Patient Bill of Rights

PURPOSE:
To provide a relationship between Palo Verde Hematology Oncology, Ltd. and its patients and to emphasize the need for the observance of the rights and responsibilities of patients.

POLICY:
Our foremost concern is to provide for our patients’ health care needs, while recognizing their dignity as human beings. We support and protect the fundamental human, civil, constitutional, and statutory rights of each patient according to the following procedure:

PROCEDURE:
Our patients have the right to:

  • expect us to operate according to a code of ethical behavior;
  • expect impartial, considerate, and respectful care regardless of race, religion, sex, national origin, age or handicap;
  • obtain from your physician current information concerning your diagnosis, treatment, and prognosis in terms you reasonably can be expected to understand;
  • receive from your physician information necessary to give informed consent before any procedure or treatment. Except in emergencies, such information should include the specific procedure or treatment, the medically significant risks involved, and the probable duration of incapacitation. Where medically significant alternatives for care or treatment exist, or when you request information concerning medical alternatives, you have the right to that information;
  • know who is responsible for your care and participate in planning for treatment. You may also refuse treatment to the extent permitted by law, and should be informed of the medical consequences of your action;
  • receive every consideration of privacy concerning your medical care program. case discussion, consultation, examination, and treatment should be conducted discreetly; and all communications and records pertaining to your care are treated as confidential;
  • prompt assessment and management of your pain by health care professionals who are committed to bringing you comfort;
  • expect that within our capacity, we will respond to your requests for services. We provide evaluation, service, and/or referral as indicated by the urgency of the case. You have the right to receive complete information and explanation concerning the needs for an alternative to a transfer to another facility;
  • present complaints regarding quality of care. Complaints may be presented in person or in writing to the department leader, or administration; and you will receive a response. Presentation of a complaint does not compromise your future access to care;
  • access protective services;
  • obtain information about any relationship of Palo Verde Hematology Oncology, Ltd. to other health care and educational institutions, as it pertains to your care;
  • expect reasonable continuity of care and that you are informed by your physician of continuing health care needs following discharge;
  • receive a reasonable estimate of charges, on request, before treatment and an explanation of your bill, regardless of source of payment. Have the right to receive full information on the availability of known financial resources for your case and, if you are eligible for Medicare, to know that our group accepts the Medicare assignments of benefits;
  • know the regulations that apply to your conduct as a patient.

Notice of Privacy Practices for Protected Health Information

Effective April 14, 2003

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!

Palo Verde Hematology Oncology, Ltd. is permitted by federal privacy laws to make uses and disclosures of your health information for purposes of treatment, payment, and health care operations. Protected healthcare information is the information we create and obtain in providing our services to you. Such information may include documenting your symptoms, examination and test results, diagnoses, treatment, and applying for future care or treatment. It also includes billing documents for those services.

Examples of uses of your health information for Treatment purposes are:
· A staff member of our office obtains treatment information about you and records it in a health record.
· During the course of your treatment, the physician determines he/she will need to consult with another specialist in the area. He/she will share the information with such a specialist in order to obtain his/her input about your care.

Example of use of your health information for Payment purposes:
· We submit requests for payment to your health insurance company. The health-insurance company or business associate helping us obtain payment requests information from us regarding your medical care given. We will provide information to them about you and the care given.

Example of use of your information for Health Care Operations:
We may obtain services from business associates such as quality assessment, quality improvement, outcome evaluation, protocol and clinical guidelines development, training programs, credentialing, medical review, legal services, and insurance. We will share information about you with such business associates as necessary to obtain these services.

Your Health Information Rights

The health and billing records we maintain are the physical property of Palo Verde Hematology Oncology, Ltd. You have the following rights with respect to your Protected Healthcare Information:

  1. Request a restriction on certain uses and disclosures of your health information by delivering the request in writing to our office—we are not required to grant the request but we will comply with any request granted;
  2. Obtain a paper copy of the Notice of Privacy Practices for Protected Health Information;
  3. Right to inspect and copy your health record and billing record—you may exercise this right by delivering the request in writing to Palo Verde Hematology Oncology, Ltd. using the form we provide to you upon request; appeal a denial of access to your protected health information except in certain circumstances;
  4. Right to request that your health care record be amended to correct incomplete or incorrect information by delivering a written request to Palo Verde Hematology Oncology, Ltd. using the form we provide to you upon request. The physician or other health care provider is not required to make such amendments; you may file a statement of disagreement if your amendment is denied, and require that the request for amendment and any denial be attached in all future disclosures of your protected health information;
  5. Right to receive an accounting of disclosures of your health information as required to be maintained by law by delivering a written request to Palo Verde Hematology Oncology, Ltd. using the form we provide to you upon request. An accounting will not include internal uses of information for treatment, payment, or healthcare operations, disclosures made to you or made at your request, or disclosures made to family members or friends in the course of providing care;
  6. Right to confidential communication by requesting that communication of your health information be made by alternative means or at an alternative location by delivering the request in writing to Palo Verde Hematology Oncology, Ltd. using the form we give you upon request; and, If you want to exercise any of the above rights, please contact Lynn Ratzlaff, Privacy Officer at: Palo Verde Hematology Oncology, Ltd, 5601 W. Eugie Ave.,Suite 106, Glendale, AZ 85304, Telephone number: 602-978-6255, in person, in writing, via telephone or fax, or by e-mail during normal hours. He will provide you with assistance on the steps to take to exercise your rights.

