Callaway
County Ambulance District
Notice of Privacy Practices
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, Callaway County Ambulance District
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 respect to your PHI.
It not only describes our privacy practices and your legal rights, but
lets you know, among other things, how Callaway County Ambulance District 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.
Callaway
County Ambulance District 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 573-642-7260.
Callaway County Ambulance District 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.
Callaway County Ambulance District is also required to abide by the terms
of the version of this Notice currently in effect.
Uses and Disclosures of PHI: Callaway County Ambulance District 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 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
provide information about other services we provide.
Use and disclosure of PHI without your authorization: Callaway County Ambulance District 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
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 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 the 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 you
PHI, including:
The right to access, copy or inspect your PHI. This means you may inspect and copy most of the medical
information 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 a 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 may 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 PHI for which you have already given us written authorization.
If you wish to request an accounting, contact our privacy officer.
The tight 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. Callaway County
Ambulance District is not required to agree to any restrictions you request, but
any restrictions agreed to by Callaway County Ambulance District in writing are
binding on Callaway County Ambulance District.
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. Callaway County Ambulance District 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 PHI 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.
Privacy Officer Contact Information:
Privacy Officer
Callaway County Ambulance District
311 Hickman Avenue
PO Box 246
Fulton, MO 65251-0246
Telephone: (573) 642-7260
Fax: (573) 642-4069
E-mail: callawayambulance@sbcglobal.net
Web Site: www.callawayambulance.org
Effective Date of Notice: April 14, 2003