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Honeoye Falls-Mendon Volunteer Ambulance
Privacy Information
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE
USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
Purpose of this Notice: HFMVA 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 HFMVA is
permitted to use and disclose PHI about you.
HFMVA 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: HFMVA 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.
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 HFMVA.
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:
HFMVA is permitted to use PHI without your written authorization, or
opportunity to object in certain situations, including:
For HFMVA'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, 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 persons 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
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 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 of 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. HFMVA is not required to agree to any
restrictions your request, but any restrictions agreed to by HFMVA
are binding on HFMVA.
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: HFMVA 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 inquires 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 our
Privacy Officer:
Pete Doyle
Chief of Operations
HFMVA
P.O. Box 335
Honeoye Falls, NY 14472
(585) 624-2200
Effective Date of the Notice: April 14, 2003
Updated February 11, 2008
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