NOTICE OF PRIVACY PRACTICES
This Notice Describes How Medical Information About
You May Be Used And Disclosed And How You Can Get Access To This
Important Information.
Please Review It Carefully.
Stat Medical Transport, LLC ("Stat Medical") 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. Stat Medical is also required to abide by the terms
of the version of this Notice currently in effect.
Uses and Disclosures of PHI: Stat
Medical 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.
Stat Medical 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
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. Stat Medical is not required to agree to any restrictions you
request, but any restrictions agreed to by Stat Medical in writing are
binding on Stat Medical.
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: Stat Medical
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
STAT Medical Transport, LLC
P.O. Box 337
Drexel Hill, PA 19026
Phone: (610) 449-STAT (7828)
Fax: (610) 626-4219
Email:
privacy@statmedicaltransport.com
Effective Date of the Notice: June 1,
2005 |