Effective Date: February 9, 2026

Notice of Privacy Practices

POLICY (Policy No. 6-004)

The privacy practices of Hospice Austin, designed to protect the privacy use and disclosure of protected health information (PHI), are delineated in the organization’s Notice of Privacy Practices which was developed and is used in accordance with Federal requirements. Provision of Notice to Electronic Disclosure

Certain health information maintained by Hospice Austin is protected by federal confidentiality laws, including 42 CFR Part 2, which applies to substance use disorder–related records and provides privacy protections beyond HIPAA.

As required by Section 181.154 of the Health and Safety Code, Hospice Austin will provide notice to patients, notifying each patient that his/her PHI is subject to electronic disclosure.

Hospice Austin may provide general notice by posting a written notice in Hospice Austin’s place(s) of business; posting a notice on our internet website; or posting a notice in any other place where patients whose PHI is subject to electronic disclosure are likely to see the notice.

Notice of Privacy Practices

Revised: July 2, 2025

Original: September 23, 2013

THIS NOTICE DESCRIBES HOW PROTECTED HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

If you have any questions about this notice or our Privacy Practices, please contact: Dan

Sheikh, Hospice Austin Privacy Officer/ Health Information Management Manager, (512) 3424718

Who Will Follow This Notice?

1. CTPCA/Austin Palliative Care providers; and
2. All Hospice Austin entities, employees, volunteers, trainees, and affiliates.

We understand that medical information about you and your health is personal and are committed to protecting this information. When you receive care at HOSPICE AUSTIN, a record of the care and services you receive is made. Typically, this record contains your treatment plan, history and physical, test results, and billing record. This record serves as a:

1. Basis for planning your treatment and services.
2. Means of communication among the physicians and other health care providers involved in your care.
3. Means by which you or a third-party payor can verify that services billed were actually provided.
4. Source of information for public health officials; and
5. Tool for assessing and continually working to improve the care rendered.

This Notice tells you the ways we may use and disclose your Protected Health Information (referred to herein as “medical information”). It also describes your rights and our obligations regarding the use and disclosure of medical information.

Our Responsibilities 

Hospice Austin is required by law to maintain the privacy of your medical information, including substance use disorder records protected by 42 CFR Part 2. If a breach involves information protected by 42 CFR Part 2, we will follow the HIPAA Breach Notification Rule as required by federal law.

Hospice Austin shall:

1. Make every effort to maintain the privacy of your medical information.
2. Provide you with notice of our legal duties and privacy practices with respect to information we collect and maintain about you.
3. Abide by the terms of this notice.
4. Notify you if we are unable to agree to a requested restriction; and
5. Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.
6. Notify you, and the Department of Health & Human Services, of any unauthorized acquisition, access, use or disclosure of your unsecured medical information that presents a significant risk of financial, reputational, or other harm to you, to the extent required by law. Unsecured medical information means medical information not secured by technology that renders the information unusable, unreadable, or indecipherable as required by law.

Ensuring Quality of Care

 

Staff Supervision Agreement 

 

Hospice Austin ensures each patient’s plan of care is followed by Hospice Austin staff members by one or more of the following methods: 

 

1. Bi-weekly review of the plan of care with all the team members providing your care.
2. Supervisory visits to the patient’s home (with permission from the patient).
3. Review of staff members’ patient care notes.

If you have any questions regarding the services provided to you, we invite you to call Hospice Austin administration at (512) 342-4700.

The Methods in Which We May Use and Disclose Medical Information about You

The following categories describe different ways we may use and disclose your medical information. The examples provided serve only as guidance and do not include every possible use or disclosure.

1. For Treatment. We will use and disclose your medical information without authorization to provide, coordinate, or manage your health care and any related service. For

example, we may share your information with your primary care physician or other specialists to whom you are referred for follow-up care.

