Notice
of Privacy Practices
IMPORTANT: 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.
As an essential part of our commitment to you,
The Notice outlines our legal duties and privacy
practices respect to your PHI. It not
only describes our privacy practices and your legal rights, but lets you know,
among other things, how
PLEASE READ THE ATTACHED DETAILED NOTICE. IF YOU HAVE ANY QUESTIONS ABOUT IT, PLEASE
CONTACT
Purpose of this Notice: PLYMOUTH AMBULANCE SERVICE INC. is required by law to maintain the
privacy of certain confidential health care information, known as Protected
Health Information or PHI, and to provide you with a notice of our legal duties
and privacy practices with respect to your PHI. This Notice describes your
legal rights, advises you of our privacy practices, and lets you know how
PLYMOUTH AMBULANCE SERVIC E INC. is permitted to use and disclose PHI about
you.
PLYMOUTH AMBULANCE SERVICE INC. is
also required to abide by the terms of the version of this Notice currently in
effect. In most situations we may use this information as described in this
Notice without your permission, but there are some situations where we may use
it only after we obtain your written authorization, if we are required by law
to do so.
Uses and Disclosures of PHI: PLYMOUTH AMBULANC SERVICE INC. may use PHI for the
purposes of treatment, payment, and health care operations, in most cases
without your written permission.
Examples of our use of your PHI:
For treatment. This includes
such things as verbal and written information that we obtain about you and use
pertaining to your medical condition and treatment provided to you by us and
other medical personnel (including doctors and nurses who give orders to allow
us to provide treatment to you). It also includes information we give to other
health care personnel to whom we transfer your care and treatment, and includes
transfer of PHI via radio or telephone to the hospital or dispatch center as
well as providing the hospital with a copy of the written record we create in
the course of providing you with treatment and transport.
For payment. This includes
any activities we must undertake in order to get reimbursed for the services we
provide to you, including such things as organizing your PHI and submitting
bills to insurance companies (either directly or through a third party billing
company), management of billed claims for services rendered, medical necessity
determinations and reviews, utilization review, and collection of outstanding
accounts.
For health care operations. This includes
quality assurance activities, licensing, and training programs to ensure that
our personnel meet our standards of care and follow established policies and
procedures, obtaining legal and financial services, conducting business
planning, processing grievances and complaints, creating reports that do not
individually identify you for data collection purposes, fundraising, and
certain marketing activities.
Reminders for Scheduled Transports and Information on
Other Services. We may also contact you to provide you with a reminder
of any scheduled appointments for non-emergency ambulance and medical
transportation, or for other information about alternative services we provide
or other health-related benefits and services that may be of interest to you.
Use and Disclosure of PHI Without
Your Authorization. PLYMOUTH AMBULANCE SERVICE INC. is permitted
to use PHI without your written
authorization, or opportunity to object in certain situations, including:
·
For
·
To
another health care provider or entity for the payment activities of the
provider or entity that receives the information (such as your hospital or
insurance company);
·
To
another health care provider (such as the hospital to which you are
transported) for the health care operations activities of the entity that
receives the information as long as the entity receiving the information has or
has had a relationship with you and the PHI pertains to that relationship;
·
For
health care fraud and abuse detection or for activities related to compliance
with the law;
·
To a
family member, other relative, or close personal friend or other individual
involved in your care if we obtain your verbal agreement to do so or if we give
you an opportunity to object to such a disclosure and you do not raise an
objection. We may also disclose health
information to your family, relatives, or friends if we infer from the
circumstances that you would not object.
·
For
example, we may assume you agree to our disclosure of your personal health
information to your spouse when your spouse has called the ambulance for
you. In situations where you are not
capable of objecting (because you are
not present or due to your incapacity or medical emergency), we may, in our
professional judgment, determine that a disclosure to your family member,
relative, or friend is in your best interest. In that situation, we will
disclose only health information relevant to that person's involvement in your
care.
