S
TAT CARE AMBULANCE SERVICESNotice of Privacy Practices
THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
Purpose of this Notice:
Stat Care 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.Uses and Disclosures of PHI:
Stat Care Ambulance may use PHI for the purposes of treatment, payment, and health care operations, in most cases without your written permission. Some 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.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 companiesFor 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,Use and Disclosure of PHI Without Your Authorization:
Stat Care Ambulance is permitted to use PHI without your written or verbal authorization, in certain situations, some of which include:• For Stat Care Ambulance’s use during your treatment, in obtaining payment for services provided to you and/or in other health care operations;
• 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 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 involved in your care if we obtain your verbal agreement to do so. We may also disclose health information to your family, relatives, or friends if we infer from the circumstances that you would not object
• To a public health authority in certain situations (such as reporting a birth, death or disease as required by law, to report child or adult abuse or neglect and domestic violence;
• For judicial and administrative proceedings as required by a court or in response to a subpoena or other legal process;
• If you are an organ donor, we may release health information to organizations that handle organ donation and transplantation;
• We may use or disclose health information about you in a way that does not personally identify you or reveal who you are.
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 office 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. 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.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.The right to request an accounting of our use and disclosure of your PHI:
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.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. Stat Care Ambulance is not required to agree to any restrictions you request, but any restrictions agreed to by Stat Care Ambulance are binding on Stat Care Ambulance.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. You may direct all inquiries to the Ambulance Officer listed at the end of this Notice. Individuals will not be retaliated against for filing a complaint.Revisions to the Notice:
Stat Care Ambulance 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. If you have any questions, or if you wish to file a complaint or exercise any rights listed in this Notice, please contact:Jason Haldeman
EMS Chief
Stat Care Ambulance
288 Kelton Rd
West Grove PA 19390
610-255-5915
Effective Date 01/04/07