2. For Payment. We will use and disclose medical information without authorization about you so that the treatment and services you receive may be billed and payment may be collected from you, an insurance company, or a third party. For example, we may need to disclose your medical information to a health plan in order for the health plan to pay for the services rendered to you.
3. For Health Care Operations. We may use and disclose medical information about you for office operations. These uses and disclosures are necessary to run HOSPICE AUSTIN in an efficient manner and ensure that all patients receive quality care. For example, your medical records and health information may be used in the evaluation of services, and the appropriateness and quality of health care treatment. In addition, medical records are audited for timely documentation and correct billing.
4. Appointment Reminders. We may use and disclose medical information in order to remind you of an appointment. For example, Hospice Austin may provide a written or telephone reminder that your next appointment with Hospice Austin is coming up.
5. Research. Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the surgical outcome of all patients for whom one type of procedure is used to those for whom another procedure is used for the same condition. All research projects, however, are subject to a special approval process. Prior to using or disclosing any medical information, the project must be approved through this research approval process. We will ask for your specific authorization if the researcher will have access to your name, address, or other information that reveals who you are, or will be involved in your care.
6. As Required by Law. We will disclose medical information about you when required to do so by federal or Texas laws or regulations.
7. To Avert a Serious Threat to Health or Safety. We may use and disclose medical information about you to medical or law enforcement personnel when necessary to prevent a serious threat to your health and safety or the health and safety of another person.
8. Sale of Organization. We may use and disclose medical information about you to another health care facility or group of physicians in the sale, transfer, merger, or consolidation of our organization.

Special Situations

1. Organ and Tissue Donation. If you have formally indicated your desire to be an organ donor, we may release medical information to organizations that handle procurement of organ, eye, or tissue transplantations.
2. Military and Veterans. If you are a member of the armed forces, we may release medical information about you as required by military command authorities.
3. Workers’ Compensation. We may release medical information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
4. Qualified Personnel. We may disclose medical information for management audit, financial audit, or program evaluation, but the personnel may not directly or indirectly identify you in any report of the audit or evaluation or otherwise disclose your identity in any manner.
5. Public Health Risks. We may disclose medical information about you for public health activities. These activities generally include the following activities: A. To prevent or control disease, injury, or disability.
   1. To report reactions to medications or problems with products.
   2. To notify people of recalls of products they may be using.
   3. To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and
   4. To notify the appropriate government authority if we believe you have been the victim of abuse, neglect, or domestic violence.

All such disclosures will be made in accordance with the requirements of Texas and federal laws and regulations.

6. Health Oversight Activities. We may disclose medical information to a health oversight agency for activities authorized by law. Health oversight agencies include public and private agencies authorized by law to oversee the health care system. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, eligibility, or compliance, and to enforce health-related civil rights and criminal laws.
7. Lawsuits and Disputes. If you are involved in certain lawsuits or administrative disputes, we may disclose medical information about you in response to a court or administrative order. This does not apply to substance use disorder records protected by 42 CFR Part 2, which may not be used in civil, criminal, administrative, or legislative proceedings without patient consent or a Part 2-compliant court order.
8. Law Enforcement. We may release medical information if asked to do so by a law enforcement official, except as limited by federal law, as follows:
   1. Substance use disorder records protected by 42 CFR Part 2 will not be disclosed to law enforcement unless the patient consents or a court order meeting Part 2 requirements is issued; or In the case of substance use disorder records protected by 42 CFR Part 2, disclosures without patient consent are permitted only in the event of a bona fide medical emergency and only to medical personnel to the extent necessary to address that emergency, as permitted by federal law..Coroners, Medical Examiners and Funeral Directors. We may release medical information to a coroner or medical examiner when authorized by law (for example, to identify a deceased person or determine the cause of death), and we may also release medical information to funeral directors. However, federal confidentiality protections for substance use disorder records under 42 CFR Part 2 continue after death, and such information will be disclosed only as permitted by federal law. Inmates. If you are an inmate of a correctional facility, we may release medical information about you to the correctional facility for the facility to provide you treatment.
9. Texas-Specific Disclosures. Under Texas law (Health & Safety Code Ch. 181):
   261. Abuse Reporting: We disclose PHI about victims of abuse/neglect to government authorities as required by **Texas Family Code §261.101**
   262. Minors’ PHI: Parents/guardians generally control minors’ PHI per (Texas Family Code §32.003), except when minors consent to their own treatment (e.g., STI, substance abuse, or mental health care)
10. Electronic Disclosure. Texas law requires that we provide you with notice that your PHI is subject to electronic disclosure (HSC §181.154) Please note that we may use and disclose your medical information electronically. For example, your medical information is maintained on an electronic health record. If another provider providing your treatment requests a copy of your medical record, we may forward such record electronically.
11. Marketing. Marketing generally includes acommunication made to describe a health-related product or service that may encourage you to purchase or use the product or service. For example, marketing includes communications to you about new state-ofthe-art equipment if the equipment manufacturer pays us to send the communication to you. We will obtain your written authorization to use and disclose PHI for marketing purposes unless the communication is made face-to-face, involves a promotional gift of nominal value, or otherwise permitted by law.            

