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HILLTOWN COMMUNITY AMBULANCE 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 information. Please review it carefully.
This Notice tells you about the ways in which Hilltown Community
Ambulance (referred to collectively in this
Notice as “we” or “HCAA”), may
use and disclose your protected health information and
your rights concerning your protected health information.
“Protected health information” is information
about you, including demographic information, that can
reasonably be used to identify you and that relates
to your past, present or future physical or mental health
or condition, the provision of health care to you or
the payment for that care.
We are required by a federal law, called the Health
Insurance Portability and Accountability Act of 1996
(referred to as HIPAA), to provide you with this Notice
about your rights and our legal duties and privacy practices
with respect to your protected health information.
We must follow the terms of this Notice while it is
in effect. It’s important to note that some
of the uses and disclosures described in this Notice
may be limited in certain cases by applicable state
laws that are more stringent than the federal standards.
HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH
INFORMATION
We may use and disclose your protected health information
for certain purposes, including for payment, health
care operations and treatment, without first obtaining
your authorization. Here are some examples of
how HCAA may use or disclose your protected health
information without your authorization for payment,
health care operations and treatment.
- Payment. “Payment” refers
to the activities of HCAA in collecting payment
for health care services you receive. For example,
we may use your protected health information for billing
purposes or to be reimbursed by an insurer that may
be responsible for payment.
- Health Care Operations. “Health
Care Operations” refers to the basic business
functions necessary to operate our ambulance service.
For example, we may use your protected health information
to review the quality of the care and services you
receive.
- Treatment. “Treatment” refers
to the provision and coordination of health care by
a doctor, hospital or other health care provider.
For example, we may disclose your protected health
information to your doctors to enable them to provide
proper medical care to you.
OTHER PERMITTED OR REQUIRED DISCLOSURES
- As Required by Law. We must disclose
protected health information about you when required
to do so by law.
- Public Health Activities. We may disclose
protected health information to public health agencies
for reasons such as preventing or controlling disease,
injury or disability.
- Victims of Abuse, Neglect or Domestic Violence.
We may disclose protected health information
about abuse, neglect or domestic violence to government
agencies.
- Health Oversight Activities. We may
disclose protected health information to government
oversight agencies (e.g., U.S. Department of Labor)
for activities authorized by law.
- Judicial and Administrative Proceedings.
We may disclose protected health information
in response to a court or administrative order.
We may also disclose protected health information
about you in certain cases in response to a subpoena,
discovery request or other lawful process.
- Law Enforcement. We may disclose protected
health information under limited circumstances to
a law enforcement official in response to a warrant
or similar process; to identify or locate a suspect;
or to provide information about the victim of a crime.
- Coroners, Funeral Directors, Organ Donation.
We may release protected health information to coroners
or funeral directors as necessary to allow them to
carry out their duties. We may also disclose
protected health information in connection with organ
or tissue donation.
- Research. Under certain circumstances,
we may disclose protected health information about
you for research purposes, provided certain measures
have been taken to protect your privacy.
- To Avert a Serious Threat to Health or Safety.
We may disclose protected health information about
you, with some limitations, when necessary to prevent
a serious threat to your health and safety or the
health and safety of the public or another person.
- Special Government Functions. We may
disclose information as required by military authorities
or to authorized federal officials for national security
and intelligence activities.
- Workers’ Compensation. We may
disclose protected health information to the extent
necessary to comply with state law for workers’
compensation programs.
OTHER USES OR DISCLOSURES WITH AN AUTHORIZATION
Other uses or disclosures of your protected health information
will be made only with your written authorization, unless
otherwise permitted or required by law. You may
revoke an authorization at any time, in writing, except
to the extent that we have already taken action on the
basis of the authorization.
YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
You have certain rights regarding protected health information
that HCAA maintains about you.
- Right To Access Your Protected Health Information.
You have the right to review or obtain copies of your
protected health information records, with some limited
exceptions. Your request to review and/or obtain
a copy of your protected health information records
must be made in writing. We may charge a fee
for the costs of producing, copying and mailing your
requested information, but we will tell you the cost
in advance.
- Right To Amend Your Protected Health Information.
If you feel that protected health information maintained
by HCAA is incorrect or incomplete, you may request
that we amend the information. Your request
must be made in writing and must include the reason
you are seeking a change. We may deny your request
if, for example, you ask us to amend information that
was not created by HCAA or you ask to amend a record
that is already accurate and complete.
If we deny your request to amend, we will notify you
in writing. You then have the right to submit
to us a written statement of disagreement with our
decision and we have the right to rebut that statement.
- Right To an Accounting of Disclosures by HCAA.
You have the right to request an accounting of disclosures
we have made of your protected health information.
The list will not include our disclosures made for
treatment, payment or health care operations, or disclosures
made to you or with your authorization. The
list may also exclude certain other disclosures, such
as for national security purposes.
Your request for an accounting of disclosures must
be made in writing and must state a time period for
which you want an accounting. This time period
may not be longer than six years and may not include
dates before April 14, 2003.
- Right To Request Restrictions on the Use and
Disclosure of Your Protected Health Information.
You have the right to request that we restrict or
limit how we use or disclose your protected health
information for treatment, payment or health care
operations. We may not agree to your request.
If we do agree, we will comply with your request unless
the information is needed for an emergency.
Your request for a restriction must be made in writing.
In your request, you must tell us (1) what information
you want to limit; (2) whether you want to limit
how we use or disclose your information, or both;
and (3) to whom you want the restrictions to
apply.
- Right To Receive Confidential Communications.
You have the right to request that we use a certain
method to communicate with you or that we send information
to a certain location. Your request to receive
confidential communications must be made in writing.
We will accommodate all reasonable requests.
Your request must specify how or where you wish to
be contacted.
- Right To a Paper Copy of This Notice. You
have a right at any time to request a paper copy of
this Notice, even if you had previously agreed to
receive an electronic copy.
- Contact Information for Exercising Your Rights.
You may exercise any of the rights described above
by contacting the HCAA Service Director (413) 667-3277.
CHANGES TO THIS NOTICE
We reserve the right to change the terms of this Notice
at any time, effective for protected health information
that we already have about you as well as any information
that we receive in the future. We will communicate
any changes to our notice through subscriber newsletters,
direct mail, and/or our website.
COMPLAINTS
If you believe that your privacy rights have been violated,
you may file a complaint with us and/or with the Secretary
of the Department of Health and Human Services.
All complaints to HCAA should be directed to Service Director at the phone number listed above.
We support your right to protect the privacy of your
protected health information. We will not retaliate
against you or penalize you for filing a complaint.
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