Palo Verde Hematology Oncology, Ltd. (PV HO) Responsibilities

PVHO is required to:

  • Maintain the privacy of your health information as required by law;
  • Provide you with a notice as to our duties and privacy practices as to the information we collect and maintain about you;
  • Abide by the terms of this Notice;
  • Notify you if we cannot accommodate a requested restriction or request; and
  • Accommodate your reasonable requests regarding methods to communicate health information with you.
  • Accommodate your request for an accounting of disclosures.

We reserve the right to amend, change, or eliminate provisions in our privacy practices and access practices and to enact new provisions regarding the protected health information we maintain. If our information practices change, we will amend our Notice. You are entitled to receive a revised copy of the Notice by calling and requesting a copy of our “Notice” or by visiting one of our offices and picking up a copy.

To Request Information or File a Complaint

If you have questions, would like additional information, or want to report a problem regarding the handling of your healthcare information, you may contact Lynn Ratzlaff, the Privacy Officer at: Palo Verde Hematology Oncology, Ltd., 5601 W. Eugie Ave., Suite 106, Glendale, AZ 85304 (602)978-6255.

Additionally, if you believe your privacy rights have been violated, you may file a written complaint at any Tennessee Oncology clinic. You may also file a complaint with the Secretary of Health and Human Services at:

U.S. Department of Health and Human Services Office of Civil Rights
200 Independence Avenue, SW
Room 515F HHH Bldg.
Washington, D.C. 20201

We cannot, and will not, require you to waive the right to file a complaint with the Secretary of Health and Human Services (HHS) as a condition of receiving treatment from the office.

We cannot, and will not, retaliate against you for filing a complaint with the Secretary of Health and Human Services.

The Following is a List of Other Uses and Disclosures

Patient Contact
We may contact you to provide you with appointment reminders, with information about treatment alternatives, or with information about other health-related benefits and services that may be of interest to you. We may contact you as part of a fund raising effort.

Notification – Opportunity to Agree or Object
Unless you object we may use or disclose your protected health information to notify, or assist in notifying, a family member, personal representative, or other person responsible for your care, about your location, and about your general condition, or your death.

Communication with Family – Using our best professional judgment, we may disclose to a family member, other relative, close personal friend, or any other person you identify, health information relevant to that person’s involvement in your care or in payment for such care if you do not object or in an emergency.

We may use and disclose your protected health information to assist in disaster relief efforts.

Disclosures That Do Not Permit You an Opportunity to Agree or Object to
the Disclosure of your Protected Healthcare Information.

PUBLIC HEALTH ACTIVITIES

Controlling Disease – As required by law, we may disclose your protected health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

Food and Drug Administration (FDA) – We may disclose to the FDA your protected health information relating to adverse events with respect to food, supplements, products and product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacements.

VICTIMS OF ABUSE, NEGLECT, OR DOMESTIC VIOLENCE
We can disclose protected health information to governmental authorities to the extent the disclosure is authorized by statute or regulation and in the exercise of professional judgment the doctor believes the disclosure is necessary to prevent serious harm to the individual or other potential victims.

OVERSIGHT AGENCIES
Federal law allows us to release your protected health information to appropriate health oversight agencies or for health oversight activities to include audits, civil, administrative or criminal investigations: inspections; licensures or disciplinary actions, and for similar reasons related to the administration of healthcare.

JUDICIAL/ADMINISTRATIVE PROCEEDINGS
We may disclose your protected health information in the course of any judicial or administrative proceeding as allowed or required by law, or as directed by a proper court order or administrative tribunal, provided that only the protected health information released is expressly authorized by such an order, or in response to a subpoena, discovery request or other lawful process.

LAW ENFORCEMENT
We may disclose your protected health information for law enforcement purposes as required by law, such as when required by court order, including laws that require reporting of certain types of wounds or other physical injury.

CORONERS, MEDICAL EXAMINERS AND FUNERAL DIRECTORS
We may disclose your protected health information to funeral directors or coroners consistent with applicable law to allow them to carry out their duties.

ORGAN PROCUREMENT ORGANIZATIONS
Consistent with applicable law, we may disclose your protected 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 donation and transplant.

RESEARCH
We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.

THREAT TO HEALTH AND SAFETY
To avert a serious threat to health or safety, we may disclose your protected health information consistent with applicable law to prevent or lessen a serious, imminent threat to the health or safety of a person or the public.

FOR SPECIALIZED GOVERNMENTAL FUNCTIONS
We may disclose your protected health information for specialized government functions as authorized by law such as to Armed Forces personnel, for national security purposes, or to public assistance program personnel.

CORRECTIONAL INSTITUTIONS
If you are an inmate of a correctional institution, we may disclose to the institution or it’s agents the protected health information necessary for your health and the health and safety of other individuals.

WORKERS COMPENSATION
If you are seeking compensation through Workers Compensation, we may disclose your protected health information to the extent necessary to comply with laws relating to Workers Compensation.

Other Uses and Disclosures
Other uses and disclosures besides those identified in this Notice will be made only as otherwise authorized by law or with your written authorization which you may