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Privacy Information:
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.
PPS Rescue 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. PPS Rescue is also required to abide
by the terms of the version of this Notice currently in effect.
Uses and Disclosures of PHI: PPS Rescue 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
obtaining verbal and written information about your medical
condition and treatment from you as well as from others, such
as doctors and nurses who give orders to allow us to provide
treatment to you. We may give your PHI to other health care
providers involved in your treatment, and may transfer your
PHI via radio or telephone to the hospital or dispatch center.
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 submitting bills
to insurance companies, making medical necessity determinations
and collecting 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, as well as certain
other management functions.
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 to provider information about
other services we provide.
Use and Disclosure of PHI Without Your Authorization.
PPS Rescue is permitted to use PHI without your written authorization,
or opportunity to object, in certain situations, and unless
prohibited by a more stringent state law, including:
- For the treatment, payment or health care
operations activities of another health care provider who
treats you;
- For health care and legal compliance activities;
- 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, and
in certain other circumstances where we are unable to obtain
your agreement and believe the disclosure is in your best
interests;
- To a public health authority in certain
situations as required by law (such as to report abuse,
neglect or domestic violence;
- 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 responding to a warrant;
- 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
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;
- We may also 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. 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 your PHI, including:
The right to access, copy or inspect your
PHI. This means you may 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. You also have the right to
receive confidential communications of your PHI. If you wish
to inspect and copy your medical information, you should contact
our privacy officer.
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. If you wish to request that
we amend the medical information that we have about you, you
should contact our privacy officer.
The right to request an accounting. You may
request an accounting from us of certain disclosures of your
medical information that we have made in the 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, contact our privacy
officer.
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. PPS Rescue is not required to agree
to any restrictions you request, but any restrictions agreed
to by PPS Rescue in writing are binding on PPS Rescue.
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. 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: PPS Rescue 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 our privacy officer.
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 our privacy
officer.
Privacy Officer Contact Information:
Attn: Privacy Officer
Perry-Port-Salem Rescue
PO Box 102 Port Jefferson, Ohio 45360 937-492-7746
Effective Date of the Notice: April 14, 2003
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