MARSHALL/HARRISON COUNTY
AMBULANCE SERVICE PRIVACY NOTICE
WE ARE REQUIRED BY FEDERAL LAW TO KEEP YOUR HEALTH
CARE INFORMATION PRIVATE. THIS NOTICE TELLS YOU HOW WE CAN USE YOUR INFORMATION AND WHAT YOUR
RIGHTS ARE. WE ARE REQUIRED BY LAW TO ABIDE BY THE TERMS OF THIS NOTICE.
PLEASE READ!!!
THIS NOTICE CONTAINS IMPORTANT INFORMATION ABOUT YOUR PRIVACY RIGHTS UNDER THE HEALTH
INFORMATION PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA):
IT TELLS YOU:
·
YOUR PRIVACY RIGHTS TO YOUR PROTECTED HEALTH INFORMATION (PHI)
·
HOW INFORMATION ABOUT YOU CAN BE USED BY US
·
WHEN AND HOW WE CAN GIVE YOUR INFORMATION TO OTHERS
·
HOW YOU CAN GET ACCESS TO YOUR INFORMATION
·
HOW YOU CAN LIMIT USES OF YOUR INFORMATION
·
HOW YOU CAN CORRECT INFORMATION THAT MAY BE ERRONEOUS
·
HOW YOU CAN FIND OUT WHO WE HAVE GIVEN YOUR INFORMATION TO
·
WHO TO CONTACT WITHIN OUR ORGANIZATION FOR INFORMATION OR TO EXERCISE
YOUR RIGHTS
OUR RIGHTS:
We may use your Protected Health Information (PHI) in the following
ways without your consent or authorization:
o
Consent
refers to how we can use your information
o
Authorization
refers to when we pass your information along to others
·
FOR YOUR TREATMENT.
Without your consent or authorization, we will use PHI about you
to treat you. We will try to get a written consent from you if we can, but in emergencies or
when we can’t reasonably get a signed consent from you we may use your information without
it. We will pass your PHI along to other medical personnel involved in your care, including
doctors and nurses at treatment facilities you may be taken to. We may use radio, telephone,
fax, written, and computer communications to transmit this information as needed for your
care. Copies of your patient care records will be given to people at facilities who treat
you. We can disclose information about you to your relatives, friends, and to other
individuals who have a need to know about your condition.
·
FOR PAYMENT
. Without your consent or authorization, we will submit your PHI
to insurance companies, to Medicare or Medicaid as appropriate to obtain payment for our services
to you. We may use an outside billing company to process our claims for payment. We may
use your PHI for determining medical necessity for your treatment, for justifying our treatments of
you for payment purposes, and when an insurance company or other payer requests further information
about you to determine our rights to payment. We may transmit your PHI to a collection agency
hired by us to collect past due accounts.
·
FOR HEALTH CARE OPERATIONS.
Without your consent or authorization we will use your PHI in
Health Care Operations. Health Care Operations means all activities that we use to evaluate
our treatment of you, our employees’ performance in treating you and following our policies and
procedures, and other processes that we engage in for the purposes of improving patient
care. We may use your PHI for Health Care Operations involving:
o
Case reviews
o
Education
o
Obtaining legal and accounting services
o
Business planning
o
Resolving complaints
o
Employee discipline
o
Fundraising and marketing activities, including contacting you to tell
you about services we can offer to you
o
Medical research
o
Data bases which involve your PHI but do not identify your individual
information
o
Reminders of when we have an appointment to transport you
somewhere
·
WHEN REQUIRED BY LAW:
Whenever we are required by law to provide your PHI we will transmit
your PHI to others without either your consent or authorization. Some examples are:
o
To law enforcement officials when necessary to identify you or someone
who has committed a crime against you
o
To law enforcement officials when there is an immediate need for the
information to prevent or solve a crime
o
To public health authorities to report births, deaths, or a disease
that we are required to report
o
To people who may have been exposed to a communicable disease you
have
o
To report child abuse, elder abuse, or domestic violence as
required by law
o
To the FDA and other agencies to report an adverse event from the use
of a drug or medical device
o
To government agencies who have a right to the information for
conducting investigations, audits, inspections, disciplinary proceedings or other
administrative or judicial actions in order to determine our compliance with the law
o
In response to subpoenas, search warrants, and other legal requests or
directives which require us to produce and disclose your PHI
o
To government military, defense, investigative, security,
and other agencies who have a right to your PHI in order to protect citizens, officials of the
United States or a foreign country, and to investigate or prevent terrorist activities
o
To public health officials of the US or foreign countries to avert a
serious threat to the safety and health of the people
o
As required by worker’s compensation laws
·
OTHER USES.
