This Notice of Privacy Practices is being provided to you as a requirement of the Health Insurance Portability and Accountability Act of 1996, as amended (“HIPAA”). This Notice describes how Tri-Hospital EMS may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. This Notice also describes your rights to access and control your protected health information in some cases. Your “protected health information” or “PHI” includes any of your written and oral health information, including demographic data that can be used to identify you. This includes health information that is created or received by your health care providers, and that relates to your past, present or future physical or mental health condition.
Tri-Hospital EMS is required by law to maintain the privacy of PHI and to provide you with notice of its legal duties and privacy practices with respect to PHI. We are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of this Notice at any time and to make new notice provisions effective immediately for all PHI that we maintain. Any changes to the Notice will be posted immediately in our offices and posted to our web site if we maintain one at the time of the change. You also may request a copy of the new Notice the next time that you visit one of our offices, or we will give you a copy of the new Notice the next time we provide health care services to you. You also may contact our Privacy Officer identified below for the latest version of the Notice.
HOW WE USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION FOR TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS
Tri-Hospital EMS may use and disclose your PHI for the purposes of treatment, payment for our services, and health care operations , as described below. For those times when we are required by state or federal laws to ask your permission, you will be asked to sign a consent to permit us to disclose your PHI. We will ask you to sign the consent at the beginning of your care so as to avoid delaying the delivery of health care services to you.
To Provide Treatment: We may use and disclose your PHI to provide and coordinate the delivery of emergency health care and other transportation services for you. We may communicate with your doctor, the doctors and staff of the hospitals and other facilities to or from which you are transported, dispatch centers, and other emergency service providers. We may give the hospital or other facility to which you are transported a copy of the written record (run sheet) we create when we treat and transport you.
To Obtain Payment: We may use and disclose your PHI, as necessary, to obtain payment for the health care services that we provide to you. This includes preparing and submitting bills to insurers, health plans, and other payers, either directly or through a third party billing company. We also may use and disclose your PHI for eligibility or coverage determinations, medical necessity determinations and reviews, pre-authorizations of services and other utilization review activities, management of claims, and collection of outstanding accounts.
To Conduct Health Care Operations: We may use and disclose your PHI, as necessary, to perform the business operations of our company. This includes such activities as quality management, performance reviews, licensing, accreditation, training programs, and business management and administration. We also may use and disclose your PHI for such purposes as obtaining legal and financial services, business planning, processing complaints, data collection, and fundraising activities for our company.
Other Uses: As part of treatment, payment and health care operations, we may contact you to remind you of a scheduled transport, or to inform you of other services we provide or other health-related benefits and services that may be of interest to you.
CIRCUMSTANCES UNDER WHICH TRI-HOSPITAL EMS MUST DISCLOSE YOUR PHI
Tri-Hospital EMS must disclose your PHI (i) to you, upon request, (ii) to the Secretary of the Department of Health and Human Services to determine whether Tri-Hospital EMS is in compliance with HIPAA, and (iii) where required by law. In this context, “required by law” means that Tri-Hospital EMS will make the disclosure only when the Federal, State or local law requires it to do so, but not if the law would simply allow it to do so.
CIRCUMSTANCES UNDER WHICH TRI-HOSPITAL EMS MAY USE AND DISCLOSE YOUR PHI WITHOUT YOUR AUTHORIZATION
When Specially Protected: In addition to the Privacy Rule, special protections under State or other Federal law may apply to the use and disclosure of your PHI. Tri-Hospital EMS will comply with these State or Federal laws where they are more protective of your privacy than HIPAA and the Privacy Rule.
When There Are Risks to Public Health: We may use and disclose your PHI for public health activities and purposes. For example, for activities related to the reporting and tracking of communicable diseases.
Business Associates: We may share your PHI with “business associates” that perform certain activities on our behalf such as billing, dispatch, utilization review or quality management services. We will have a written agreement with our business associates that requires them to protect the privacy of your PHI in the same way Tri-Hospital EMS is required to.