·
For
example, we may inform the person who accompanied you in the ambulance that you
have certain symptoms and we may give that person an update on your vital signs
and treatment that is being administered by our ambulance crew;
·
To a
public health authority in certain situations (such as reporting a birth, death
or disease as required by law, as part of a public health investigation, to
report child or adult abuse or neglect or domestic violence, to report adverse
events such as product defects, or to notify a person about exposure to a
possible communicable disease as required by law;
·
For
health oversight activities including audits or government investigations,
inspections, disciplinary proceedings, and other administrative or judicial
actions undertaken by the government (or their contractors) by law to oversee
the health care system;
·
For
judicial and administrative proceedings as required by a court or
administrative order, or in some cases in response to a subpoena or other legal
process;
·
For law
enforcement activities in limited situations, such as when there is a warrant
for the request, or when the information is needed to locate a suspect or stop
a crime;
·
For
military, national defense and security and other special government functions;
·
To
avert a serious threat to the health and safety of a person or the public at
large;
·
For
workers’ compensation purposes, and in compliance with workers’ compensation
laws;
·
To
coroners, medical examiners, and funeral directors for identifying a deceased
person, determining cause of death, or carrying on their duties as authorized
by law;
·
If you
are an organ donor, we may release health information to organizations that
handle organ procurement or organ, eye or tissue transplantation or to an organ
donation bank, as necessary to facilitate organ donation and transplantation;
·
For
research projects, but this will be subject to strict oversight and approvals
and health information will be released only when there is a minimal risk to
your privacy and adequate safeguards are in place in accordance with the law;
·
We may
use or disclose health information about you in a way that does not personally
identify you or reveal who you are.
Any other use or disclosure of PHI, other than those
listed above will only be made with your written authorization, (the
authorization must specifically identify the information we seek to use or
disclose, as well as when and how we seek to use or disclose it). You may revoke your authorization at any
time, in writing, except to the extent that we have already used or disclosed
medical information in reliance on that authorization.
Patient Rights: As a patient,
you have a number of rights with respect to the protection of your PHI,
including:
The right to access, copy or
inspect your PHI. This means you may come to our offices and
inspect and copy most of the medical information about you that we
maintain. We will normally provide you
with access to this information within 30 days of your request. We may also charge you a reasonable fee for
you to copy any medical information that you have the right to access. In limited circumstances, we may deny you
access to your medical information, and you may appeal certain types of
denials.
We have available forms to request access to your PHI
and we will provide a written response if we deny you access and let you know
your appeal rights. If you wish to
inspect and copy your medical information, you should contact the privacy
officer listed at the end of this Notice.
The right to amend your PHI. You have the
right to ask us to amend written medical information that we may have about
you. We will generally amend your
information within 60 days of your request and will notify you when we have
amended the information. We are
permitted by law to deny your request to amend your medical information only in
certain circumstances, like when we believe the information you have asked us
to amend is correct. If you wish to
request that we amend the medical information that we have about you, you
should contact the privacy officer listed at the end of this Notice.
The right to request an
accounting of our use and disclosure of your PHI. You may
request an accounting from us of certain disclosures of your medical
information that we have made in the last six years prior to the date of your
request. We are not required to give you
an accounting of information we have used or disclosed for purposes of
treatment, payment or health care operations, or when we share your health information
with our business associates, like our billing company or a medical facility
from/to which we have transported you.
We are also not required to give you an
accounting of our uses of protected health information for which you have
already given us written authorization.
If you wish to request an accounting of the medical information about
you that we have used or disclosed that is not exempted from the accounting
requirement, you should contact the privacy officer listed at the end of this
Notice.
The right to request that we
restrict the uses and disclosures of your PHI. You have the right to request that we restrict how
we use and disclose your medical information that we have about you for
treatment, payment or health care operations, or to restrict the information
that is provided to family, friends and other individuals involved in your
health care. But if you request a
restriction and the information you asked us to restrict is needed to provide
you with emergency treatment, then we may use the PHI or disclose the PHI to a
health care provider to provide you with emergency treatment. PLYMOUTH AMBULANCE SERVICE INC. is not
required to agree to any restrictions you request, but any restrictions agreed to
by PLYMOUTH AMBULANCE SERVICE INC. are binding on PLYMOUTH AMBULANCE SERVICE
INC.
Internet, Electronic Mail, and
the Right to Obtain Copy of Paper Notice on Request. If
we maintain a web site, we will prominently post a copy of this Notice on our
web site and make the Notice available electronically through the web
site. If you allow us, we will forward
you this Notice by electronic mail instead of on paper and you may always
request a paper copy of the Notice.
Revisions to the Notice: PLYMOUTH
AMBULANCE SERVICE INC. reserves the
right to change the terms of this Notice at any time, and the changes will be
effective immediately and will apply to all protected health information that
we maintain. Any material changes to the
Notice will be promptly posted in our facilities and posted to our web site, if
we maintain one. You can get a copy of
the latest version of this Notice by contacting the Privacy Officer identified
below.
Your Legal Rights and
Complaints: You also have the right to complain to us, or to the
Secretary of the United States Department of Health and Human Services if you
believe your privacy rights have been violated. You will not be retaliated
against in any way for filing a complaint with us or to the government. Should you have any questions, comments or
complaints you may direct all inquiries to the privacy officer listed at the
end of this Notice. Individuals will not
be retaliated against for filing a complaint.
If you have any questions or if you wish to file a
complaint or exercise any rights listed in this Notice, please contact our
privacy officer:
Effective Date of the Notice: