Privacy Policy

 

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NOTICE OF PRIVACY

 

RESPECT Ambulance Company Inc.,
1993 Hummel Avenue, Suite 100
Camp Hill, PA 17011
(717) 412-7965

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Contact Information

Privacy Officer:

Connie Levkovich

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EMS Coordinator:

Geoffrey Coder

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Notice of Privacy As required by the Privacy Regulations created as a result of the Health
Insurance Portability and Accountability Act of 1996 (HIPAA).

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU
MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS
TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.

Questions regarding this notice may be directed to the above contact information.

This Notice of Privacy describes how our company 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. It also describes your rights to
access and control your protected health information. “Protected health information” (PHI) is
information about you, including demographic information, that may identify you and that
relates to your past, present or future physical or mental health or condition and related
health care services. Our Company is dedicated to maintaining the privacy of your protected
health information.

We are required to abide by the terms of this Notice of Privacy. We may revise or
amend the terms of our notice, at any time. The new notice will be effective for all protected
health information that we have at that time and for future information. We will post our
current Notice in our office in a visible location at all times and upon your request, we will
provide you with any revised Notice.

DISCLOSURES

Uses and Disclosures to carry out treatment, payment or health care operations:
Under HIPAA regulations, we do not need to obtain permission to use health
information for treatment, payment and health care operations. We may use and disclose
your Protected Health Information (PHI) for the following reasons:

Treatment: We will use and disclose your PHI to provide, coordinate, or manage
your health care and any related services. This includes the coordination or management of
your health care with a third party. We may disclose your PHI to others who may assist in
your care, such as your spouse, children or parents. Finally, we may also disclose your PHI
to other health care providers for purposes related to your treatment.

Payment: Your protected health information will be used, as needed, to obtain
payment for your health care services. This may include certain activities that your health
insurance plan may undertake before it approves or pays for the health care services we
provided for you.

 

Healthcare Operations: We may use or disclose, as-needed, your protected health
information in order to support the business activities of (company name). These activities
include, but are not limited to, quality assessment activities, employee review activities,
training of students, certification activities. We will share your protected health information
with third party “business associates” that perform activities (e.g., billing) for the company.
However, whenever an arrangement between our office and a business associate involves
the use or disclosure of your protected health information, we will have a written contract
that contains terms that will protect the privacy of your protected health information.
Appointment Reminders (if applicable) We may use or disclose your protected health
information, as necessary, to contact you to remind you of appointments or prescheduled
transports.

Treatment Options and Services (if applicable ) We may use or disclose your protected
health information, as necessary, to provide you with information about transport
alternatives or other health-related benefits and services that may be of interest to you.
However, we will get a written authorization from you for further marketing purposes.

Uses and disclosures that you can agree or object to
We may use and disclose your protected health information in the following
instances, which you have the opportunity to object to:

Others Involved in Your Healthcare: Unless you object, we may disclose to a
member of your family, a relative, a close friend or any other person you identify, your
protected health information that directly relates to that person’s involvement in your health
care. If you are unable to agree or object to such a disclosure, we may disclose such
information as necessary if we determine that it is in your best interest based on our
professional judgment. We may use or disclose protected health information to notify or
assist in notifying a family member, personal representative or any other person that is
responsible for your care of your location, general condition or death. Finally, we may use or
disclose your protected health information to an authorized public or private entity to assist
in disaster relief efforts and to coordinate uses and disclosures to family or other individuals
involved in your health care.

Emergencies We may use or disclose your protected health information in an
emergency treatment situation. If this happens, your physician shall allow you to object to
future disclosures as soon as reasonably practicable after the delivery of treatment.

Uses and disclosures that we will obtain your written authorization for
Marketing
for most marketing purposes, we will obtain your written consent.

Uses and disclosures for which and authorization or opportunity to
agree or object to is not required
We may use or disclose your protected health information in the following situations:

Required By Law: We may use or disclose your protected health information to the
extent that the use or disclosure is required by law. The use or disclosure will be made in
compliance with the law and will be limited to the relevant requirements of the law. You will
be notified, as required by law, of any such uses or disclosures.

