Cortlandt Community Volunteer Ambulance Corps
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAYBE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT
CAREFULLY.
Cortlandt Community Volunteer Ambulance Corps
("CCVAC")
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.
CCVAC
is also required to abide by the terms of the version of this Notice currently
in
effect.
Uses and Disclosures
of
PHI-
CCVAC
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, rnakinq 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 provide.
·
Use and Disclosure of PHI Without Your Authorization.
CCVAC
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.
-
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 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. CCVAC is not required to agree to
any restrictions you request, but any restrictions agreed to by CCVAC in writing
are binding on CCVAC
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: CCVAC 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 Complaint
-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
P.O. Box 275
Montrose, NY 10548
Phone: 914-739-0881
Fax: 914-739-8573
Effective Date of the Notice: April 14, 2003
|