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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,
Bellefonte Emergency Medical Services 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 with respect to your PHI. It not only
describes our privacy practices and your legal
rights, but lets you know, among other things, how
Bellefonte Emergency Medical Services 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.
Bellefonte Emergency Medical Services 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 OUR
PRIVACY OFFICER, AT 814-355-2907.
Purpose of This Notice:
Bellefonte Emergency Medical Services
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
Bellefonte Emergency Medical Services is permitted
to use and disclose PHI about you.
Bellefonte Emergency Medical Services 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:
Bellefonte Emergency Medical Services 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 Bellefonte Emergency
Medical Services, 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.
Bellefonte Emergency Medical Services is permitted
to use PHI without your written
authorization, or opportunity to object in certain
situations, including:
-
For Bellefonte Emergency Medical
Service’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;
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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, such as 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. Bellefonte Emergency Medical
Services is not required to agree to any
restrictions you request, but any restrictions
agreed to by Bellefonte Emergency Medical Services
are binding on Bellefonte Emergency Medical
Services.
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:
Bellefonte Emergency Medical Services 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:
Privacy Officer
Bellefonte Emergency Medical
Services
369 Phoenix Ave
Bellefonte, PA 16823
814-355-2907
Effective Date of the Notice: Aug 5, 2009
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