CROWN HOSPICE may use your health information, information that constitutes protected health information as defined in the Privacy Rule of the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996, and the Omnibus Final Rule that includes “HITECH” Act effective 2013, for purposes of providing you treatment, obtaining payment for your care and conducting health care operations.  The Hospice has established policies to guard against unnecessary disclosure of your health information.


To Provide Treatment.  The Hospice may use your health information to coordinate care within the Hospice and with others involved in your care, such as your attending physician, members of the Hospice interdisciplinary team and other health care professionals who have agreed to assist the Hospice in coordinating care.  For example, physicians involved in your care will need information about your symptoms in order to prescribe appropriate medications.  The Hospice also may disclose your health care information to individuals outside of the Hospice involved in your care including family members, clergy who you have designated, pharmacists, suppliers of medical equipment or other health care professionals.

To Obtain Payment.  The Hospice may include your health information in invoices to collect payment from third parties for the care you receive from the Hospice.  For example, the Hospice may be required by your health insurer to provide information regarding your health care status so that the insurer will reimburse you or the Hospice.  The Hospice 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.

Conduct Health Care Operations.  The Hospice may use and disclose health information for its own operations in order to facilitate the function of the Hospice and as necessary to provide quality care to all of the Hospice’s patients.  Health care operations include such activities 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 practitioners in health care learn under supervision.
  • Training of non-health care professionals.
  • Accreditation, certification, licensing or credentialing activities.
  • Review and auditing, including compliance reviews, medical reviews, legal services and compliance programs
  • Business planning and development including cost management and planning related analyses and formulary development.
  • Business management and general administrative activities of the Hospice.
  • Fundraising for the benefit of the Hospice.
  • For example,  the Hospice may use your health information to evaluate its 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 as part of general Fund-raising and community information mailings (unless you tell us you do not want to be contacted). Hospice Directory.  The Hospice may disclose certain information about you including your name, your general health status, your religious affiliation and where you are in the Hospice’s facility in a Hospice directory while you are in the Hospice inpatient facility.  The Hospice may disclose this information to people who ask for you by name.  Please inform us if you do not want your information to be included in the directory.
    For Fundraising Activities.  The Hospice may use information about you including your name, address, phone number and the dates you received care in order to contact you or your family to raise money for the Hospice.  The Hospice may also release this information to a related Hospice foundation. You must provide us with our written authorization for our use of your information for any fundraising and you also have the opportunity to opt out or restrict your receiving future fundraising communications. Your request to opt out of receiving future fundraising communication will revoke any prior authorizations and you will not receive any future fundraising communications. You or your family  may contact your SEASONS HOSPICE Privacy Official: 417-890-5533 and indicate your wishes at any timeFor Appointment Reminders.  The Hospice may use and disclose your health information to contact you as a reminder that you have an appointment for a home visit.

    For Treatment Alternatives.  The Hospice may use and disclose your health information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.


    When Legally Required.  The Hospice 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.  The Hospice 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, product defects, to 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 workforce as legally required.

    To Report Abuse, Neglect or Domestic Violence.  The Hospice is allowed to notify government authorities if the Hospice believes a patient is the victim of abuse, neglect or domestic violence.  The Hospice 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.  The Hospice may disclose your health information to a health oversight hospice for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action.  The Hospice, however, 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.  The Hospice 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 the Hospice 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, the Hospice 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 the Hospice has a suspicion that your death was the result of criminal conduct including criminal conduct at the Hospice.
    In an emergency in order to report a crime.

    To Coroners and Medical Examiners.  The Hospice 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.  The Hospice 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, the Hospice may disclose your health information prior to and in reasonable anticipation of your death.

    For Organ, Eye or Tissue Donation.  The Hospice 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.  The Hospice may, under very select circumstances, use your health information for research.  Before the Hospice discloses any of your health information for such research purposes, the project will be subject to an extensive approval process.

    In the Event of a Serious Threat to Health or Safety.  The Hospice may, consistent with applicable law and ethical standards of conduct, disclose your health information if the Hospice, 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 the Hospice 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.  The Hospice may release your health information for worker’s compensation or similar programs.


    Other than is stated above, the Hospice will not disclose your health information other than with your written authorization.  If you or your representative authorizes the Hospice to use or disclose your health information, you may revoke that authorization in writing at any time.


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

    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 the Hospice’s disclosure of your health information to someone who is involved in your care or the payment of your care.  However, the Hospice is not required to agree to your request.  If you wish to make a request for restrictions, please contact CROWN HOSPICE Privacy Official at: 417 890-5533

    Right to receive confidential communications.  You have the right to request that the Hospice communicate with you in a certain way.  For example, you may ask that the Hospice only conduct communications pertaining to your health information with you privately with no other family members, friend, or other person present or involved in your care.  If you wish to receive confidential communications, please contact CROWN HOSPICE Privacy Official at: 417 890-5533  The Hospice will not request that you provide any reasons for your request and will attempt to honor your reasonable requests for confidential communications. We may not be able to honor your request for restriction if the law does not permit us too. If your restriction applies to disclosure of information to a health plan, for payment or health care operations purposes and is not otherwise required by law and where you paid out of pocket, in full, for items or services, we are required and will honor your restriction request.

