WARREN COUNTY AMBULANCE
DISTRICT
604 Fairgrounds Road, Warrenton, MO 63383-4420
Business: 636-456-8413 E-Mail: wcadmin@centurytel.net Fax: 636-456-1147
Health Insurance Portability and Accountability
Act (HIPAA) Policy
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.
The Warren 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. The Warren 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:
The Warren 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 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 provide information
about other services we provide.
Use and Disclosure of PHI Without
Your Authorization. The Warren 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 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 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 expect privacy. You have the
right to have reasonable privacy with respect to emergency, non-emergency
care and transportation.
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 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 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. The Warren County
Ambulance is not required to agree to any restrictions you request,
but any restrictions agreed to by the Warren County Ambulance District
in writing are binding on the Warren 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 paper and you may always request a paper copy of the
Notice.
Revisions to the Notice: The Warren 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 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
inquires to our privacy officer.
Privacy Officer Contact Information:
Privacy Officer
Warren County Ambulance District
604 Fairgrounds Road
Warrenton, MO 63383-4420
Telephone Number: 636-456-8413, extension 5
Fax Number: 636-456-1147
E-Mail: wcadmin@centurytel.net
Effective Date of the Notice: April 14, 2007
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