This notice describes how medical information about you may be used and disclosed and how you can get access to this information.
Use and Disclosure of Health Information: Central Wyoming Hospice Program, (“CWHP”, “we”, “our”, “us”, or “the program”) may use protected health information (“PHI”) for purposes of providing treatment, obtaining payment for care, and conducting health care operations. We have established policies to guard against unnecessary disclosure of PHI.
To Provide Treatment: CWHP will use PHI to coordinate your care: (within the Hospice Team, and with others involved in your care including your doctor, pharmacists, suppliers of medical equipment or other health care professionals, and with family members.) For example, your doctor will need information about your symptoms in order to prescribe medicines.
To Obtain Payment: CWHP may include PHI in invoices to collect payment from third parties for the care you receive from us. For example, we may be required by your health insurer to provide PHI regarding your health care status so that the insurer will reimburse you or CWHP. 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: CWHP may use and disclose PHI for its own operations in order to facilitate the function of its program and as necessary to provide quality care to all of our patients. Health care operations include such activities as:
We may disclose certain PHI about you including your name, your general health status, your religious affiliation and where you are in the Charles M. and Cara Lou Chapman Hospice Home.
We may disclose this information to people who ask for you by name. Please inform us if you do not want your information to be disclosed.
For Fundraising Activities. CWHP may use PHI excluding your name, address or phone number without permission in order to raise money for the program. If you do not want us to contact you, your family, or anyone associated with you, notify a staff member at Central Wyoming Hospice Program.
For Appointment Reminders. We may use and disclose PHI to contact you as a reminder that you have an appointment for a home visit.
For Treatment Alternatives. We may use and disclose PHI to inform you about possible treatment options or alternatives that may be of interest.
When Legally Required. CWHP will disclose your PHI when it is required to do so by any federal, state, or local law.
When There Are Risks to Public Health. CWHP may disclose PHI for public activities and purposes in order to:
To Conduct Health Oversight Activities: CWHP may disclose PHI to a health oversight agency for activities including audits, civil administrative or criminal investigations related to receipt of health care or public benefits, inspections, licensure or disciplinary action. We may not disclose your PHI if you are the subject of an investigation and your PHI is not directly related to your receipt of health care or public benefits.
In Connection With Judicial And Administrative Proceedings: CWHP may disclose PHI 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 CWHP makes 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, CWHP may disclose your PHI to a law enforcement official for certain law enforcement purposes as follows:
To Funeral Directors: CWHP may disclose PHI 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, we may disclose PHI prior to and in reasonable anticipation of your death. For Organ, Eye Or Tissue Donation: CWHP may use or disclose PHI 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: CWHP may, under very select circumstances, use your PHI for research. Before the program discloses any PHI for such research purposes, the project will be subject to an extensive approval process.
Other than is stated above, CWHP will not disclose your PHI other than with your written authorization. If you or your representative authorizes CWHP to use or disclose your PHI, you may revoke that authorization in writing at any time.
You have the following rights regarding your PHI maintained by CWHP:
CWHP is required by law to maintain the privacy of your PHI as provided by law and to provide you and your representative this Notice of its duties and privacy practices. CWHP is 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 PHI that we maintain. If CWHP changes its Notice, we will provide a copy of the revision to you or your appointed representative. You or your representative have the right to express complaints to CWHP and to the Secretary of the Department OF Health and Human Services (DHHS) if you or your representative believe that your privacy rights have been violated. Any complaints to CWHP should be made in writing to the Executive Director, 319 S Wilson Casper WY 82601. CWHP 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.
CONTACT PERSON: CWHP has designated the Executive Director as its contact person for all issues regarding patient privacy and your rights under the Federal privacy standards. You may contact this person at: 319 S. Wilson Casper WY 82601 (307) 577-4832.
EFFECTIVE DATE: This notice is effective April 14, 2003.
319 S. Wilson
Casper, WY 82601
Central Wyoming Hospice & Transitions (CWHTP) depends upon donations from individuals and businesses, as well as grants and fundraisers to offset the ever increasing gap between third party reimbursements and the actual costs of providing services.