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.

Harmon Hospice, LLC (“Harmony”) is strongly committed to protecting your health information. This Notice of Privacy Practices (“Notice”) is provided pursuant to the Health

Insurance Portability and Accountability Act of 1996 and describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. This Notice also describes your rights and our duties with respect to your protected health information. “Protected health information” is information about you that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.

We must follow the privacy practices that are described in this Notice while it is in effect.

Uses and Disclosures

Treatment. Your health information may be used by staff members or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example, results of laboratory tests and procedures will be available in your medical record to all health professionals who may provide treatment or who may be consulted by staff members. Further, your protected health information may be provided to a physician or other health care provider (e.g. a specialist) to whom you have been referred to ensure that the physician or other health care provider has the necessary information to diagnose or treat you.

Payment. Your health information may be used to seek payment from your health plan, government program or other third party payor that you may use to pay for services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you, such as making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, we may provide your health plan with medical information about the health care services Harmony rendered to you for reimbursement purposes.

Health Care Operations. Your health information may be used as necessary to support the day-to-day activities and management of the facility. For example, information on the services you received may be used to support budgeting and financial reporting, and activities to evaluate and promote the quality of care provided to you.

Business Associates. Your health information may be disclosed to third party “business associates” that perform various activities (e.g., billing, transcription services) for us. Whenever an arrangement between our office and a business associate involves the use or disclosure of your health information, we will have a written agreement with that business associate that contains terms that will protect the privacy of your health information to the same extent that we must. For example, we may hire a billing company to submit claims to your health care insurer. Your health information will be disclosed to this billing company, but a written agreement between our office and the billing company will prohibit the billing company from using your health information in any way other than what we allow.

Others Involved In Your Health Care. Unless you object, your health information may be disclosed to a member of your family, a relative, a close friend or any other person you identify if such information directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. Your health information may be disclosed to notify a family member or any other person that is responsible for your care of your location and general health condition. Finally, your health information may be disclosed to an authorized public or private entity to assist in disaster relief efforts.

Resident Directory. Unless you object, we may use and disclose in our resident directory your name, your location in the community, your general condition and your religious affiliation. All of this information, except religious affiliation, may be disclosed to people that ask for you by name. Members of the clergy will be told your religious affiliation. You have the opportunity to agree or object to the use or disclosure of all or part of your protected health information. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment.

As Required By Law. Your health information may be disclosed to the extent that the use or disclosure is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, when required by law, of any such uses or disclosures.

Law Enforcement. Your health information may be disclosed to law enforcement agencies or other government agencies, so long as all legal requirements are met, to support government audits and inspections, to facilitate law-enforcement investigations, and to comply with government mandated reporting. We may disclose your protected health information to a public health authority that is authorized by law to receive reports of abuse or neglect. In addition, we may disclose your protected

health information if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.

Legal Proceedings. Your health information may be disclosed in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), and in certain conditions in response to a subpoena or other lawful request.

Public Health Reporting. Your health information may be disclosed to public health agencies as required by law. For example, we are required to report certain communicable diseases to the state’s public health department.

Health Oversight. Your health information may be disclosed to a health oversight agency for activities authorized by law. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs (such as Medicare or Medicaid), other government regulatory programs and civil rights laws.

Coroners, Funeral Directors, and Organ Donation. Your health information may be disclosed to a coroner, medical examiner, or funeral director when an individual dies. Your health information may also be disclosed to organ procurement organizations.

Research. Your health information may be disclosed to researchers when their research has been established as required by federal and state law.

Public Safety. Consistent with applicable federal and state laws, your health information may be disclosed if we 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. We may also disclose certain information if it is necessary to assist law enforcement authorities locate a suspect or fugitive.

Workers’ Compensation. Your health information may be disclosed by us as authorized by law to comply with workers’ compensation laws and other similar legally established programs.

Required Uses And Disclosures. Under the law, we must make disclosures to you and, when required by the Secretary of the Department of Health and Human Services, to investigate or determine our compliance with the requirements of the Health Insurance Portability and Accountability Act and its regulations.

By Your Authorization. Other uses and disclosures require your authorization. Disclosure of your health information or its use for any purposes other than those listed above requires your specific written authorization. If you change your mind after authorizing a use or disclosure of your information, you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision to revoke your authorization.

Special Protections for HIV, Substance Abuse, Mental Health and Genetic Information. Certain federal and state laws may require special privacy protections that restrict the use and disclosure of certain health information, including HIV-related information, alcohol and substance abuse information, mental health information, and genetic information. We will abide by those specific laws when applicable, therefore some parts of this Notice may not apply to these types of information. If you have concerns or questions, please contact the Privacy Officer.

Additional Uses of Information

Appointment Reminders. Your health information will be used by our staff to send you appointment reminders.

Information About Treatments. Your health information may be used to send you information on the treatment and management of your medical condition that you may find interesting.

We may also send you information describing other health-related products and services that we believe may interest you.

Without your authorization, we are expressly prohibited to use or disclose your protected health information for marketing purposes when financial remuneration is involved. Generally, we may not use or disclose most psychotherapy notes contained in your protected health information unless authorized by you.

Fundraising. We will not use your name and address to support fund-raising efforts.

Marketing. We may not sell your protected health information without your authorization. We will not use your name and address for marketing communications without your authorization.

Breach Notification. We may use or disclose your protected health information to provide legally required notices of unauthorized access to or disclosure of your health information.

Individual Rights

You have certain rights under the federal privacy standards. These include:

  • The right to request restrictions on the use and disclosure of your protected health information. We are not required to agree to your request unless it is a request to restrict disclosures of your protected health information to your health insurer for a particular item or services that you have paid us for in full out of pocket at the time of the services.
  • The right to receive confidential communications concerning your medical condition and treatment.
  • The right to inspect and copy your protected health information.
  • The right to amend or submit corrections to your protected health information.
  • The right to receive an accounting of how and to whom your protected health information has been disclosed.
  • The right to receive a printed copy of this Notice.

As stated above, you may generally inspect or copy the protected health information that we maintain. As permitted by federal regulation, we require that requests to inspect or copy protected health information be submitted in writing. You may obtain a form to request access to your records by contacting the business office of the facility or the Privacy Officer. Your request will be reviewed and will generally be approved unless there are legal or medical reasons to deny the request.

Facility Duties

We are required by law to maintain the privacy and security of your protected health information and to provide you with this notice of privacy practices. We also are required to abide by the privacy policies and practices outlined in this notice. In the event of a breach of unsecured protected health information, if your information has been compromised it is our duty to notify you.

Right to Revise Privacy Practices

As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations. The most recently revised notice will be available upon request, in our office, and on our website.

The revised policies and practices will be applied to all protected health information we maintain.

Complaints

If you would like to submit a comment or complaint about our privacy practices, you may do so by sending a letter outlining your concerns to:

Mary Lynn Leach, Privacy Officer
Harmony Hospice, LLC
3621 Suite 200
Metairie, LA 70002

If you believe that your privacy rights have been violated, you should call the matter to our attention by sending a letter describing the cause of your concern to the same address. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, SW., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.

You will not be penalized or otherwise retaliated against for filing a complaint.

Contact Person

The contact information of the person you may contact for further information concerning our privacy practices is:

Mary Lynn Leach, Privacy Officer
Harmony Hospice, LLC
3621 Suite 200
Metairie, LA 70002

This notice is effective on or after July 8, 2015.