Notice of Privacy Practices



To Provide Treatment: The agency may use your health information to coordinate care within the agency and with others involved in your care, such as your attending physician, members of the interdisciplinary team and other health care professionals who have agreed to assist the agency in coordinating care. For example, physicians involved in your care will need information about your symptoms in order to prescribe appropriate medications. The agency also may disclose your health care information to individuals outside of the agency 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 agency may include your health information in invoices to collect payment from third parties for the care you receive from the agency. For example, the agency may be required by your health insurer to provide information regarding your health care status so that the insurer will reimburse you or the agency. HNC 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: The agency may use and disclose health information for its own operations in order to facilitate the function of the agency and as necessary to provide quality care to all of our patients. Health care operations include such activities as:

  1. Quality Assessment and Improvement activities;
  2. Activities designed to improve health or reduce health care costs;
  3. Protocol development, case management and care coordination;
  4. Contacting health care providers and patients with information about treatment alternatives and other related functions that do not include treatment;
  5. Professional review and performance evaluation;
  6. Training programs including those in which students, trainees or practitioners in health care learn under supervision;
  7. Training of non-health care professionals;
  8. Accreditation, certification, licensing or credentialing activities;
  9. Review and auditing, including compliance reviews, medical reviews, legal services and compliance programs; 10) Business planning and development including cost management and planning related analysis and formulary development;
  10. Business management and general administrative activities of the agency;
  11. Patient safety activities (as defined in 42CFR3.20);
  12. Fundraising for the benefit of the agency, unless you choose to opt out.

For example the agency may use your health information to evaluates its staff performance, combine your health information with other agency patients, in evaluating how to more effectively serve all hospice patients, disclose your health information to agency staff and contracted personnel for training purposes, use your health information to contact you as part of general fundraising and community information mailings (unless you tell us you do not want to be contacted). The agency remembers former patients at memorial services. If you do not want your name read at a memorial service or printed on a memorial service program, notify the agency at 970-352-8487. The agency may disclose certain information about you including your name and where you are in the agency’s inpatient facility. The agency may disclose this information to persons who ask for you by name. Please inform us if you do not want your information to be disclosed.

For Appointment Reminders: The agency 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 agency may use and disclose your health information to tell you about or recommend possible treatment options or alternatives that me be of interest to you.

Communication and Marketing: Except as permitted by law, the agency will not use your PHI for marketing purposes without your prior written authorization.


When legally Required: The agency 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 agency may disclose your health information for public activities and purposes in order to: 1) 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; 2) 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; 3) Notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease; 4) Notify an employer about an individual who is a member of the workforce as legally required.

To Report Abuse, Neglect or Domestic Violence: The agency is allowed to notify government authorities if the agency believes a patient is the victim of abuse, neglect or domestic violence. The agency 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 agency 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 agency, 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 agency 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 agency 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 agency may disclose your health information to a law enforcement official for certain law enforcement purposes as follows: 1) 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; 2) For the purpose of identifying or locating a suspect, fugitive, material witness or missing person; 3) Under certain limited circumstances, when you are the victim of a crime; 4) To a law enforcement official if the agency has a suspicion that your death was the result of criminal conduct including criminal conduct at the agency; 5) In an emergency in order to report a crime.

To Coroners and Medical Examiners: The agency 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; and as a routine operating practice.

To Funeral Directors: The agency may disclose your health information to funeral directors consistent with applicable law and if necessary, to carry out their duties with respect of your funeral arrangements. If necessary to carry out their duties, the agency may disclose your health information prior to and in reasonable anticipation of your death.

For Organ, Eye, or Tissue Donation: The agency may use or disclose your health information to organ procurement organizations or entities engaged in the procurement, banking or transplantation of organs, eyes or tissue for the purpose of facilitating the donation or transplantation, if you so desire.

For Research Purposes: The agency may, under very select circumstances, use your information for research. Before the agency 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 agency may, consistent with applicable law and ethical standards of conduct, disclose your health information if the agency, 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 agency 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 agency may release your health information for worker’s compensation or similar programs.

