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.

Mt. Hood Hospice may use your health information for purposes of providing you treatment, obtaining payment for your care and conducting health care operations.

Your health information may be used or disclosed only after hospice has obtained your written consent. Hospice has established a policy to guard against unnecessary disclosure of your health information.

The following is a summary of the circumstances under which and purposes for which your health information may be used and disclosed after you have provided your written consent.

• Health care operations includes 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 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 and certain marketing activities.
• Bereavement Program activities 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 or your family as part of general fundraising, bereavement program, and community information mailings (unless you tell us you do not want to be contacted.

For Fundraising Activities: The Hospice may use information about you including your name, address, phone, and the dates you received care at the Hospice in order to contact you or your family to raise money for the Hospice. If you do not want the Hospice to contact you or your family, please notify MHH Privacy Official, PO Box 1269, Sandy, Oregon 97055 and indicate that you do not wish to be contacted.

Federal privacy rules allow the Hospice to use or disclose your health information without your consent or authorization for the following reasons:

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.
• To 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.
• To notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease.
• To 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 the patient is a victim of abuse, neg1ect 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 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.

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: The Hospice may disclose your health information to a law enforcement official for 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
• In an emergency in order to report a

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.

In the Eventof 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 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.

Authorization to Use or Disclose Health Information

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.

Your Rights With Respect to Your Health Information

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

• Right to request. You may request restrictions on certain uses and disclosure of your health 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.
• 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 communication, pertaining to your health information with you privately with no other family members present. The Hospice will not request that you provide any reasons for your request and will attempt to honor your reasonable requests for confidential
• You have the right to inspect and copy your health information. You have the right to inspect and copy your health information, including billing records. 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.

Contact Us

Office: 503-668-5545
After Hours Answering Service: 503-668-5545
Fax: 503-668-7951

Mt. Hood Hospice

39085 Pioneer Blvd., Suite 1018
Sandy, Oregon 97055

Mailing Address

PO Box 1269 | Sandy, Oregon 97055

Email Us

inquire@mthoodhospice.org