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Shippensburg Area Emergency Medical
Services
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.
Shippensburg Area Emergency Medical Services 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. Shippensburg Area Emergency Medical
Services is also required to
abide by the terms of the version of this Notice currently in
effect.
Uses and Disclosures of PHI: Shippensburg Area Emergency Medical
Services 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. Shippensburg
Area Emergency Medical Services 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.
Shippensburg Area Emergency Medical Services is not required to agree to any restrictions
you request, but any restrictions agreed to by Shippensburg Area
Emergency Medical Services
in writing are binding on Shippensburg Area Emergency Medical
Services.
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: Shippensburg Area Emergency Medical
Services 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
Shippensburg Area Emergency Medical Services
235 E King St
P.O. Box 69
Shippensburg, PA 17257
(717) 532-6069
FAX (717) 532-9413
E-MAIL cvems@pa.net
Effective Date of the Notice: April 14, 2003
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