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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.
Brentwood
Emergency Medical Service, Inc. (“Brentwood EMS”) 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. Brentwood EMS is also
required to abide by the terms of the version of this Notice currently
in effect.
Uses and Disclosures of PHI:
Brentwood EMS 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 render.
Use
and Disclosure of PHI Without Your Authorization.
Brentwood EMS 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.
Brentwood EMS is
not required to agree to any restrictions you request, but any
restrictions agreed to by Brentwood
EMS in writing are
binding on Brentwood EMS.
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:
Brentwood EMS
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:
Privacy Officer
Brentwood
EMS
3624 Brownsville Road
Pittsburgh
,
Pa.
15227
Phone: 412-884-8740
Fax: 412-884-8681
Effective
Date of the Notice:
April 14, 2003
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