We may use your PHI without your express consent or
authorization for other unnamed uses if they can be reasonably said to fall within any of the
categories listed above.
We have the right to amend this notice, but no amendments may go into
effect until the amended notice has been posted.
YOUR RIGHTS:
You have the right to:
§
COMPLAIN TO US OR TO THE SECRETARY OF HEALTH AND HUMAN SERVICES OF THE
USA IF YOU THINK WE HAVE VIOLATED YOUR RIGHTS.
If you file a complaint:
o
Your complaint must be in writing, either on paper or by email
o
You must address a complaint to us to the Privacy Officer listed at
the bottom of this notice
o
You must address a complaint to the Secretary of Health and Human
Services to: Secretary of Health and Human Services, Washington, D.C.
o
Your complaint must describe the event you are complaining about in
sufficient detail for us to determine what you’re complaining about
o
Your complaint must be filed within 180 days of the occurrence you’re
complaining about or when you first found out about it and tell us whether or not it was us or
somebody else that violated the rules. The Secretary of Health and Human Services may extend
the time for filing.
·
LOOK AT AND COPY YOUR PHI
. You can come to our offices during business hours and request
to look at and copy your medical information, subject to the exceptions provided by law:
o
Exceptions:
§
When disclosure to you would be contrary to law, would be harmful to
you or to someone else
o
We must inform you of why we deny you access to your PHI and let tell
you your rights to appeal our refusal
o
We can charge you reasonable fees for copying your records, postage
for mailing to you, and summarizing your records if you agree to a summary rather than a full set
of records.
o
We must provide your records to you within 30 days of your request if
the records are in our possession, or 60 days if they are in the possession of somebody
else. If we can’t provide the records to you within this time we can have an additional 30
days but we must let you know why we can’t furnish them and tell you when we will furnish them to
you.
§
RESTRICT OUR USE OF YOUR PHI.
You have the right to require us to restrict our use and
disclosure of your PHI with certain exceptions, but we don’t have to agree if any of the following
exceptions applies:
o
Exceptions.
§
We are not required to agree with your request for restriction, but if
we refuse your request we must tell you why we did
§
If we DO agree to your requested restrictions, we must honor them and
must tell all others that we have disclosed your PHI to or will disclose your PHI to about your
restrictions and require them to honor them
§
When we are required by law to disclose your information
§
When your PHI is needed for your treatment in an emergency
§
AMEND YOUR PHI
. If you think your PHI is not correct you can ask us to amend
it, and if we agree we must do so within 60 days from your request. However, we can refuse
your request if:
o
Your records were not created by us
o
We don’t have access to your records or we can’t get access to
them
o
We believe our records are correct
o
Amendment would result in our being unable to obtain payment for
services rendered to you
§
REQUEST AN ACCOUNTING FOR OUR USE AND DISCLOSURES OF YOUR PHI DURING
THE LAST 6 YEARS BEGINNING ON APRIL 14, 2003, THE DATE WHEN HIPAA PRIVACY PROVISIONS TAKE
EFFECT
. However, we will not be required to account for use and
disclosures prior to April 14, 2002. We do not have to account to you for disclosures made in
connection with your treatment, for payment, health care operations or disclosures that we were
required by law to make. You have the right to one free accounting in any 12 month period; for
additional accountings we may charge a reasonable fee.
§
RECEIVE CONFIDENTIAL COMMUNICATIONS FROM US.
If you want us only to contact you at an alternative address,
telephone number, or email address, you can request that we do so and we will abide by your
request.
NO RETALIATION
. WE WILL NOT RETALIATE AGAINST YOU IN ANY WAY FOR EXERCISING ANY
OF YOUR RIGHTS UNDER HIPAA.
HOW TO CONTACT US:
THE PERSON FOR YOU TO CONTACT WITHIN OUR ORGANIZATION IF YOU HAVE ANY QUESTIONS OR
COMPLAINTS, AND TO EXERCISE ANY RIGHTS YOU HAVE UNDER HIPAA IS:
YOU HAVE A RIGHT TO OBTAIN A COPY OF THIS NOTICE IN WRITING BY CONTACTING ANY EMPLOYEE OF
MARSHALL/HARRISON COUNTY AMBULANCE SERVICE.
We will ask you to sign an acknowledgement that you have received this
notice. If you cannot do so, we will make a reasonable attempt later to obtain your
acknowledgment.
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