Community Ambulance Service Incorporated
Purpose of this notice:
Eureka Community Ambulance Service 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 we are permitted to use and disclose PHI about you.
Eureka Community Ambulance Service is also required to abide by the terms of the version of this notice currently in effect and may use this PHI after obtaining your consent or in an emergency or other situation without your immediate consent.
Uses and disclosures of PHI:
Eureka Community Ambulance Service may use your PHI for purposes of treatment, payment and other healthcare operations. Examples of PHI use;
For Treatment. This includes such things as verbal and written information that we obtain about you and use it 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 that we give to other healthcare personnel to whom we transfer your care and treatment and includes the 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 such 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 determination and reviews, utilization review and collection of outstanding accounts.
For Healthcare 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 Eureka Community Ambulance Service 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 consent:
Eureka Community Ambulance Service is authorized to use PHI without your consent, authorization or written permssion in certain situations including; emergency situatons (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, a death or disease as required by law as part of a public health investigation. To a report child or adult abuse or neglect or domestic violence. To report 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 healthcare 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 that 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.
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 that you may come to our offices and inspect and or 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. Eureka Community Ambulance Service has forms available for you 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 our 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 your denial of your request to amend the information. If you wish to amend the medical information that we have about you, you should contact our 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 6 years prior to the date of your request. We are not required to give you an accounting of your request nor required to give you an accounting of information we have used or disclosed for purposes of treatment, payment, healthcare operations or of uses of 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 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, healthcare operations or to restrict the information that is provided to family, friends and other individuals involved in your healthcare. But if you request a restriction and the information that you ask us to restrict is needed to provide you with emergency treatment, then we may use the PHI or disclose the PHI to a healthcre provider to provide you with emergency treatment. Eureka Community Ambulance Service is not required to agree to any restrictions you request but any any restrictions agreed to by Eureka Community Ambulance Service is binding on us.
Legal Rights and Complaints:
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 un any way for filing a complaint with us or the government.
Should you have any questions, comments or complaints, you may direct all inquiries to the Privacy Officer at the end of this notice.
Larry Johnson, Privacy Officer
Shannon McKruit, Operations Manager
Eureka Community Ambulance Service
304 Third Avenue
Tarentum, PA 15084
THE EFFECTIVE DATE OF THIS NOTICE IS APRIL 01, 2003
NOTE, THE ABOVE INFORMATION IS NOT VERBATIM FROM THE PRINTED COPY THAT SHOULD HAVE BEEN HANDED TO YOU AT A SPECIFIC TIME OF OR AFTER TREATMENT BY PERSONNEL OF EUREKA COMMUNITY AMBULANCE SERVICE, BUT IT'S PRETTY DAMN CLOSE.
Health Insurance Portability and Accountability Act