Medical Information Notice

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.
(Hospice of East Texas will be referred to as HOET throughout this Notice)

To Provide Treatment: HOET may use your health information to coordinate care within HOET 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 HOET in coordinating care.

To Obtain Payment: HOET may include your health information in invoices to collect payment from third parties for the care you may receive from HOET. For example, HOET will need to provide information about your health status so that the insurer will pay for services provided.

To Conduct Health Care Operations: HOET may use and disclose health care information for its own operations in order to facilitate the function of HOET and as necessary to provide quality care to all of the Hospice's patients. For example, HOET may use your health information to evaluate staff performance, or combine your health information with other Hospice patients in evaluating how to serve all HOET patients more effectively. Your health information may also be used or disclosed for accreditation, certification, licensing or credentialing activities.

Inpatient Facility: HOET may disclose certain information about you including your name, your general health status, your religious affiliation and what room you are in while you are in the inpatient facility. HOET 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.

Appointment Reminders: HOET may use and disclose your health information to contact you as a reminder that you have an appointment for a home visit.

For Financial Support: HOET may use information about you, specifically: your name, address, and the dates you received care at HOET in order to contact you or your family by mail of the Light Up a Life memorial service that is also a fundraiser. If you do not want HOET to contact you or your family, notify HOET and indicate that you do not wish to be contacted.

Use or Disclosure without Authorization: HOET will only use or disclose your health information without your consent or authorization when legally required to do so. For example, when there are risks to public health, to report abuse, neglect or domestic violence, for law enforcement purposes, to conduct oversight activities including audits and investigations, or for funeral arrangements.

Authorization to use or disclose health information: Other than as stated above, HOET will not disclose your health information without your written authorization. If you or your representative authorizes HOET 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 HOET maintains:
Right to request restrictions: You may request restrictions on certain uses and disclosures of your health information. However, HOET is not required to agree to your request. If you wish to make a request for restrictions, please contact HOET to submit a written request.

Right to receive confidential communications: You have the right to request that HOET communicate with you in a certain way. For example, you may ask that HOET 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 HOET.

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 HOET. If you request a copy of your health information, the HOET may charge a reasonable fee for copying and assembling costs associated with your request.

Right to amend health care information: If you or your representative believes that your health information records are incorrect or incomplete, you may request that HOET amend the records. That request may be made as long as the information is maintained by HOET. A request for an amendment of records must be made in writing to HOET.

Right to an accounting: You or your representative have the right to request an accounting of disclosures of your health information made by HOET for any reason other than for treatment, payment or health operations. The request for an accounting must be made in writing to HOET.

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 have received this Notice previously. To obtain a separate paper copy, please contact HOET. This Notice is also available on the HOET website, www.hospice-etex.com

DUTIES OF THE HOSPICE: HOET is required by law to maintain the privacy of your health information and to provide to you or your representative this Notice of its duties and privacy practices. HOET is required to abide by terms of this Notice. HOET 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 HOET changes its Notice, a copy will be provided to you or your appointed representative by mail or delivered by your nurse. You or your personal representative have the right to express complaints to HOET 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 HOET should be made in writing to HOET Privacy Official. HOET encourages you to express any concerns you may have regarding the privacy of your health information. You will not be retaliated against in any way for filing a complaint.

CONTACT PERSON: The HOET contact person for all issues regarding patient privacy and your rights under the Federal Privacy Standards is the Privacy Official at 903-266-3400 , 800-777-9860, 4111 University Blvd., Tyler, Texas 75701.

EFFECTIVE DATE: This Notice is effective April 14, 2003.

Click here to download a printable PDF of the Hospice Medical Information Notice.