    –    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 SEASONS HOSPICE Privacy Official at 417 890-5533. If you request a copy of your health information, the Hospice may charge a reasonable fee for copying and assembling costs associated with your request.  The Hospice has the right to a reasonable amount of time to make the records available during normal business hours.  The Hospice has the right to have a representative supervise any inspection of health information.

    Right to receive Notice of Breech. We will notify you first class mail or by e-mail (if you have indicated a preference to receive information by e-mail), of any breaches of Unsecured Protected Health Information as soon as possible, but in an event, no later than 60 days following the discovery of the breach. A “breach” means the unauthorized access, acquisition, use, or disclosure of Protected Health Information which compromises the security or privacy of Protected Health Information, except: (1) an unauthorized person to whom such information is disclosed would not reasonably have been able to retain such information; (2) any unintentional acquisition, access, or use of Protected Health Information by an employee or individual acting under the authority of a covered entity or business associate (a) was made in good faith and within the course and scope of the employment r other professional relationship of such employee, or individual, respectively, with the covered entity or business associate; and (b) such information is not further acquired, accessed, or used or disclosed by any person; or (3) any inadvertent disclosure from an individual who is otherwise authorized to access Protected Health Information at a facility operated by a covered entity or business associate to another similarly situated individual at the same facility provided that any such information received as a result of such disclosure is not further acquired, accessed,  used, or disclosed without authorization. The Provider must notify you of any breach unless we can demonstrate, based on a risk assessment, that there is a low probability that the Protected Health Information has been compromised.

    “Unsecured Protected Health Information” is information that is not secured through the use of a technology or methodology identified by the U.S. Department of Health and Human Services to render the Protected Health Information unusable, unreadable, and undecipherable to unauthorized users. The notice is required to include the following information:
    – a brief description of the breach, including the date of the breach and the date of its discovery, if
    – a description of the type of Unsecured Protected Health Information involved in the breach;
    – steps you should take to protect yourself from potential harm resulting from the breach
    – a brief description of action we are taking to investigate the breach, mitigate losses, and protect
    against further breaches; and
    – contact information, including a toll-free number, e-mail address, Website or postal address to
    permit you to ask questions or obtain additional information.

    In the event the breach involves 10 or more individuals whose contact information is out of date, we will post a notice of the breach on the home page of our web site or in a major print or broadcast media. If the breach involves more than 500 individuals in the state or jurisdiction, we will send notices to prominent media outlets. If a breach occurs we will notify the Secretary of Health and Human Services as soon as we are aware and will maintain a written log of all breaches.

    Right to amend health care information.  You or your representative has the right to request that the Hospice 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 the Hospice.  A request for an amendment of records must be made in writing to CROWN HOSPICE ATTN:  Privacy Official 1831 W. Melville Rd, Springfield, MO 65803.  The Hospice 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 the Hospice, if the records you are requesting are not part of the Hospice‘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 the Hospice, the records containing your health information are accurate and complete.

    –    Right to an accounting.  You or your representative have the right to request an accounting of disclosures of your health information made by the Hospice for certain reasons, including reasons related to public purposes authorized by law and certain research. The request for an accounting must be made in writing to CROWN HOSPICE, ATTN: Privacy Official. 1831 W Melville Rd, Springfield, MO 65803  The request should specify the time period  that is within six years or less from the date of your request.   Accounting requests may not be made for periods of time in excess of six (6) years.  The Hospice 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. Records maintained in an Electronic HEALTH Record will include disclosures made for treatment, payment, health care operations and other purposes. Where an Electronic Health Record is used, we will provide you with an accounting of disclosures for a three year period.

    –    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 CROWN HOSPICE Privacy Official at: 417-890-5533, this notice may also be viewed and printed from our website @ .


    The Hospice 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.  The Hospice is required to abide by the terms of this Notice as may be amended from time to time.  The Hospice 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 the Hospice changes its Notice, the Hospice 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 the Hospice and/or to the Secretary of DHHS if you or your representative believe that your privacy rights have been violated.  Any complaints to the Hospice should be made in writing to CROWN HOSPICE, ATTN: Privacy Official. 1831 W Melville Rd, Springfield, MO 65803.
    The Hospice 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.


    The Hospice has designated the Privacy Official as its contact person for all issues regarding patient privacy and your rights under the Federal privacy standards.  You may contact this person at 417-890-5533 1831 W. Melville Rd., Springfield, MO  65803


    This Notice is effective September 19, 2013.