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					         NOTICE OF RAINBOW HOSPICE PRIVACY PRACTICES

                          USE AND DISCLOSURE OF HEALTH INFORMATION


Rainbow Hospice has established policies to guard against unnecessary disclosure of your medical
information. This notice describes how medical information about you may be used and disclosed and
how you can access this information. Please review it carefully. The following is a summary of the
circumstances under which your medical information may be used and disclosed:

To Provide Treatment. Rainbow Hospice will use your medical information to coordinate care within
Rainbow Hospice and with others involved in your care, such as your attending physician, members of
the Rainbow Hospice interdisciplinary team, and other health care professionals who have agreed to
assist Rainbow Hospice in coordinating care. For example, physicians involved in your care will need
information about your symptoms in order to prescribe appropriate medications. Rainbow Hospice also
may disclose your medical information to individuals outside of the hospice who are involved in your
care, including family members, clergy, pharmacists, suppliers of medical equipment, or other health
care professionals.

To Obtain Payment. Rainbow Hospice will include your medical information in invoices to collect
payment from third parties for the care you receive. For example, Rainbow Hospice may be required
by your health insurer to provide information regarding your health care status so that the insurer will
reimburse the hospice. Rainbow Hospice also 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. Rainbow Hospice may use and disclose medical information in
order to operate the hospice and, as necessary, to provide quality care to all of the hospice’s patients.
Health care operations include such activities as:

               Quality assessment and improvement activities;
               Procedure development, case management and care coordination;
               Professional review and performance evaluation;
               Training programs including those in which students, trainees, or
                practitioners in health care learn under supervision;
               Accreditation, certification, licensing or credentialing activities;
               Review and auditing, including compliance reviews, medical reviews,
                legal services and compliance programs;
               Business management and general administrative activities of Rainbow
                Hospice;
               Fundraising for the benefit of Rainbow Hospice; and
               Marketing information about Rainbow Hospice.
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For example, Rainbow Hospice may use your medical information to evaluate its staff performance,
combine your health information with other hospice patients’ information in evaluating how to more
effectively serve all hospice patients, disclose your medical information to Rainbow Hospice staff and
contracted personnel for training purposes, use your medical information to contact you as a reminder
regarding a visit to you, or contact you as part of general fundraising and community information
mailings.

For Fundraising Activities. Rainbow Hospice may use information about you including your name,
address, phone number and the dates you received care in order to contact you or your family to raise
money for the hospice. If you do not want Rainbow Hospice to contact you or your family, please notify
the Director of Development at 847-685-9900 and indicate that you do not wish to be contacted.

Business Associates. We provide some services through other persons or companies that need
access to your medical information to carry out these services. The law refers to these persons or
companies as our Business Associates. Examples of these Business Associates include the
accreditation programs and medical records storage facility. We may disclose your medical information
to our Business Associates so that they can do the job we have contracted with them to do. We require
that they use appropriate safeguards to ensure the privacy of your medical information.

Health Oversight Activities and Specialized Government Functions. We may disclose your
medical information to an agency that oversees healthcare systems and ensures compliance with the
rules of government health programs, such as Medicare or Medicaid, and under certain circumstances
to the U.S. Military or U.S. Department of State.

Law Enforcement Officials, Medical Examiners and Coroners, and Court or Administrative
Orders. We may disclose your medical information to the police, other law enforcement officials,
medical examiners and coroners, and to the courts or administrative proceedings as allowed or
required by law, or required by a court order or other legal process.

Notification and Other Communications with Your Relatives, Close Friends, or Caregivers. You
or your legal representative must tell your physician, nurse, or other healthcare team members which of
your relatives or other persons may or may not receive information about you. After learning who these
persons are, we may, using our best judgment, use and disclose your medical information to notify
these persons of what they need to know to care for you. In an emergency or other situation where you
are not able to identify your chosen person to receive communications about you, we may exercise our
professional judgment to determine whether such a disclosure is in your best interest, who is the
appropriate person, and what medical information is relevant to their involvement with your healthcare.

Funeral Directors and Organ, Eye, and Tissue Organizations. We may disclose your medical
information to funeral directors as necessary to carry out their duties and as allowed by law. We may
also disclose your health information to organizations that facilitate organ, eye, or tissue procurement,
banking, or transplantation.

Public Health Activities. We may report your identity and other medical information to: public health
authorities for the purpose of controlling disease, injury, or disability; the U.S. Food and Drug
Administration for regulating certain products or activities; governmental authorities about suspected or
known child or elder abuse and neglect, or domestic violence; a person exposed to a contagious
disease or has the risk of contracting or spreading disease; your employer and governmental agencies
as required by federal and state laws regarding work-related illness or injury; to prevent or lessen a
serious or imminent threat to a person’s or the public’s health or safety; or to a public or private entity
that is authorized to assist in disaster relief efforts.



