Town of Waldoboro
Emergency Medical Services
Privacy Statement
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.
Purpose of this Notice:
Waldoboro EMS 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 PHI Notice describes your legal rights, advises
you of our privacy practices, and lets you know how Waldoboro EMS is permitted to use
and disclose PHI about you.
Waldoboro EMS is also required to abide by the terms of the version of this PHI Notice
currently in effect. In most situations we may use this information as described in this
PHI 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:
Waldoboro EMS 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.
-
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.
Waldoboro EMS is permitted to use PHI without your written authorization, or opportunity to
object in certain situations, including:
-
For Waldoboro EMS 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, 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 rise an objection, and in certain other circumstances where we are unable
to obtain your agreement and believe the disclosure is in your best interest;
-
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. Waldoboro EMS is not required to agree to any restrictions
you request, but any restrictions agreed to by Waldoboro EMS are binding on Waldoboro EMS.
-
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: Waldoboro EMS 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:
Scott Lash, Director of EMS, Privacy Officer
Waldoboro EMS
PO Box J
1600 Atlantic Highway
Waldoboro, Maine 04572
(207) 832-2160
http://www.waldoboromaine.org
Effective Date of the Notice: December 14, 2005