 

All other uses and disclosures of your information for marketing purposes require your written authorization.

12. Sale of your Medical Information. Hospice Austin will not sell your medical information for marketing purposes. However, there are instances in which HOSPICE AUSTIN may disclose PHI in exchange for remuneration to another covered entity for treatment, payment, or certain health care operations. For example, should HOSPICE AUSTIN merge or the organization is sold to another healthcare organization, your medical record may be part of the asset transfer. Any other sale of Protected Health Information requires your written authorization.
13. Other Uses or Disclosures. Any other use or disclosure of PHI not described in this Notice requires your individual written authorization.

This includes, but is not limited to, the following uses or disclosures, which require your authorization:

164. Marketing Communications (as defined by 45 CFR §164.508)
165. Sale of PHI (except for treatment/payment/operations as permitted under 45 CFR §164.502(a)(5))
166. Disclosure of psychotherapy notes (requiring authorization per HIPAA

• 164.508(a)(2)) (where applicable)

164. Commercial fundraising communications (required by 45 CFR §164.514(f))

(if applicable)

We maintain certain health information about you that is protected by federal confidentiality laws, including 42 CFR Part 2. These laws provide additional privacy protections for substance use disorder–related information. When we disclose information protected by these federal rules, special restrictions apply.

The following notice is required by federal law and applies to information disclosed under 42 CFR Part 2:

This information has been disclosed from records protected by federal confidentiality rules (42 CFR Part 2). The federal rules prohibit you from making any further disclosure of this information unless further disclosure is expressly permitted by the written consent of the individual to whom it pertains or as otherwise permitted by 42 CFR Part 2. A general authorization for the release of medical or other information is NOT sufficient for this purpose. The federal rules restrict any use of the information to criminally investigate or prosecute any patient.

You may provide one written consent authorizing us to disclose substance use disorder information for future treatment, payment, and health care operations, as permitted by federal law. You may revoke your authorization in writing at any time, except to the extent that we have already relied on it. YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION 

You have the following rights regarding medical information collected and maintained about you:

Additional Rights for Substance Use Disorder Information (42 CFR Part 2)

Some medical information we maintain about you may be protected by federal confidentiality laws, including 42 CFR Part 2, which apply to substance use disorder–related records. In addition to the rights described below, you have the following rights with respect to information protected by these federal rules:

1. Right to an Accounting of Disclosures. You have the right to receive an accounting of certain disclosures of your substance use disorder information, as permitted by federal law.
2. Right to Request Restrictions. You have the right to request restrictions on certain uses and disclosures of your substance use disorder information. We are not required to agree to all requested restrictions, but we will comply with any restriction that is required by law. Right to Inspect and Copy. The right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records.

 

To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to the Privacy Officer for HOSPICE AUSTIN. If you request a copy of the information, HOSPICE AUSTIN may charge a fee established by the Texas Medical Board for the costs of copying, mailing, or summarizing your records.             

 

HOSPICE AUSTIN may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by HOSPICE AUSTIN will review your request and denial. The person conducting the review will not be the person who denied your request. HOSPICE AUSTIN will comply with the outcome of the review.

3. Right to Amend. If you feel that medical information maintained about you is incorrect or incomplete, you may ask Hospice Austin to amend the information. You have the right to request an amendment for as long as the information is kept by Hospice Austin.