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Research. With your authorization, we may use or disclose your medical information to identify you as
a potential candidate for a research study that has been approved by an Institutional Review Board or
for governmental research studies in which your identifiable information will not be released.

Workers’ Compensation. We may disclose your medical information as allowed or required by Illinois
law relating to Workers’ Compensation or to other similar programs.

Other Communications With You. We may contact you to remind you of appointments with
physicians or other healthcare team members and to follow up on the services you received. We may
leave messages about appointments or other reminders on your telephone or with a person who
answers the phone. Rainbow Hospice may also use your medical information to tell you about or
recommend possible treatment options or alternatives that may be of interest to you.


                 YOUR RIGHTS WITH RESPECT TO YOUR MEDICAL INFORMATION

Other than as stated above, Rainbow Hospice will not disclose your medical information without your
written authorization. You have the following rights regarding your medical information contained in the
medical record that Rainbow Hospice keeps about you:

Right to request restrictions. You may request restrictions on certain uses and disclosures of your
medical information. You have the right to request a limit on Rainbow Hospice’s disclosure of your
health information to someone who is involved in your care or the payment of your care. However,
Rainbow Hospice is not required to agree to your request. If you wish to make a request for
restrictions, please contact the Rainbow Hospice Privacy Officer at 847-685-9900.

Right to receive confidential communications. You have the right to request that Rainbow Hospice
communicate with you in a certain way. For example, you may ask that we not leave phone messages
for you at work. If you wish to receive confidential communications in a specific way, please contact the
Rainbow Hospice Privacy Officer at 847-685-9900. Rainbow Hospice will not request that you provide
any reasons for your request and will attempt to honor your reasonable requests regarding confidential
communications.

Right to inspect and copy your medical information. You have the right to inspect and copy your
medical records, including billing records. A request to inspect and copy records containing your
medical information may be made to the Rainbow Hospice Privacy Officer at 847-685-9900. If you
request a copy of your medical information, the Hospice may charge a reasonable fee for copying and
assembling costs associated with your request.

Right to amend medical information. You or your representative have the right to request that
Rainbow Hospice amend your records if you believe that your medical 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 Rainbow Hospice Privacy Officer.
Rainbow 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 medical information records were not created by
Rainbow 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 medical information you or your representative are
permitted to inspect and copy, or if, in the opinion of Rainbow Hospice, the records containing your
medical information are accurate and complete.




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Right to an accounting. You or your representative have the right to request an accounting of
disclosures of your medical information made by Rainbow 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 Rainbow Hospice Privacy Officer. 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. Rainbow 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 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 Rainbow Hospice Privacy Officer, at 847-685-
9900. You or your representative may also obtain a copy of the current version of Rainbow Hospice’s
Notice of Privacy Practices on our website at http://www.rainbowhospice.org.

Right to revoke consent. You have the right to revoke your written consent/authorization to use or
disclose your medical information except when the disclosure has already happened. If you wish to
revoke consent, please contact the Rainbow Hospice Privacy Officer at 847-685-9900.


                                         DUTIES OF THE HOSPICE

Rainbow Hospice is required by law to:

               Make sure that your medical information is protected;
               Give you this Notice, which describes your medical privacy rights and our
                duties to maintain the privacy of your medical information;
               Follow the terms of the Notice that is currently in effect; and
               Notify you if we are unable to agree to your requested restrictions on
                disclosure of your medical information.

You or your representative have the right to express complaints to Rainbow Hospice and to the
Secretary of the Department of Health and Human Services if you or your representative believe that
your privacy rights have been violated. Any complaints to Rainbow Hospice should be made in writing
to the Rainbow Hospice Privacy Officer. Rainbow Hospice encourages you to express any concerns
you may have regarding the privacy of your medical information. You will not be retaliated against in
any way for filing a complaint.

Rainbow Hospice reserves the right to change our privacy practices and to use a new Notice of Privacy
Practices for all health information we maintain about you. Rainbow Hospice will post the latest copy of
its privacy practices at our offices and on our website. The Notice will contain an effective date and will
be available upon request.

CONTACT PERSON

Rainbow Hospice has designated a Privacy Officer, Jennifer Aitken, as its contact person for all issues
regarding patient privacy and your rights under the Federal privacy standards. You may contact her at
Rainbow Hospice by phone at 847-685-9900, by mail at 444 North Northwest Highway, Suite 145, Park
Ridge, IL 60068, or online at http://www.rainbowhospice.org.

EFFECTIVE DATE

This Notice is effective April 14, 2003.

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