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Burholme
Emergency
Medical Services
First To Respond
First To Help
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PRIVACY
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Burholme Emergency Medical Services Inc.
Notice of Privacy Practices
IMPORTANT: 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.
As an essential part of our commitment to you, Burholme Emergency Medical Services Inc. (herein known as BFAC) maintains the privacy of certain
confidential health care information about you, known as Protected
Health Information or PHI. We are required by law to protect your health
care information and to provide you with the attached Notice of Privacy
Practices.
The Notice outlines our legal duties and privacy practices with
respect to your PHI. It not only describes our privacy practices and
your legal rights, but lets you know, among other things, how BFAC is
permitted to use and disclose PHI about you, how you can access and copy
that information, how you may request amendment of that information, and
how you may request restrictions on our use and disclosure of your PHI.
BFAC 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.
We respect your privacy, and treat all health care information about
our patients with care under strict policies of confidentiality that all
of our staff are committed to following at all times.
PLEASE READ THE ATTACHED DETAILED NOTICE. IF YOU HAVE ANY QUESTIONS
ABOUT IT, PLEASE CONTACT TIM HINCHCLIFF OUR PRIVACY OFFICER, AT
215-745-7410 ext. 19.
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: BFAC 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 BFAC is permitted to use and disclose
PHI about you.
BFAC 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: BFAC 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 Burholme Ambulance, 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. BFAC is
permitted to use PHI without your written authorization, or
opportunity to object in certain situations, including:
· For BFAC’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. BFAC is
not required to agree to any restrictions you request, but any
restrictions agreed to by BFAC are binding on BFAC’s ambulance.
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: BFAC 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:
Tim Hinchcliff
Privacy Officer
Burholme Emergency Medical Services
830 Bleigh Street
Philadelphia, PA 19111
215-745-7410 ext. 19 |
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