To Individuals Involved With Your Care Or Payment For Your Care: Tri-Hospital EMS may disclose your PHI to adult members of your family or another person identified by you who is involved in your care or payment for your care if: (i) you authorize Tri-Hospital EMS to do so; or (ii) Tri-Hospital EMS informs you that it intends to do so and you do not object; or (iii) Tri-Hospital EMS infers from the circumstances, based upon its professional judgment, that you do not object to the disclosure. Tri-Hospital EMS will, whenever possible, try to get your written agreement or objection to these disclosures (as the case may be), but in certain circumstances it may rely on your oral agreement or disagreement to disclosures to family members.
To Personal Representatives: Tri-Hospital EMS may disclose your PHI to someone who is your personal representative. Before Tri-Hospital EMS will give that person access to your PHI or allow that person to take any action on your behalf, it will require him or her to provide proof that he or she may act on your behalf (e.g., a court order or power of attorney granting such power). Generally, the parent of a minor child will be the child’s personal representative. In some cases, however, state law allows minors to obtain treatment without parental consent, and in those cases, Tri-Hospital EMS may not disclose certain information to the parents. Tri-Hospital EMS may also deny a personal representative access to PHI to protect people, including minors, who may be subject to abuse or neglect.
To Report Abuse, Neglect, or Domestic Violence: Tri-Hospital EMS is allowed to notify government authorities if it believes a patient is the victim of abuse, neglect or domestic violence. Tri-Hospital EMS will make this disclosure only when specifically required or authorized by law or when the patient agrees to the disclosure.
Health Oversight Activities: We may use and disclose your PHI for audits or government investigations, inspections, disciplinary proceedings, and other administrative or judicial actions undertaken by the government (or their agents) by law to oversee the health care system.
Judicial and Administrative Proceedings: We may use and disclose your PHI as required by a court or administrative order, or in certain circumstances, in response to a subpoena or other legal process but only when Tri-Hospital EMS makes reasonable efforts to either notify you about the request or to obtain an order protecting your PHI.
Law Enforcement: We may use and disclose your PHI for law enforcement activities in certain limited circumstances, such as in an emergency in order to report a crime, or for the purpose of identifying or locating a suspect, fugitive, material witness or missing person.
Coroners, Medical Examiners, and Funeral Directors: We may disclose your PHI to coroners and medical examiners for purposes of determining your cause of death or for other duties, as authorized by law.
Funeral Directors: Tri-Hospital EMS may disclose your PHI to funeral directors consistent with applicable law and if necessary, to carry out their duties with respect to your funeral arrangements.
Organ Donation: If you are an organ donor, we may use and disclose your PHI 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.
Research: We may use and disclose your PHI in limited circumstances to researchers when an institutional review board has reviewed the research proposal and protocols to ensure the privacy of your PHI and has approved the research.
Serious Threat to Health or Safety: We may use and disclose your PHI to prevent or lessen the imminent threat to the health or safety of a person or the public in accordance with federal and state laws.
Military Activity and National Security: We may use and disclose your PHI for certain limited military, national defense and security, or other special government functions.
Workers Compensation: We may use and disclose your PHI to comply with workers’ compensation laws and other similar legally established programs.
Limited Data Sets: Tri-Hospital EMS may disclose PHI in a limited data set for purposes of research, public health or health care operations, but only if a data use agreement has been signed.
For Emergencies and Disaster Relief: Tri-Hospital EMS may disclose PHI to organizations engaged in emergency and disaster relief efforts.
USES AND DISCLOSURE OF PHI BASED UPON YOUR WRITTEN AUTHORIZATION
Except in the circumstances described above, we will use and disclose your PHI only with your written authorization. The requirement for your written authorization applies especially to most uses or disclosures of psychotherapy notes, for Tri-Hospital EMS to disclose your PHI for remuneration, or to use or disclose your PHI for marketing purposes. If you or your representative authorizes Tri-Hospital EMS to use or disclose your PHI, you may revoke the authorization at any time, in writing, except to the extent that we have already used or disclosed PHI in reliance on your authorization.
YOUR RIGHTS WITH RESPECT TO YOUR PROTECTED HEALTH INFORMATION
The following describes your rights with respect to your PHI and how you may exercise your rights.
THE RIGHT TO INSPECT AND COPY YOUR PHI
You have the right to inspect and copy your PHI that is contained in a designated record set of medical and billing records for as long as we maintain the PHI. In certain circumstances, we may deny your access to PHI, and you may appeal certain types of denials. You will need to complete a form to request access to or copying of PHI. Normally, you will be provided access to your PHI within 30 days. We have the right to charge a reasonable fee for copying any PHI for you. If you wish to inspect and/or copy your PHI, contact the Privacy Officer designated at the end of this Notice.
