 us. A request for an amendment of records must be made in writing to our medical records supervisor at Samaritan, 3906 Church Road, Mount Laurel, NJ 08054. We 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 Samaritan, if the records you are requesting are not part of Samaritan‘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 Samaritan, the records containing your health information are accurate and complete.
Right to an accounting. You or your representative has the right to request an accounting of disclosures of your health information made by Samaritan for the previous six (6) years. The accounting will not include disclosures made for treatment, payment or health care operations unless we maintain your health information in an Electronic Health Record (EHR). The request for an accounting must be made in writing to our medical records supervisor at Samaritan, 3906 Church Road, Mount Laurel, NJ 08054. The request should specify the time period for the accounting starting on or after April 14, 2003. Accounting requests may not be made for periods of time in excess of six (6) years. Samaritan 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 opt out of fundraising. You or your representative have the right to opt out of receiving fundraising communications at any time.
Right to receive notification of a breach. You or your representative has the right to receive notification of a breach of your unsecured health information. If you have questions regarding what constitutes a breach or your rights with respect to breach notification, please contact our privacy officer at Samaritan, 3906 Church Road, Mount Laurel, NJ 08054.
Right to a paper copy of this notice. You or your representative has a right to a separate paper copy of this Notice at any time even if you or your representative has received this Notice previously. To obtain a separate paper copy, please contact our privacy officer at (856) 596-1600.
DUTIES OF SAMARITAN
We are 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. We are required to abide by the terms of this Notice as may be amended from time to time. We reserve the right to change the terms of its Notice and to make the new Notice provisions effective for all health information that it maintains, as well as any health information we receive in the future. We will post a copy of the current Notice in a clear and prominent location to which you have access. The Notice also is available to you upon request. The Notice contains, at the end of this document, the effective date. In addition, if we revise the Notice, we will offer you a copy of the current Notice in effect. If Samaritan changes its Notice, we will provide a copy of the revised Notice to you or your appointed representative. You or your personal representative has the right to express complaints to Samaritan and to the Secretary of the Department of Health & Human Services (DHHS) if you or your representative believes that your privacy rights have been violated. Any complaints to Samaritan should be made in writing to our privacy officer at Samaritan, 3906 Church Road, Mount Laurel, NJ 08054. Samaritan encourages you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against for filing a complaint.
CONTACT PERSON
Samaritan has designated the director of quality and compliance as its contact person for all issues regarding patient privacy and your rights under the Federal privacy standards. IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT this person at Samaritan, 3906 Church Road, Mount Laurel, NJ 08054, (856) 596-1600.