Use and Disclosure of Health Information
CareSource may use your health information, information that constitutes protected health information as defined in the Privacy Rule of the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996, for purposes of providing you treatment, obtaining payment for your care and conducting health care operations. CareSource has established policies to guard against unnecessary disclosure of your health information.

THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCE UNDER WHICH AND PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED:

1. To provide treatment
2. To obtain payment
3. To conduct health care operations
4. For fundraising activities
5. For appointment reminders
6. For treatment alternatives
7. When legally required
8. When there are risks to public health
9. To report abuse, neglect or domestic violence
10. To conduct health oversight activities
11. In connection with Judicial and administrative proceedings
12. For law enforcement purposes
13. To coroners and medical examiners
14. To funeral directors
15. For organ, eye or tissue donation
16. For research purposes
17. In the event of a serious threat to health or safety
18. For specified government functions
19. For worker's compensation

CareSource may disclose certain information about you including your name, your general health status, your religious affiliation and where you are in The Residence. The hospice 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.

Authorization to use or disclose health information
Other than stated above, CareSource will not disclose your health information other than with your written authorization. If you or your representative authorizes CareSource 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 CareSource maintains:

1. Right to request restrictions
2. Right to receive confidential communications
3. Right to inspect and copy your health information
4. Right to amend health care information
5. Right to an accounting
6. Right to a paper copy of this notice

Duties of CareSource
CareSource 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. CareSource is required to abide by the terms of this notice as may be amended from time to time. CareSource 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 CareSource changes its notice, CareSource will provide a copy of the revised notice to you or your appointed representative. You and your personal representative have the right to express complaints to CareSource and the Secretary of DHHS if you or your representative believe that your privacy rights have been violated. Any complaints to CareSource should be made in writing to the Privacy Officer at 1624 East 4500 South, Salt Lake City, Utah 84117 or through e-mail at webmaster@ecaresource.com. The Privacy Officer is CareSource's contact person for all issues regarding patient privacy and your rights under the Federal privacy standards. CareSource encourages you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way for filing a complaint.