Public Health: We may disclose your protected health information for public health
activities and purposes to a public health authority that is required or permitted by law to
receive the information. The disclosure will be made for the purpose of controlling or
reporting disease, injury or disability. We may also disclose your protected health
information, if directed by the public health authority, to a foreign government agency that is
collaborating with the public health authority.

Communicable Diseases: We may disclose your protected health information, if
authorized by law, to a person who may have been exposed to a communicable disease or
may otherwise be at risk of contracting or spreading the disease or condition.

Abuse or Neglect: We may disclose your protected health information to a public
health authority that is authorized by law to receive reports of child abuse or neglect. In
addition, we may disclose your protected health information if we believe that you have
been a victim of abuse, neglect or domestic violence to the governmental entity or agency
authorized to receive such information. In this case, the disclosure will be made consistent
with the requirements of applicable federal and state laws.

Maintenance of Vital Records: We may report data such as births and deaths.

Health Oversight: We may disclose protected health information to a health
oversight agency for activities authorized by law, such as audits, investigations, and
inspections. Oversight agencies seeking this information include government agencies that
oversee the health care system, government benefit programs, other government regulatory
programs and civil rights laws.

Legal Proceedings: We may disclose protected health information in the course of
any judicial or administrative proceeding, in response to an order of a court or administrative
tribunal (to the extent such disclosure is expressly authorized), in certain conditions in
response to a subpoena, discovery request or other lawful process.

Law Enforcement: We may also disclose protected health information, so long as
applicable legal requirements are met, for law enforcement purposes. These law
enforcement purposes include (1) legal processes and otherwise required by law, (2) limited
information requests for identification and location purposes, (3) pertaining to victims of a
crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event
that a crime occurs on the premises of the company and (6) medical emergency (not on the
company’s) premises) and it is likely that a crime has occurred.

Coroners, Funeral Directors, and Organ Donation: We may disclose protected
health information to a coroner or medical examiner for identification purposes, determining
cause of death or for the coroner or medical examiner to perform other duties authorized by
law. We may also disclose protected health information to a funeral director, as authorized
by law, in order to permit the funeral director to carry out their duties. We may disclose such
information in reasonable anticipation of death. Protected health information may be used
and disclosed for cadaveric organ, eye or tissue donation purposes.

Research: We may disclose your protected health information to researchers when
their research has been approved by an institutional review board that has reviewed the
research proposal and established protocols to ensure the privacy of your protected health
information. Otherwise, we will ask for a written authorization from you.

Criminal Activity: Consistent with applicable federal and state laws, we may
disclose your protected health information, if we believe that the use or disclosure is
necessary to prevent or lessen a serious and imminent threat to the health or safety of a
person or the public. We may also disclose protected health information if it is necessary for
law enforcement authorities to identify or apprehend an individual.

Workers’ Compensation: Your protected health information may be disclosed by us
as authorized to comply with workers’ compensation laws and other similar legally established
programs.

Required Uses and Disclosures: Under the law, we must make disclosures to you
and when required by the Secretary of the Department of Health and Human Services to
investigate or determine our compliance with the requirements of Section 164.500 et. seq.

YOUR RIGHTS

The following is a statement of your rights with respect to your protected health
information and a brief description of how you may exercise these rights.
You have the right to inspect and copy your protected health information. This means you
may inspect and obtain a copy of protected health information about you that is contained in
a designated record set for as long as we maintain the protected health information. A
“designated record set” contains medical and billing records and any other records that your
physician and the Company use for making decisions about you. This may not include
psychotherapy notes.
You must submit your request in writing to:

RESPECT Ambulance Company Inc.,

1993 Hummel Avenue, Suite 100
Camp Hill, PA 17011
(717) 412-7965

 

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In order to inspect and/or obtain a copy of your PHI. Our Company may charge a fee for the
costs of copying, mailing, labor and supplies associated with your request. Our Company
may deny your request to inspect and/or copy in certain limited circumstances; however,
you may request a review of our denial. Another licensed health care professional chosen
by us will conduct reviews.

Please contact the EMS Coordinator or Privacy Officer at (717) 412-7965 if you have questions about
access to your medical record.

