ADAMS
Phone: (217) 277-2001 Fax: (217) 277-2006
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: Adams County Ambulance & EMS is required
by law to maintain the privacy of certain confidential health care information,
know 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 the Adams County
Ambulance & EMS is permitted to use and disclose PHI about you.
Adams County Ambulance
& EMS 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: The Adams County Ambulance & EMS may use
PHI for the purpose 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 you 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, and creating reports that do not individually
identify you for data collection purposes.
Use and Disclosure
of PHI Without Your Authorization: Adams County
Ambulance & EMS is permitted to use PHI without your written authorization,
or opportunity to object in certain situations, including:
·
For Adams
County Ambulance & EMS 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 a 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 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 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. 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 at our office 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 medial
information, you should contact the office staff or 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 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 office staff or 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.
We are also not
required to give you an accounting of our uses of PHI 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 office staff or 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. Adams County Ambulance &
EMS is not required to agree to any restrictions you request, but any restrictions
agreed to by Adams County Ambulance & EMS are binding on Adams County
Ambulance & EMS.
Internet and
Electronic Mail, and the Right to Obtain a Copy of Paper Notice on Request: We will
prominently post a copy of this Notice on our portion of the
Revisions to the
Notice: Adams County Ambulance & EMS 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 portion of
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 inquires to the Adams County Ambulance & EMS
office staff or 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:
(217) 277-2001
or
Paul Davis, Ambulance Director &
Privacy Office
(217) 277-2001
Effective Date of the
Notice: April 14, 2003