For Other Covered Entities or Business Associates: The agency may disclose personal information to other covered entities or business associates. We will only share your personal information with third parties as outlined in the Privacy Policy and as otherwise permitted by law. For example, we may disclose information to government entities if it has been arranged for us to do so in order to assist in determining state or federal benefit programs such as Medicaid and Medicare.

Sale of Your PHI: Except as permitted by state law, we will not sell your PHI for financial remuneration without your prior written authorization.

For Fundraising Activities: We may contact you as part of our fund raising efforts and disclose for fundraising activities your contact information, dates of service, health insurance status, department of service information, name of treating physician and outcome information. Such disclosures would be to associates of, or a foundation related to, the hospice. You have the right to opt out of receiving such communications. If you do not want the agency to contact you or your family, notify the agency at 970-352-8487 and indicate that you do not wish to be contacted.

Authorization to Use or Disclose Health Information

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

You have the following rights regarding your health information the hospice maintains:

1) 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 agency’s disclosure of your health information to someone who is involved in your care or the payment of your care. However, the agency is not required to agree to your request. If you wish to make a request for restrictions, please contact the agency’s Compliance and Privacy Official at 970-352-8487.

2) Right to Receive Confidential Communications: You have the right to request that the agency communicate with you in a certain way. For example, you may ask that the agency 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 agency’s Compliance and Privacy Official at 970-352-8487.

3) Right to Inspect and Copy your Health Information: You have the right to inspect and obtain a copy of your health information, including billing records. A request to inspect and obtain a copy of records containing your health information may be made to the agency’s Compliance and Privacy Official at 970-352-8487. If you request and a copy of your health information, the agency may charge a reasonable fee for copying and assembling cost associated with your request.

4) Right to Amend Health Care Information: You or your representative has the right to request that the agency 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 agency. A request for an amendment of records must be made in writing to the agency’s Compliance and Privacy Official, Hospice of Northern Colorado, 2726 W. 11th Street Road, Greeley, Colorado 80634. The agency 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 agency, if the records you are requesting are not part of the agency’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 agency, the records containing your health information are accurate and complete.

5) Right to an Accounting: You or your representative has the right to request an accounting of disclosures of your health information made by the agency for certain reasons, including reasons related to public purposes authorized by law and certain research. The request for accounting must be made in writing to the Compliance and Privacy official, Hospice of Northern Colorado 2726 W. 11th Street Road, Greeley, CO 80634. The request should specify the time period for the accounting starting on or after April 14, 2003. Accounting requests may not be made for periods of time in excess of six (6) years. The agency 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.

6) Right to notification of breach: If the agency determines that there has been a breach of your protected health information we will provide you or your representative with written notice by first class mail or by email if you agree to receive electronic notices. The notification will be provided no later than 60 days following the discovery of the breach. The notification will include a description of the breach; description of the type of information involved in the breach; the steps that you or your representative should take to protect you from harm; brief description of what the agency is doing to investigate the breach, mitigate the harm, and prevent further breaches; and the contact information for the agency. The agency will notify you by telephone as well as written notice in cases deemed by the hospice to require urgency because of possible imminent misuse of protected health information.

7) 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 the Compliance and Privacy official at 970-352-8487.

Duties of Hospice of Northern Colorado:

The agency 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 agency is required to abide by the terms of this Notice as may be amended from time to time. The agency 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 agency changes its Notice, the agency 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 agency to the Secretary of DHHS if you or your representative believes that your privacy rights have been violated. Any complaints to the agency should be made in writing to HNC’s Compliance and Privacy Official, 2726 W. 11th Street Road, Greeley, CO 80634. The agency encourages you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way to filing a complaint.

Contact Person: The agency has designated the agency’s Compliance and 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 Hospice of Northern Colorado, 2726 W. 11th Street Road, Greeley, CO 80634; phone 970-352-8487.

Effective Date: This Notice is effective April 14, 2003. Revised September 2010 to include agency name change to “Hospice of Northern Colorado”, Revised September 2013 to include new privacy requirements.