 

To request an amendment, your request must be made in writing and submitted to HOSPICE AUSTIN. In addition, you must provide a reason that supports your request.

 

HOSPICE AUSTIN may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, HOSPICE AUSTIN may deny your request if you ask us to amend information that:

1. Was not created by HOSPICE AUSTIN, unless the person or entity that created the information is no longer available to make the amendment;
2. Is not part of the medical information kept by HOSPICE AUSTIN;
3. Is not part of the information which you would be permitted to inspect and copy; or
4. Is accurate and complete.

4. Right to an Accounting of Disclosures. To request an “accounting of disclosures.” This is a list of the disclosures made of your medical information for purposes other than treatment, payment, or health care operations.      

 

To request this list you must submit your request in writing to Dan Sheikh, Privacy

Officer/Health Information Management Manager    at   4107 Spicewood Springs Rd

#100 Austin, TX 78759, or   HIM@hospiceaustin.org. Your request must state a time period, which may not be longer than six (6) years. Your request should indicate in what form you want the list (for example, on paper or electronically). The first list you request within a 12-month period will be free. For additional lists within the 12-month period, you may be charged for the cost of providing the list. HOSPICE AUSTIN will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

5. Right to Request Restrictions. To request a restriction or limitation on the medical information HOSPICE AUSTIN uses or discloses about you for treatment, payment, or health care operations. You also have the right to request a limit on the medical information HOSPICE AUSTIN discloses about you to someone who is involved in your care or the payment for your care.

 

HOSPICE AUSTIN is not required to agree to your request unless the request pertains solely to a healthcare item or service for which HOSPICE AUSTIN has been paid out of pocket in full. Should HOSPICE AUSTIN agree to your request, HOSPICE AUSTIN will comply with your request unless the information is needed to provide you emergency treatment.       

 

To request restrictions, you must make your request in writing to HOSPICE AUSTIN. In your request, you may indicate: (1) what information you want to limit; (2) whether you want to limit HOSPICE AUSTIN’s use and/or disclosure; and (3) to whom you want the limits to apply.

6. Right to Request Confidential Communications. To request that HOSPICE AUSTIN communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that HOSPICE AUSTIN contact you only at work or by mail.

 

To request that HOSPICE AUSTIN communicate in a certain manner, you must make your request in writing to the Privacy Officer. You do not have to state a reason for your request. HOSPICE AUSTIN will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

7. Right to Revoke an Authorization. There are certain types of uses or disclosures that require your express authorization. For example, HOSPICE AUSTIN may not sell your information to a third party for marketing purposes without first obtaining your authorization. If you provide authorization for a particular use or disclosure of your medical information, you may revoke such authorization in writing by contacting Dan Sheikh, Privacy Officer/Health Information Management Manager    at   4107 Spicewood Springs Rd #100 Austin, TX 78759, or HIM@hospiceaustin.org. We will honor your revocation except to the extent that we have already taken action in reliance of the specific authorization.
8. Right to Receive a Copy of this Document. You have a right to obtain a paper copy of this document upon request.

 

 

HOW TO FILE A COMPLAINT

If you believe your privacy rights have been violated: 

1. Contact our HIPAA Privacy Officer:

 Dan Sheikh | (512) 342-4718  

 4107 Spicewood Springs Rd #100, Austin, TX 78759  

 HA/APC Complaint Intake site: https://hospiceaustin.navexone.com/intake

2. File with U.S. Dept. of HHS:

 200 Independence Ave SW, Washington, DC 20201  

 1-800-368-1019 | www.hhs.gov/ocr   3. File with Texas Attorney General:  

 Consumer Protection Division  

 P.O. Box 12548, Austin, TX 78711-2548  

 1-800-621-0508 | www.texasattorneygeneral.gov  

 

You will not face retaliation for filing a complaint.

CHANGES TO THIS NOTICE

We reserve the right to update our privacy practices. You will be notified of material changes through:

1. Posted notices at all Hospice Austin locations.
2. Updated versions on our website: hospiceaustin.org & www
3. Copies available upon request at our facilities.

Changes apply to all protected health information we maintain.