Firelands Ambulance Service Privacy Practices
HOW WE MAY USE AND DISCLOSE YOUR PERSONAL HEALTH INFORMATION
USE AND DISCLOSURE THAT DOES NOT REQUIRE YOUR AUTHORIZATION
Uses and Disclosure for Treatment. We will make uses and disclosures of your personal health information as necessary for your treatment. For instance paramedics/EMT’s and others involved in your care, will use information in your medical record and that you provide to plan and care for you. We also may release your personal health information to another health care facility or professional who is not affiliated with our organization, but who is or will be providing treatment to you. For instance – emergency room personnel.
Uses and Disclosures for Payment. We will make uses and disclosures of your personal health information as necessary for the payment of pre-hospital care and emergency ambulance transportation. For example, we will give information to our billing department and to your health plan or to you or the person responsible for your payment to get paid for the services provided to you. We may give your information to our billing company and to your health plan or to you or the person responsible for your payment to get paid for the service provided to you. We may give your information to our business associates, such as billing companies, claims processing companies, law firms, collections agencies, and others that process our health care claims. We may also give your information to another health care provider who has treated you for their payment purpose.
Uses and Disclosures for Health Care Operations. We will use and disclose your personal health information as necessary and as permitted by law, for our health care operations. These include quality improvement/assurance, critical incident debriefing, accrediting, licensing, business management, etc. We may provide information about you to our accountants, attorneys, consultants and others in order to make sure we are complying with laws that affect us. We may also disclose your information to another health care facility, health care professional or health plan for their health care operations if they have or had a patient relationship with you.
USES AND DISCLOSURES PERMITTED OR REQUIRED BY LAW
For Public Health Activities. For example, we may release your personal health information about deaths and various government officials in charge of collecting that information, and we give coroners, medical examiners and funeral directors necessary information relating to death.
When Required by Federal, State or Local Law, Judicial or Administrative Proceedings or Law Enforcement. We may release your personal health information for any purpose required by law. For example, we may release your information when a law requires that we report information to the government or law enforcement personnel about victims of abuse, neglect or domestic violence; when dealing with gunshots or other wounds or when ordered by a court.
For Health Oversight Activities. For example, we will provide information to assist the government when it conducts and audit, investigation inspection or civil/criminal proceeding regarding a health care provider or organization. We may release your information to the Food and Drug Administration if necessary to report adverse events, product defects or to participate in product recalls.
To Avoid Harm. In order to avoid a serious threat to the health or safety of a person or the public, we may give your information to law enforcement personnel or person able to prevent or lessen such harm.
For Employee Health and Workers Compensation Purposes. We may release your personal health information to your employer when we have provided health care at your employer’s request to determine workplace-related illness/injury. In most cases you will receive notice that the information is disclosed to your employer. We may release information in order to comply with workers’ compensation laws.
Legal Actions. We may release your personal health information if required to do so by subpoena or discovery request. In some cases, you will have notice of such release.
Business Associates. Certain aspects of our services are performed through contracts with outside people or organizations such as auditing, legal services, etc. At times it may be necessary for us to provide you information to one or more of these outside people or organizations who assist us with our health care operations.
YOU HAVE THE OPPURTUNITY TO OBJECT TO THESE DISCLOSURES.
Disclosures to family, friends or others. We may provide your information to a family member, friend or their person that you indicate is involved in your care or the payment for your health care, unless you object and fill out the appropriate form.
YOUR HELATH INFORMATION RIGHTS.
The Right to Request Limits on How We Use and Disclose Your Health Information. You have the right to ask that we limit certain uses and disclosures of your information for treatment, payment or health care operations. A restriction request form can be obtained from Firelands Ambulance Service. We will carefully consider your request. We are not required to agree to your restriction request, but will attempt to accommodate reasonable request when appropriate. We retain the right to terminate an agreed restriction if we believe such termination is appropriate. If we terminate, we will notify you. You have the right to terminate in writing or orally, any agreed to restriction by contacting Firelands Ambulance Service, 25 James St, New London, Ohio 44851.
The Right to Correct or Update Your Health Information. You have the right to request in writing that personal health information that we maintain about you be amended or corrected. We are not obligated to make all requested amendments, but will carefully consider each. All amendment requests must be in writing, signed by you or your representative, and must state the reasons for the amendment. If an amendment you request is made by us, we may notify others who work with us and have copies of the uncorrected record if we believe that such notification is necessary. You may obtain an amendment request form from Firelands Ambulance Service, 25 James St. New London, Ohio 44851.
The Right to Access Your Personal Health Information. You have the right to copy and/or inspect much of the personal health information that we retain on your behalf. All request for access must be made in writing and signed by you or your representative. Some processing fees may apply. You may obtain an access form from Firelands Ambulance Service, 25 James St. New London, Ohio 44851.
The Right to Accounting for Disclosure of Your Health Information. You have the right to receive an accounting of certain disclosures made by us of your personal health information after April 14, 2003. Requests must be made in writing and signed by you or your representative. Accounting request forms are available from Firelands Ambulance Service, 25 James St. New London, Ohio 44851. Some fees may apply.
The Right to Choose How We Send Your Information to You. You have the right to ask that we send information to an alternate address. For example, you may ask us to send information to your work address rather than your home address. You can also ask that it be sent by alternate means. For example, you can ask that we send information by fax instead of regular mail. We will agree to your request if we can easily provide it in the format you request.
The Right to Get this Notice. You will be asked to acknowledge that you have received this Notice of Privacy Practices. You have the right to request a paper copy of this notice.
CHANGES TO THE POLICY
If our policy should change at any time in the future, we will change and post the new notice.
If you believe that your privacy rights have been violated, you can file a complaint with the person listing in Section VII below. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services in writing within 180 days of a violation of your rights. There will be no action taken against you if you file a complaint about our privacy practices.
FOR FURTHER INFORMATION
If you have any questions or need further assistance regarding this Notice, you may contact Firelands Ambulance Service, 25 James St. New London, Ohio 44851.
THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAYBE USED AND DISCLOSED AND HOW YOU CAN ACCESS YOUR MEDICAL INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice of Privacy Practices applies to Firelands Ambulance Service. All employees of Firelands Ambulance Service will share personal health information of our patients as necessary to carry out treatment, payment, and health care operations as permitted by law.
WE HAVE A LEGAL DUTY TO PROTECT YOU PERSONAL HEALTH INFORMATION.
We are required by law to maintain the privacy of our patient’s personal health information and to provide patients with notice of our legal duties and privacy practices with respect to your personal health information. We are required to abide by the terms of this Notice so long as it remains in effect. We reserve the right to change the terms of this Notice of Privacy Practices as necessary to make the new Notice effective for all personal health information maintained by us. You may receive a copy of any revised notices by mailing a request to Firelands Ambulance Service, 25 James St. New London, Ohio 44851