 


You have the right to request a restriction of your protected health information. This
means you may ask us not to use or disclose any part of your protected health information
for the purposes of treatment, payment or healthcare operations. You may also request that
any part of your protected health information not be disclosed to family members or friends
who may be involved in your care or for notification purposes as described in this Notice of
Privacy. Your request must state the specific restriction requested and to whom you want
the restriction to apply. Your physician is not required to agree to a restriction that you may
request. You may request a restriction by contacting:

RESPECT Ambulance Company Inc.,

1993 Hummel Avenue, Suite 100
Camp Hill, PA 17011
(717) 412-7965

 

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You have the right to request that our Company communicate with you about your
health and related issues in a particular manner or at a certain location. For instance, you
may ask that we contact you at home, rather than work. In order to request a type of
confidential communication, you must make a written request to us specifying the requested method of contact, or the location where you wish to be contacted. Our Company will accommodate reasonable requests. You do not need to
give a reason for your request.

You may have the right to have the company amend your protected health
information. This means you may request an amendment of protected health information
about you in a designated record set for as long as we maintain this information. In certain
cases, for example if we think the information is correct, or was not created by our
Company, we may deny your request for an amendment. If we deny your request for
amendment, you have the right to file a statement of disagreement with us and we may
prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.

Please contact our EMS Coordinator or Privacy Officer to determine if you have questions about
amending your medical record. To file an amendment, your request must be in writing and
must be submitted to us at:

 

RESPECT Ambulance Company Inc.,
1993 Hummel Avenue, Suite 100
Camp Hill, PA 17011
(717) 412-7965

 

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.
You have the right to receive an accounting of certain disclosures we have made, if
any, of your protected health information. This right applies to disclosures for purposes
other than treatment, payment or healthcare operations as described in this Notice of
Privacy Statement. Accounting is not required for disclosures we may have made to you,
incidental disclosures, disclosures you have authorized, disclosures for a facility directory,
disclosures to family members or friends involved in your care, or disclosures made to carry
out treatment, payment or health care operations. You have the right to receive specific
information regarding disclosures that occurred after April 14, 2003 up to a six year
timeframe. You may request a shorter timeframe. The right to receive this information is
subject to certain exceptions, restrictions and limitations. In order to obtain an accounting of
disclosures, you must submit your request in writing to the EMS Coordinator or Privacy Officer at:

 

RESPECT Ambulance Company Inc.,
1993 Hummel Avenue, Suite 100
Camp Hill, PA 17011
(717) 412-7965

 

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The Company may charge you for additional lists within the same 12-month period.
Our Company will notify you of the costs involved with additional requests, and you may
withdraw your request before you incur any costs.
You have a right to a paper copy of this notice. You are entitled to receive a paper copy of
our notice of privacy even if you have agreed to receive an electronic copy of the Notice.
You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this
notice, contact EMS Coordinator or Privacy Officer at:

 

RESPECT Ambulance Company Inc.,
1993 Hummel Avenue, Suite 100
Camp Hill, PA 17011
(717) 412-7965

 

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You have a right to file a complaint if you believe your privacy rights have been violated.
You may file a complaint with our Company or with the Secretary of the Department of
Health and Human Services. To file a complaint with our Company, EMS Coordinator or Privacy Officer:

 

RESPECT Ambulance Company Inc.,
1993 Hummel Avenue, Suite 100
Camp Hill, PA 17011
(717) 412-7965

 

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All complaints must be submitted in writing. You will not be penalized for filing a complaint.
This notice was published and becomes effective on June 1, 2011.

Definition of Terms:

Business Associate (BA):
A person or organization that performs an activity involving the
use or disclosure of individually identifiable health information, including claims processing
or administration, data analysis, processing or administration, utilization review, quality
assurance, billing, benefit management, and company management, on behalf of a covered
entity, but is not part of the covered entity’s workforce. A business associate can also be a
covered entity in its own right.

Covered Entity (CE): Under HIPAA, this is a health plan, a health care clearinghouse, or a
health care provider who transmits any health information in electronic form in connection
with a HIPAA transaction.

