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Patient
Privacy Notice
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:
911 Billing Services by their contracts with ambulance 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 911 Billing Services is
permitted to use and disclose PHI about you. 911 Billing
Services is also required to abide by the terms of the version
of this Notice currently in effect. We may use this information
after we obtain your consent, and in emergency and other
situations without your immediate consent.
Uses and
Disclosures of PHI:
911 Billing Services may use PHI for the purposes of treatment,
payment, and other health care operations. 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 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.
Use and
Disclosure of PHI Without Your Consent.
911 Billing Services is authorized to use PHI without
your consent, authorization, or written permission in certain
situations, including:
·
Emergency
situations (in these situations, in accordance with the law we
will attempt to get your written consent after the emergency
service is provided and we would appreciate your cooperation
when we do so);
·
To a
relative, friend or individual involved in your care;
·
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 to a person or the
public at large;
·
For workers’
compensation purposes, in compliance with workers’ compensation
laws.
Any other
use or disclosure of PHI, other than those listed above will
only be made with your written consent or an authorization (an
authorization specifically identifies 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 consent or authorization at
any time, in writing, except to the extent that we have already
used or disclosed medical information in reliance on that
consent or 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 certain types of denials may be
appealed. We have available forms to request PHI and 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. You can appeal our
denial of your request to amend the information. If you wish to
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 disclosures 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 of
uses or disclosures made prior to April 14, 2003. If you wish
to request an accounting of the medical information about you
that we have used or disclosed, 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 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. 911 Billing Services is not
required to agree to any restrictions you request, but any
restrictions agreed to by 911 Billing Services are binding on
911 Billing Services.
Legal Rights
and Complaints:
Notice of any changes in 911 Billing Service’s privacy policy
may be shown directly on the consent form and this Notice will
be updated when any significant changes in our privacy practices
occur. 911 Billing Services reserves the right to change the
terms of this Notice at any time, and the changes will be
effective immediately. We also reserve the right to make any
changes effective for PHI that we have created or received prior
to the effective date of the Notice provision that was changed.
You also
have the right to complain to us, or to the Secretary of the
federal 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.
If you have
any questions or if you wish to file a complaint or exercise any
rights listed in this Notice, please contact:
Jackie Dame, HIPAA Compliance Officer
911 Billing Services and Consultant,
Inc.
Po Box 589
Madisonville, KY 42431
270-824-8123
Effective
Date of the Notice:
April 15, 2002
We will
revise this Notice if we make material changes to it. You can
get a copy of the latest version of this notice by contacting
the Privacy Officer or any staff member.
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