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.
Purpose
of this Notice: North Conway Ambulance Inc./Valley Transfer
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 North Conway Ambulance Inc./Valley Transfer
Inc. is permitted to use and disclose PHI about you.
North
Conway Ambulance Inc./Valley Transfer 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: North Conway Ambulance Inc./Valley
Transfer 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. North
Conway Ambulance Inc./Valley Transfer Inc. is permitted to use PHI without
your written authorization, or opportunity to object in certain
situations, including:
·
For North Conway Ambulance Inc./Valley Transfer Inc. use in
treating you or in obtaining payment for services provided to you or
in other health care operations;
·
For the treatment activities of another health care
provider;
·
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. North Conway Ambulance Inc./Valley
Transfer Inc. is not required to agree to any restrictions you
request, but any restrictions agreed to by North Conway Ambulance
Inc./Valley Transfer Inc. are binding on North Conway Ambulance
Inc./Valley Transfer 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: North Conway Ambulance Inc./Valley Transfer 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:
William
Riley, Operations Manager
North Conway Ambulance Inc.
Valley Transfer Inc.
PO Box 2787
North Conway, NH 03860
603-356-5248
Effective/Updated
Date of the Notice: March 14, 2006
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