Designated Record Set: A group of records maintained by or for a covered entity that is:
a. The medical records and billing records about individuals maintained by or for a covered
health care provider;
b. The enrollment, payment, claims adjudication, and case or medical management record
systems maintained by or for a health plan; or
c. Used, in whole or in part, by or for the covered entity to make decisions about individuals.
Health Information: any information, whether oral or recorded in any form or medium, that
a. is created or received by a health care provider, health plan, public health authority,
employer, life insurer, school or university, or health care clearinghouse, and
b. relates to the past, present or future physical or mental health of condition of an
individual, the provision of health care to an individual, or the past, present or future
payment for provision of health care to an individual.

Health Insurance Portability and Accountability Act of 1996 (HIPAA): A Federal law
that allows persons to qualify immediately for comparable health insurance coverage when
they change their employment relationships. Title II, Subtitle F, of HIPAA gives HHS the
authority to mandate the use of standards for the electronic exchange of health care data; to
specify what medical and administrative code sets should be used within those standards;
to require the use of national identification systems for health care patients, providers,
payers (or plans), and employers (or sponsors); and to specify the types of measures
required to protect the security and privacy of personally identifiable health care information.
Also known as the Kennedy- Kassebaum Bill, the Kassebaum-Kennedy Bill, K2, or Public
Law 104-191.Accountability Act of 1996.

Individually identifiable data is data that can be readily associated with a specific
individual. Examples would be a name, a personal identifier, or a full street address. If life
was simple, everything else would be non-identifiable data. But even if you remove the
obviously identifiable data from a record, other data elements present can also be used to
re-identify it. For example, a birth date and a zip code might be sufficient to re-identify half
the records in a file. The re-identifiability of data can be limited by omitting, aggregating, or
altering such data to the extent that the risk of it being re-identified is acceptable.

Individually Identifiable Health Information (IIHI) and Protected Health Information
(PHI)
Individually identifiable health information is information that is a subset of health
information, including demographic information collected from an individual, and:
(1) Is created or received by a health care provider,
(2) relates to past, present or future health condition, provision of health care or payment for
health care; and
a. That identifies the individual; or
b. With respect to which there is a reasonable basis to believe the information can be used
to identify the individual.
Protected health information means individually identifiable health information with a few
statuary exemptions.

Marketing: Marketing means to make a communication about a product or service a
purpose of which is to encourage recipients of the communication to purchase or use the
product or service.
Marketing does not include:
(i) describing the entities participating in a health care provider network or health plan
network, or for the purpose of describing if and the extent to which a product or service (or
payment for such product or service) is provided by a covered entity or included in a plan of
benefits; or
(ii) communication made by health care provider as part of treatment or to further treatment
or to recommend alternative treatments, health care providers, therapies or settings for care
(iii) the communication is made orally
(iv) the communication is in writing and the covered entity does not receive direct or indirect
remuneration from a third party for making the communication.

Minimum Scope of Disclosure or “Minimum Necessary”: The principle that, to the
extent practical, individually identifiable health information should only be disclosed to the
extent needed to support the purpose of the disclosure.

Treatment, Payment and Health Care Operations

Treatment includes consultation, referral, coordination and management of care
Payment - activities of provider to obtain reimbursement, including: determinations of
eligibility, billing, utilization review, and disclosure relating to collections
Health Care Operations – include any of the following:
(i) Quality assessment and improvement
(ii) Credentialing activities and education and training programs
(iii) Arranging for medical review, legal services, auditing
(iv) Business planning and development
(v) Business management and administration

IDENTIFY PRIVACY OFFICIAL AND CONTACT PERSON, POLICY

General Requirements:
A covered entity must designate a privacy official who will be responsible for the
development and implementation of the policies and procedures that comply with the
HIPAA regulations.
A covered entity must also designate a contact person or office that is responsible for:
• receiving complaints concerning the substance of the provider’s HIPAA policies and
procedures
• receiving complaints concerning the covered entity’s compliance with such policies and
procedures or with the requirements of the HIPAA Privacy Rule generally; and
• providing further information about matters covered by the notice of privacy required by
164.520 of the HIPAA Privacy Rule

Policies and Procedures:
A written or electronic record of the designation of the privacy official and the contact
person/office must be maintained.
Identity of Contact Person:
The contact person may be, but is not required to be, the same individual as the privacy
official.
The choice in that regard is left to the discretion of the covered entity.
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