STAUNTON AREA AMBULACE SERVICE, INC.
THIS NOTICE DESCRIBES
HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET
ACCESS TO THIS INFORMATION.
Staunton Area Ambulance Service, Inc. ("Staunton Area Ambulance") 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.
Staunton Area Ambulance Service is
also required to abide by the terms of the version of this Notice currently in
effect.
Uses and Disclosures of PHI:
For treatment. This includes such things as obtaining verbal
and written information about your medical condition and treatment from you as
well as from others, such as doctors and nurses who give orders to allow us to
provide treatment to you. We may give
your PHI to other health care providers involved in your treatment, and may
transfer your PHI via radio or telephone to the hospital or dispatch
center.
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 submitting bills to insurance companies, making
medical necessity determinations and collecting 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, as well as
certain other management functions.
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 to provider information about other services we
provide.
Use and Disclosure of PHI Without Your Authorization. Staunton Area Ambulance
Service is permitted to use PHI without your written authorization, or
opportunity to object, in certain situations, and unless prohibited by a more
stringent state law, including:
Ø For the
treatment, payment or health care operations activities of another health care
provider who treats you;
Ø For health care
and legal compliance activities;
Ø
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, and in certain other circumstances where we are
unable to obtain your agreement and believe the disclosure is in your best
interests;
Ø To a public
health authority in certain situations as required by law (such as to report
abuse, neglect or domestic violence;
Ø 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;
Ø 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;
Ø For law
enforcement activities in limited situations, such as when responding to a
warrant;
Ø For military,
national defense and security and other special government functions;
Ø To avert a
serious threat to the health and safety of a person or the public at large;
Ø For workers'
compensation purposes, and in compliance with workers' compensation laws;
Ø 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;
Ø 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;
Ø For research
projects, but this will be subject to strict oversight and approvals;
Ø We may also 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. 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 your PHI, including:
The
right to access, copy or inspect your PHI.
This means you may 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. You also have the right to receive
confidential communications of your PHI.
If you wish to inspect and copy your medical information, you should
contact our privacy officer.
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 our privacy
officer.
The
right to request an accounting.
You may request an accounting from us of certain disclosures of your
medical information that we have made in the 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, contact our privacy officer.
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. Staunton Area Ambulance Service is not required to agree to any restrictions you request, but any
restrictions agreed to by Staunton Area Ambulance
Service in writing are binding on Staunton
Area Ambulance Service.
Internet,
Electronic Mail, and the Right to Obtain Copy of Paper Notice on Request. We will prominently post a
copy of this Notice on our 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: Staunton Area Ambulance Service 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
our privacy officer.
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 our privacy officer.
Privacy Officer Contact Information:
William Adler, Privacy Officer
Staunton Area Ambulance Service, Inc.
618-635-3290
privacyofficer@staunton-ambulance.org
Effective Date of the Notice:
©2003-2004 Staunton Area Ambulance Service
http://www.staunton-ambulance.org/privacy_statement.htm