Notice of Privacy Practices
NORTH JEFFERSON COUNTY
AMBULANCE DISTRICT
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.
North Jefferson County Ambulance District.
(“NJCAD”) 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. North Jefferson
County Ambulance District is also required to
abide by the terms of the version of this Notice
currently in effect.
Uses and Disclosures of PHI: ABC Ambulance
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 re minder
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. North Jefferson County
Ambulance District 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 con- tractors) 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 re- quest access to your PHI and we will
pro- vide 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 in- formation
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 in- formation 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. North Jefferson County Ambulance District is
not required to agree to any restrictions you request, but any restrictions agreed to by North
Jefferson County Ambulance District in writing
are binding on North Jefferson County
Ambulance District .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: North Jefferson County
Ambulance District 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:
North Jefferson County
Ambulance District
3131 Rock Creek Rd
High Ridge, MO 63049
636-677-3399
Effective Date of the Notice: April 14, 2003
Copyright 2003, Page, Wolfberg & Wirth, LLC. Use
by individual ambulance services permitted. Any
other use or reproduction in any form requires our
express written permission. This is not legal advice.
Contact us at www.pwwemslaw.com. Delete this
copyright statement prior to patient distribution.