A. maintain the privacy of your health information, also known as “protected
health information” or “PHI;”
B. provide you with this Notice, and
C. comply with this Notice.
II. Future Changes to Our Practices and This Notice
We reserve the right to change our privacy practices and to make any such change
applicable to the PHI we obtained about you previously. If a change in our practices
is material, we will revise this Notice to reflect the change.
III. How We May Use and Disclose Your Protected Health Information
The law requires us to have your authorization for some uses and disclosures.
In other circumstances, the law allows us to use or disclose PHI without your
authorization. This section gives examples of each of these circumstances.
Uses and Disclosures That Require Us to Give You the Opportunity to Object. Unless
you object, we may provide relevant portions of your PHI to a family member,
friend or other person you indicate is involved in your health care or in helping
you get payment for your health care. We may use or disclosure your PHI to notify
your family or personal representative of your location or condition. In an emergency
or when you are not capable of agreeing or objecting to these disclosures, we
will disclose PHI as we determine is in your best interest, but will tell you
about it later, after the emergency, and give you the opportunity to object to
future disclosures to family and friends. Unless you object, we may also disclose
your PHI to persons performing disaster relief activities.
A. Certain Uses and Disclosures Do Not Require Your Authorization The law allows
us to disclose PHI without your authorization in the following circumstances:
(1) When Required by Law.
(2) For Public Health Activities.
(3) For Reports About Victims of Abuse, Neglect or Domestic Violence.
(4) To Health Oversight Agencies.
(5) For Lawsuits and Disputes.
(6) To Law Enforcement. We may release PHI if asked to do so by a law enforcement
official, in the following circumstances: (a) in response to a court order, subpoena,
warrant, summons or similar process; (b) to identify or locate a suspect, fugitive,
material witness or missing person; (c) about the victim of a crime if, under
certain limited circumstances, we are unable to obtain the person’s agreement;
(d) about a death we believe may be due to criminal conduct; (e) about criminal
conduct at our facility; and (f) in emergency circumstances, to report a crime,
its location or victims, or the identity, description or location of the person
who committed the crime.
(7) To Coroners, Medical Examiners and Funeral Directors.
(8) To Organ Procurement Organizations.
(9) For Medical Research. We may disclose your PHI without your authorization
to medical researchers who request it for approved medical research projects
(10) To Avert a Serious Threat to Health or Safety.
(11) For Specialized Government Functions.
(12) To Workers’ Compensation or Similar Programs.
IV. Other Uses and Disclosures of Your Protected Health
Information
Other uses and disclosures of your PHI that are not covered by this Notice or
the laws that apply to us will be made only with your written authorization.
If you give us written authorization for a use or disclosure of your PHI, you
may revoke that authorization, in writing, at any time. If you revoke your authorization
we will no longer use or disclosure your PHI for the purposes specified in the
written authorization, except that we are unable to retract any disclosures we
have already made with your permission. In addition, we can use or disclose your
PHI after you have revoked your authorization for actions we have already taken
in reliance on your authorization. We are also required to retain certain records
of the uses and disclosures made when the authorization was in effect.
V. Your Rights Related to Your Protected Health Information
You have the following rights:
A. The Right to Request Limits on Uses and Disclosures of Your PHI. You have
the right to ask us to limit how we use and disclose your PHI. Any such request
must be submitted in writing to our Privacy Officer. We are not required to agree
to your request. If we do agree, we will put it in writing and will abide by
the agreement except when you require emergency treatment.
B. The Right to Choose How We Communicate With You. You have the right to ask
that we send information to you at a specific address (for example, at work rather
than at home) or in a specific manner (for example, by e-mail rather than by
regular mail, or never by telephone). We must agree to your request as long as
it would not be disruptive to our operations to do so. You must make any such
request in writing, addressed to our Privacy Officer.
C. The Right to See and Copy Your PHI. Except for limited circumstances, you
may look at and copy your PHI if you ask in writing to do so. Any such request
must be addressed to our Patient Billing Service Center, which will respond to
your request within 10 days (or 30 days if the extra time is needed). In certain
situations we may deny your request, but if we do, we will tell you in writing
of the reasons for the denial and explain your rights with regard to having the
denial reviewed.
D. The Right to Correct or Update Your PHI. If you believe that the PHI we have
about you is incomplete or incorrect, you may ask us to amend it. Any such request
must be made in writing and must be addressed to our Patient Billing Service
Center, and must tell us why you think the amendment is appropriate. We will
not process your request if it is not in writing or does not tell us why you
think the amendment is appropriate. We will act on your request within 30 days
or less if state law requires (or 60 days if the extra time is needed), and will
inform you in writing as to whether the amendment will be made or denied. If
we agree to make the amendment, we will ask you who else you would like us to
notify of the amendment.
We may deny your request if you ask us to amend information that:
(1) was not created by us, unless the person who created the information is no
longer available to make the amendment;
(2) is not part of the PHI we keep about you;
(3) is not part of the PHI that you would be allowed to see or copy; or
(4) is determined by us to be accurate and complete.
If we deny the requested amendment, we will tell you in writing how to submit
a statement of disagreement or complaint, or to request inclusion of your original
amendment request in your PHI.
E. The Right to Get a List of the Disclosures We Have Made. You have the right
to get a list of instances in which we have disclosed your PHI. The list will
not include disclosures we have made for our treatment, payment and health care
operations purposes, those made directly to you or your family or friends or
through our facility directory, or for disaster relief purposes. Neither will
the list include disclosures we have made for national security purposes or to
law enforcement personnel, or disclosures made before April 14, 2003.
Your request for a list of disclosures must be made in writing and be addressed
to the Patient Billing Service Center address that is listed on your invoice.
We will respond to your request within 30 days, or less if state law requires
(or 60 days if the extra time is needed). The list we provide will include disclosures
made within the last six years unless you specify a shorter period. The first
list you request within a 12-month period will be free. You will be charged our
costs for providing any additional lists within the 12-month period.
F. The Right to Get a Paper Copy of This Notice. Even if you have agreed to receive
the Notice by e-mail, you have the right to request a paper copy as well. You
may obtain a paper copy of this Notice by contacting STAT EMS, Inc., at 520 W.
3rd St., Flint MI, 48503 or by phone at (810)238-7672.
VI. Complaints
If you believe your privacy rights have been violated, you may file a complaint
with us or with the Secretary of the federal Department of Health and Human Services.
To file a complaint with the DHHS put your complaint in writing and address it
to the U S Department of Health & Human Services, 200 Independence Ave. S.W.,
Washington DC, 20201. Or call them at (877)696-6775. To file a complaint with
us, please put your complaint in writing and address it to STAT EMS, Inc., at
520 W. 3rd St., Flint, MI 48503 or by phone at (810)238-7672. |
