Notice of Privacy Practice
Notice of Privacy Practice
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.
Tri-County Ambulance Service (“TCA”) is required by law to maintain the privacy of certain confidential health care information, known as Protected Health Information (PHI), and to provide you with a notice of our legal duties and privacy practices with respect to your PHI. TCA is also required to abide by the terms of the version of this notice currently in effect.
Uses and Disclosures of PHI:
TCA may use PHI for the purpose of treatment, payment, and health care operations in most cases without your written permission. Examples of our use of your PHI:
Treatment: This may include 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.
Payment: This may include 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, and making medical necessity determinations and collecting outstanding accounts.
Health Care Operations: This may include 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 of 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:
TCA 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, 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 the public health authority in certain situations as required by law (such as reporting an abuse, neglect, or domestic violence);
● For health oversight activities including audits or government investigations, inspections, disciplinary 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, security, and other special government functions;
● To avert a serious threat to the health and safety of a person or 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 PHI 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 PHI 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 you 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 any access and let you know your appeal rights. You may also have the right to receive confidential communications of your PHI. If you wish to inspect and copy your PHI, you should contact our director of operations.
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 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 director of operations.
The right to request an accounting.
You may have the right to request an accounting from us of certain disclosures of your PHI that we have made within the last six years prior to the date of your request. We are not required to give you an accounting of information we have disclosed for the purposes of treatment, payment, health care operations, or when we share your PHI 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 PHI for which you have already given us written authorization. If you wish to request an accounting, contact the director of operations.
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 PHI that we have about you. TCA is not required to agree to any restrictions you request, but any restrictions agreed to by TCA in writing are binding on TCA.
Internet, E-mail,and the right to obtain copy of paper notice on request.
If TCA maintains a web site a copy of this notice will be posted at our earliest convenience. If you request TCA will forward a copy of this notice via e-mail instead of on paper. You may always request a paper copy of this notice. Click here to download Privacy Notice in adobe reader format.
Revision to the notice.
TCA 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 PHI that we maintain. Any materials that changes to the notice will be promptly posted in our facilities and posted to our website, if we maintain one. You can get a copy of the latest version of this notice by contacting the director of operations.
Your legal rights and complaints.
You also have the right to complain to us, or 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 th the government. Should you have any questions, comments or complaints you may direct all inquiries to the director of operations.
Contact Information:
Tri-County Ambulance
Director of Operations
P.O. Box 975
East Liverpool, OH 43920
(330)385-1829
Effective Date of Notice: April 14th, 2003
Revision Date: February 5th, 2008