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Fame Emergency Medical Services
Inc.
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
Fame Emergency Medical Service, Inc. (Fame 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. Fame EMS is also
required to abide by the terms of the version of this Notice
currently in effect.
Use and Disclosure of PHI: Fame 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 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 o other health care providers
involved in your treatment, and may transfer you 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 provide
information about other services we provide
Use and Disclosure of PHI Without Your
Authorization: Fame EMS is permitted to use PHI without
your written authorization, or opportunity to object in certain
situation, 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
interest;
- 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 use or disclose health information about you in a way
that does not personally identify you or reveal who you are.
Any other use of 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 the protection of 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 the 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 the
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 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 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. Fame EMS is not required
to agree to any restrictions you request, but any restrictions
agreed to by Fame EMS are binding on Fame 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. 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:
Fame 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 promptly posted in our
facilities and posted on our web site, if we maintain one. You can
get a copy of the latest version of this Notice by contacting the
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 anyway for filing a complaint with us or to
the government. Should you have any questions, comments or
complaints you may direct all inquires to the privacy officer.
Privacy Officer Contact Information:
Mick Abrashoff
FAME EMS
701 Valley Street
Lewistown, PA. 17044
Phone: (717) 248-5553
Fax: (717) 248-8777
mabrashoff@fameems.org
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