North
Country Emergency Medical Service
Notice
of Privacy Practices
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.
Purpose of this Notice: North
Country 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. This Notice describes your legal rights, advises you of our privacy
practices, and lets you know how North Country EMS is permitted to use and
disclose PHI about you.
North Country EMS 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.
Uses and Disclosures of PHI: North Country 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 verbal and written information that we
obtain about you and use 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 we give to other health care personnel to whom we transfer your care
and treatment, and includes transfer of PHI via radio or telephone to the
hospital or dispatch center 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, including such things as organizing your PHI
and submitting bills to insurance companies, management of billed claims for
services rendered, medical necessity determinations and reviews, utilization
review, and collection of 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, 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.
Use and Disclosure of PHI Without Your Authorization.
North Country EMS is permitted to use PHI without
your written authorization, or opportunity to object in certain situations,
including:
·
For North Country EMS’s use in treating you or in
obtaining payment for services provided to you or in other health care
operations;
·
For the treatment activities of another health care
provider;
·
To another health care provider or entity for the payment
activities of the provider or entity that receives the information (such as your
hospital or insurance company);
·
To another health care provider (such as the hospital to
which you are transported) for the health care operations activities of the
entity that receives the information as long as the entity receiving the
information has or has had a relationship with you and the PHI pertains to that
relationship;
·
For health care fraud and abuse detection or for
activities related to compliance with the law;
·
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.
We may also disclose health information to your family, relatives, or
friends if we infer from the circumstances that you would not object. In
situations where you are not capable of objecting
(because you are not present or due to your incapacity or medical
emergency), we may, in our professional judgment, determine that a disclosure to
your family member, relative, or friend is in your best interest. In that
situation, we will disclose only health information relevant to that person's
involvement in your care;
·
To a public health authority in certain situations (such
as reporting a birth, death or disease as required by law, as part of a public
health investigation, to report child or adult abuse or neglect or domestic
violence, to report adverse 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 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 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 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 and health information will be released only when there
is a minimal risk to your privacy and adequate safeguards are in place in
accordance with the law;
·
We may 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, (the authorization must specifically identify the
information we seek to use or disclose, as well as when and how we seek to use
or disclose it). 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 the protection
of your PHI, including:
·
The
right to access, copy or inspect your PHI. We will normally provide you with access to this
information within 30 days of your request. In limited circumstances, we may
deny you access to your medical information, and you may appeal certain types of
denials. If you wish to inspect and
copy your medical information, you should contact the 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. If you wish to request that we amend the medical
information that we have about you, you should contact the 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 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 of the medical information about you
that we have used or disclosed that is not exempted from the accounting
requirement, you should contact the privacy officer listed 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 request that we restrict how we use and disclose your
medical information that we have about you for treatment, payment or health care
operations, or to restrict the information that is provided to family, friends
and other individuals involved in your health care. But if you request a restriction and the information you
asked us to restrict is needed to provide you with emergency treatment, then we
may use the PHI or disclose the PHI to a health care provider to provide you
with emergency treatment. North
Country EMS is not required to agree to any restrictions you request, but any
restrictions agreed to by North Country EMS are binding on North Country 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 and make the Notice
available electronically through the web site.
·
Revisions
to the Notice: North
Country 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 the
Privacy Officer identified below.
·
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.
If you have any questions
or if you wish to file a complaint or exercise any rights listed in this Notice,
please contact:
Privacy Officer
North Country EMS
P.O. Box 189
Yacolt, WA 98675
360-686-3271
Effective Date of the Notice: April 14th, 2003