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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.
County Rescue Services 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. County Rescue Services is also required to abide by
the terms of the version of this Notice currently in effect.
Uses and Disclosures of PHI: County
Rescue Services 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 reminder 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. County
Rescue Services 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;
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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 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;
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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;
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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 request access to your PHI and we will
provide 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 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 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 information
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.
County Rescue Services is not required to agree to any restrictions
you request, but any restrictions agreed to by County Rescue Services
in writing are binding on County Rescue Services.
Revisions
to the Notice: County Rescue Services 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:
Terri
Winske
County Rescue Services Squad, Inc.
1765 Allouez Ave
Green Bay, WI 54311
(920) 469-9779
twinske@countyrescue.com
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