NOTIFICATION
OF PATIENT PRIVACY
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: The Williamsport Volunteer Ambulance
Service, Inc. (WVAS, Inc.) 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 WVAS, Inc. is permitted to use and disclose
PHI about you. WVAS, Inc. 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: WVAS, Inc. 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 (either directly or through a third party
billing company), 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.
Fundraising. We may contact you when we are in
the process of raising funds for WVAS, Inc., or to provide you with information
about our annual subscription program.
Use and Disclosure of PHI Without
Your Authorization. WVAS,
Inc. is permitted to use PHI without your written authorization, or
opportunity to object in certain situations, including:
• For WVAS, Inc.'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. For
example, we may assume you agree to our disclosure of your personal
health information to your spouse when your spouse has called the ambulance
for you. 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. For example, we may inform the person who accompanied you in the
ambulance that you have certain symptoms and we may give that person an
update on your vital signs and treatment that is being
administered by our ambulance crew;
• 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. This means you may come to our offices and 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. 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, 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 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. WVAS, Inc. is not required to agree to any restrictions you
request, but any restrictions agreed to by WVAS, Inc. are binding on WVAS, Inc.
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 www.wvas29.org and make the Notice
available electronically through the 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: WVAS,
Inc. 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. 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. Should you have any questions,
comments or complaints you may direct all inquiries to the privacy officer listed at
the end of this Notice. Individuals will not be retaliated against for filing a complaint.
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
WVAS, Inc.
P.O. Box 102
Williamsport, MD 21795
301 223-8532
Effective Date of the Notice: April 14th, 2003