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, County Ambulance,
Inc.
maintains the privacy of certain confidential health care
information about you, known as Protected Health Information
or PHI. We are required by law to protect your health care
information and to provide you with the attached Notice of
Privacy Practices.
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
County Ambulance, Inc.
is permitted to use and disclose PHI about you, how you can
access and copy that information, how you may request
amendment of that information, and how you may request
restrictions on our use and disclosure of your PHI.
County
Ambulance, 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.
We
respect your privacy, and treat all health care information
about our patients with care under strict policies of
confidentiality that all of our staff are committed to
following at all times.
PLEASE
READ THE ATTACHED DETAILED NOTICE. IF YOU HAVE ANY QUESTIONS
ABOUT IT, PLEASE CONTACT LUANNE WEISKOTTEN, OUR PRIVACY
OFFICER, AT (413)499-2527.
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:
County
Ambulance, 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 County
Ambulance, Inc. is permitted to use and disclose PHI about
you.
County
Ambulance, 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:
County Ambulance, 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.
Fundraising.
We may
contact you when we are in the process of raising funds for
County Ambulance, Inc. , or to provide you with information
about our annual subscription program.
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.
County Ambulance, Inc. is permitted to use PHI without
your written authorization, or opportunity to object in
certain situations, including:
·
For
County Ambulance, Inc. ’s 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. County Ambulance, Inc.
is not required to agree to any restrictions you request, but
any restrictions agreed to by County Ambulance, Inc. are
binding on County Ambulance, 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:
County Ambulance, 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:
Luanne Weiskotten
County Ambulance, Inc.
P.O. Box 752
Pittsfield, MA 01202
(413)499-2527
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An Evolving Service 
