Notice of Privacy Practices





Hospice of the Miami Valley (“hospice”) takes the privacy of your health information seriously.  The hospice is required by law to maintain that privacy and to provide you with this Notice of Privacy Practices.  This Notice is provided to tell you about our duties and practices with respect to your information.  The hospice is required to abide by the terms of this Notice as are currently in effect.


The following categories describe the ways that we use and disclose your health information. For each category, an explanation of the category is provided, in some cases with examples.  Not every use of disclosure in a category will be listed.  However, all of the ways we are permitted to use and disclose your health information will fall into one of the categories.


Treatment. The hospice may use and disclose your health information about you to provide you with medical treatment and may disclose medical information about you to doctors, nurses, and others who are involved in your care. The hospice will also disclose your medical information to your physician and other practitioners, providers and health care facilities for their use in treating you in the future. For example, if you are transferred to a hospital or nursing home, the hospice will send medical information about you to them.


Payment.  The hospice may use and disclose your personal health information so that the hospice can bill and receive payment for the treatment and services you receive from hospice. For billing and payment purposes, we may disclose your personal health information to your representative, an insurance or managed care company, Medicare, Medicaid or another third party payer. For example Hospice 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, disclose your health information to members of the hospice workforce for training purposes, use your health information to contact you as a reminder regarding a visit to you, or contact you as part of community information mailings (unless you tell us you do not want to be contacted.)


Health Care Operations. The hospice may use and disclose your personal health information for our regular hospice operations. These uses and disclosures are necessary to manage our operations and to monitor our quality of care. For example, physicians may review your medical information for quality improvement and training purposes.


Business Associates. The hospice may disclose your personal health information to business associates and allow them to create, use and disclose your medical information to perform their job.  For example, hospice may disclose your medical information to an outside medical supplier who provides a hospital bed for your use.


Transfer of Information at Death. The hospice may disclose health information to funeral directors, medical examiners, and coroners to carry out these duties consistent with applicable law.


Organ, Eye or Tissue Donation.  The hospice may release medical information to organ, eye or tissue procurement, transplantation or banking organizations or entities as necessary to facilitate organ, eye or tissue donation and transplantation.


Threats to Health or Safety. Under certain circumstances, consistent with applicable law and ethical standards of conduct, the hospice may use or disclose your medical information to avert a serious threat to health and safety if, in good faith, the hospice believes the use of disclosure is necessary to prevent or lessen a serious threat to your health or safety or to the health and safety of the public.


Workers’ Compensation. The hospice may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers’ compensation or other similar programs established by law.


Public Health. As required by law, the hospice may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, disability, reporting adverse events, product defects, FDA compliance requirements, or notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease.


Limited Data Set. The hospice 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.


Specified Government Functions.  In certain circumstances, the Federal regulations authorize the hospice to use or disclose your health information to facilitate specified government functions.


Health Oversight Activities.  The hospice may disclose your health information to a health oversight agency 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.


Law Enforcement.  As permitted or required by state law, the hospice may disclose your health information to a law enforcement official for certain law enforcement purposes such as: reporting certain types of wounds or other physical injuries pursuant to a court order; for the purpose of identifying or locating a suspect, fugitive, material witness or missing person; under certain limited circumstances, if you are the victim of crime and in an emergency in order to report a crime; and to a law enforcement official if the hospice has a suspicion that your death was the result of criminal conduct.


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.

As Required by Law.  The hospice will disclose your health information when it is required to do so by any federal, state or local law. Other uses and disclosures not described in the notice will be made only with the individual’s written authorization.  The types of uses and disclosures of PHI that require authorization could include marketing purposes.  The individual may revoke an authorization at any time.  The sale of protected health information without individual authorization is prohibited.





Right to request for restrictions. You have the right to request a 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. The hospice is 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 of restrictions, please contact the Office Manager at 937-458-6028.


Right to inspect and copy medical information.  You have the right to inspect and obtain a copy of your health information, including billing records. A request to inspect and copy records containing your health information may be made to the Office Manager, 937-458-6028. You have the right to request that the hospice provide you, an entity or a designated individual with an electronic copy of your electronic health record containing your health information, if the hospice uses or maintains electronic health records containing patient health information. Hospice has 30 days to provide access to records to individuals, with a one-time 30 day extension.  The hospice may require you to pay the labor costs incurred by the hospice in responding to your request.  You have the right to request your PHI be sent directly to another individual.


Right to be notified following a breech of unsecured PHI.


Right to amend health care information.  You or your representative have 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 the Office Manager, 937-458-6028.  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 have the right to request an “accounting” of our disclosures of your personal 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 the Office Manager, at 937-458-6028. The request should specify the time period for the accounting  and may not be made for periods of time in excess of six (6) years.  The hospice will 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 confidential communications. You may request that we communicate with you about your medical information 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 present.  If you wish to receive confidential communications please contact the Director of Clinical Services, at 937-458-6028.  The hospice will not request that you provide any reasons for your request and will attempt to honor your reasonable requests for confidential communication.

Right to a paper copy of this notice.  You or your representative have 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 the hospice office at 937-458-6028.


The hospice reserves the right to change this Notice.  The hospice reserves the right to make the revised Notice effective for health information w already have about you, 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 will contain, at the end of this document, the effective date.  In addition, if the Hospice revises the Notice, the hospice will offer a copy of the current Notice in effect.




The hospice has designated the President as its contact person for all issues regarding patient privacy and your rights under the Federal privacy standards.  You may contact this person at 46 N. Detroit St. Suite B, Xenia, Ohio 45385 or 937-458-6028.




You or your representative have the right to express complaints to the hospice and to the Secretary of the U.S. Department of Health and Human Services if you or your representative believe that your privacy rights have been violated.  Any complaints to the Hospice should be made in writing to the Privacy Officer, Hospice of the Miami Valley, 46 N. Detroit St., Suite B, Xenia, Ohio 45385.



This Notice is effective July 1, 2011.

Revised April 30, 2013.



Regional V

Regional Manager, Office for Civil Rights

U.S. Dept. of Health and Human Services

233 N. Michigan Ave., Suite 240

Chicago, Illinois  60601

Phone (800) 368-1019

Fax (312)886-1807