THE RIGHT TO AMEND YOUR PHI
You have the right to ask us to amend your PHI, if you believe your PHI is incorrect or incomplete. We have the right to deny your request in certain circumstances. For example, we will deny the request if we believe the PHI is correct. If we deny the request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal statement. You will need to complete a request form to amend your PHI. Normally, we will respond to your request to amend within 60 days. If you wish to amend your PHI, contact the Privacy Officer designated at the end of this Notice.
THE RIGHT TO REQUEST A RESTRICTION OF THE USE OR DISCLOSURE OF YOUR PHI
You have the right to request a restriction of the use and disclosure of your PHI for the purpose of treatment, payment, and health care operations. You may also request that your PHI not be disclosed to family members or friends who may be involved in your care. We have the right to deny your request for a restriction; provided, however, that Tri-Hospital EMS must agree to your request for a restriction on disclosure if done for payment or health care operations, and the disclosure pertains only to a health care item or service which has already been paid for. If we do agree to a restriction, we will not disclose your PHI in violation of the restriction except in emergency circumstances. You will need to complete a form to request a restriction of the use and disclosure of PHI. If you wish to request a restriction of the use and disclosure of PHI, contact the Privacy Officer designated at the end of this Notice.
THE RIGHT TO REQUEST TO RECEIVE CONFIDENTIAL COMMUNICATIONS FROM US BY ALTERNATIVE MEANS OR AT AN ALTERNATIVE LOCATION
You have the right to request that we send confidential communications to you by an alternative means or at an alternative location without giving us an explanation as to why you are making the request. For example, you may ask that all correspondence be sent to a work address rather than a home address. We will accommodate reasonable requests. We may condition our agreement to your request on you providing us with information as to how payment will be handled and the specification of an alternative address or method of contact. You will need to complete a form to request to receive confidential communications from us by alternative means or at an alternative location. If you wish to request to receive confidential communications from us by alternative means or at an alternative location, contact the Privacy Officer designated at the end of this Notice.
THE RIGHT TO RECEIVE AN ACCOUNTING OF DISCLOSURES WE HAVE MADE OF YOUR PHI
You may ask for an accounting from us of certain disclosures of your PHI that we have made in the last six years prior to your request. We are not required by law to account for certain disclosures. For example, we are not required to account for disclosures for treatment, payment or operations, disclosures to you or disclosures pursuant to your written authorization. If you wish to request an accounting of the disclosures that are not exempted from the accounting requirement, contact the Privacy Officer designated at the end of this Notice.
THE RIGHT TO RECEIVE NOTICE OF A BREACH
If for any reason your unencrypted PHI is improperly disclosed, you have a right to receive notice of that breach, unless it is determined, based on an adequate risk assessment, that the probability that the PHI has been compromised is low. The notice will include (i) a brief description of the event, (ii) a description of the unsecured PHI involved, (iii) a brief description of the steps taken by Tri-Hospital EMS to mitigate the consequences of the breach, (iv) mitigation steps you might take, and (v) Tri-Hospital EMS contact information so you can find out more about what occurred.
THE RIGHT TO OBTAIN PAPER COPY OF NOTICE OF PRIVACY PRACTICES
You have the right to obtain a paper copy of this Notice of Privacy Practices, even if you agree to accept the Notice electronically. If you wish to request a paper copy of the Notice of Privacy Practices, contact the Privacy Officer designated at the end of this Notice.
HOW TO MAKE A COMPLAINT
You have the right to express complaints to us, or to the Secretary of the U.S. Department of Health and Human Services if you believe your privacy rights have been violated. We will not retaliate against you in any way for filing a complaint with the government or us. You may file a complaint by notifying our Privacy Officer who will give you further information about the Complaint Process.
If you have any questions about this Notice, your rights with respect to PHI, or wish to file a complaint, please contact :
309 Grand River Avenue
To express a complaint to the Secretary of the Department of Health and Human Services, send your complaint to:
The U.S. Department of Health and Human Services,
200 Independence Avenue, S.W.
Washington, DC 20201
Toll free: 1 (877) 696-6775
This Notice of Privacy Practices is effective September 23, 2013.