Purpose of this Notice: Howard County Ambulance Service 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. This Notice describes your legal rights, advises you of our
privacy practices, and lets you know how Howard County Ambulance Service is permitted to use and disclose PHI about
you.
Howard County Ambulance Service is also required to abide by the terms of the version of this Notice currently in effect.
In most situations we may use this information as described in this Notice without your permission, but there are some
situations where we may use it only after we obtain your written authorization, if we are required by law to do so.
Uses and Disclosures of PHI: Howard County Ambulance Service 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 verbal and written information that we obtain about you and use pertaining
to your medical condition and treatment provided to you by us and other medical personnel (including doctors and
nurses who give orders to allow us to provide treatment to you). It also includes information we give to other health care
personnel to whom we transfer your care and treatment, and includes transfer of PHI via radio or telephone to the
hospital or dispatch center as well as providing the hospital with a copy of the written record we create in the course of
providing you with treatment and transport.
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 organizing your PHI and submitting bills to insurance companies (either directly or through
a third party billing company), management of billed claims for services rendered, medical necessity determinations and
reviews, utilization review, and collection of 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, obtaining legal and financial
services, conducting business planning, processing grievances and complaints, creating reports that do not individually
identify you for data collection purposes, fundraising, and certain marketing activities.
Fundraising. We may contact you when we are in the process of raising funds for Howard County Ambulance Service, or
to provide you with information about our annual subscription program.
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 for other
information about alternative services we provide or other health-related benefits and services that may be of interest to
you.
Use and Disclosure of PHI Without Your Authorization. Howard County Ambulance Service is permitted to use PHI without
your written authorization, or opportunity to object in certain situations, including:
· For Howard County Ambulance Service’s use in treating you or in obtaining payment for services provided to you
or in other health care operations;
· For the treatment activities of another health care provider;
· To another health care provider or entity for the payment activities of the provider or entity that receives the
information (such as your hospital or insurance company);
· To another health care provider (such as the hospital to which you are transported) for the health care operations
activities of the entity that receives the information as long as the entity receiving the information has or has had a
relationship with you and the PHI pertains to that relationship;
· For health care fraud and abuse detection or for activities related to compliance with the law;
· 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. We may also disclose health information to your family, relatives, or friends if we infer from the circumstances
that you would not object. For example, we may assume you agree to our disclosure of your personal health information
to your spouse when your spouse has called the ambulance for you. In situations where you are not capable of
objecting (because you are not present or due to your incapacity or medical emergency), we may, in our professional
judgment, determine that a disclosure to your family member, relative, or friend is in your best interest. In that situation,
we will disclose only health information relevant to that person's involvement in your care. For example, we may inform
the person who accompanied you in the ambulance that you have certain symptoms and we may give that person an
update on your vital signs and treatment that is being administered by our ambulance crew;
· To a public health authority in certain situations (such as reporting a birth, death or disease as required by law, as
part of a public health investigation, to report child or adult abuse or neglect or domestic violence, to report adverse
events such as product defects, or to notify a person about exposure to a possible communicable disease as required by
law;
· 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 there is a warrant for the request, or when the
information is needed to locate a suspect or stop a crime;
· 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 and health information will be
released only when there is a minimal risk to your privacy and adequate safeguards are in place in accordance with the
law;
· We may 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, (the
authorization must specifically identify the information we seek to use or disclose, as well as when and how we seek to
use or disclose it). 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 the protection of your PHI, including:
The right to access, copy or inspect your PHI. This means you may come to our offices and 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. If you wish to inspect and copy your medical information, you should contact the privacy
officer listed at the end of this Notice.
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 the privacy officer listed at the end of this
Notice.
The right to request an accounting of our use and disclosure of your PHI. You may request an accounting from us of
certain disclosures of your medical information that we have made in the last 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 of the medical information about you that we
have used or disclosed that is not exempted from the accounting requirement, you should contact the privacy officer
listed at the end of this Notice.
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 for treatment, payment or health care
operations, or to restrict the information that is provided to family, friends and other individuals involved in your health
care. But if you request a restriction and the information you asked us to restrict is needed to provide you with
emergency treatment, then we may use the PHI or disclose the PHI to a health care provider to provide you with
emergency treatment. Howard County Ambulance Service is not required to agree to any restrictions you request, but
any restrictions agreed to by Howard County Ambulance Service are binding on Howard County Ambulance Service.
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 and make the Notice available electronically through the 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: Howard County Ambulance Service 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 the Privacy Officer identified below.
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 the privacy officer listed at the end of this Notice. Individuals will not be
retaliated against for filing a complaint.
If you have any questions or if you wish to file a complaint or exercise any rights listed in this Notice, please contact:
Laura Gray
Howard County Ambulance Service
P.O.Box 581
Nashville, AR 71852
870-451-0400
Effective Date of the Notice:06/09/2003
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. This Notice describes your legal rights, advises you of our
privacy practices, and lets you know how Howard County Ambulance Service is permitted to use and disclose PHI about
you.
Howard County Ambulance Service is also required to abide by the terms of the version of this Notice currently in effect.
In most situations we may use this information as described in this Notice without your permission, but there are some
situations where we may use it only after we obtain your written authorization, if we are required by law to do so.
Uses and Disclosures of PHI: Howard County Ambulance Service 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 verbal and written information that we obtain about you and use pertaining
to your medical condition and treatment provided to you by us and other medical personnel (including doctors and
nurses who give orders to allow us to provide treatment to you). It also includes information we give to other health care
personnel to whom we transfer your care and treatment, and includes transfer of PHI via radio or telephone to the
hospital or dispatch center as well as providing the hospital with a copy of the written record we create in the course of
providing you with treatment and transport.
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 organizing your PHI and submitting bills to insurance companies (either directly or through
a third party billing company), management of billed claims for services rendered, medical necessity determinations and
reviews, utilization review, and collection of 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, obtaining legal and financial
services, conducting business planning, processing grievances and complaints, creating reports that do not individually
identify you for data collection purposes, fundraising, and certain marketing activities.
Fundraising. We may contact you when we are in the process of raising funds for Howard County Ambulance Service, or
to provide you with information about our annual subscription program.
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 for other
information about alternative services we provide or other health-related benefits and services that may be of interest to
you.
Use and Disclosure of PHI Without Your Authorization. Howard County Ambulance Service is permitted to use PHI without
your written authorization, or opportunity to object in certain situations, including:
· For Howard County Ambulance Service’s use in treating you or in obtaining payment for services provided to you
or in other health care operations;
· For the treatment activities of another health care provider;
· To another health care provider or entity for the payment activities of the provider or entity that receives the
information (such as your hospital or insurance company);
· To another health care provider (such as the hospital to which you are transported) for the health care operations
activities of the entity that receives the information as long as the entity receiving the information has or has had a
relationship with you and the PHI pertains to that relationship;
· For health care fraud and abuse detection or for activities related to compliance with the law;
· 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. We may also disclose health information to your family, relatives, or friends if we infer from the circumstances
that you would not object. For example, we may assume you agree to our disclosure of your personal health information
to your spouse when your spouse has called the ambulance for you. In situations where you are not capable of
objecting (because you are not present or due to your incapacity or medical emergency), we may, in our professional
judgment, determine that a disclosure to your family member, relative, or friend is in your best interest. In that situation,
we will disclose only health information relevant to that person's involvement in your care. For example, we may inform
the person who accompanied you in the ambulance that you have certain symptoms and we may give that person an
update on your vital signs and treatment that is being administered by our ambulance crew;
· To a public health authority in certain situations (such as reporting a birth, death or disease as required by law, as
part of a public health investigation, to report child or adult abuse or neglect or domestic violence, to report adverse
events such as product defects, or to notify a person about exposure to a possible communicable disease as required by
law;
· 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 there is a warrant for the request, or when the
information is needed to locate a suspect or stop a crime;
· 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 and health information will be
released only when there is a minimal risk to your privacy and adequate safeguards are in place in accordance with the
law;
· We may 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, (the
authorization must specifically identify the information we seek to use or disclose, as well as when and how we seek to
use or disclose it). 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 the protection of your PHI, including:
The right to access, copy or inspect your PHI. This means you may come to our offices and 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. If you wish to inspect and copy your medical information, you should contact the privacy
officer listed at the end of this Notice.
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 the privacy officer listed at the end of this
Notice.
The right to request an accounting of our use and disclosure of your PHI. You may request an accounting from us of
certain disclosures of your medical information that we have made in the last 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 of the medical information about you that we
have used or disclosed that is not exempted from the accounting requirement, you should contact the privacy officer
listed at the end of this Notice.
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 for treatment, payment or health care
operations, or to restrict the information that is provided to family, friends and other individuals involved in your health
care. But if you request a restriction and the information you asked us to restrict is needed to provide you with
emergency treatment, then we may use the PHI or disclose the PHI to a health care provider to provide you with
emergency treatment. Howard County Ambulance Service is not required to agree to any restrictions you request, but
any restrictions agreed to by Howard County Ambulance Service are binding on Howard County Ambulance Service.
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 and make the Notice available electronically through the 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: Howard County Ambulance Service 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 the Privacy Officer identified below.
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 the privacy officer listed at the end of this Notice. Individuals will not be
retaliated against for filing a complaint.
If you have any questions or if you wish to file a complaint or exercise any rights listed in this Notice, please contact:
Laura Gray
Howard County Ambulance Service
P.O.Box 581
Nashville, AR 71852
870-451-0400
Effective Date of the Notice:06/09/2003
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