NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMANTION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION
PLEASE REVIEW IT CAREFULLY
If you have any questions about this notice please contact the Privacy Officer of Rescue Eight Paramedic Services, Inc. at 847-605-8400, 1520 Industrial Dr., Unit C, Lake In The Hills, IL 60156
This notice describes the information privacy practices followed by our employees, staff and other office personnel.
Your health information:
This notice applies to the information and records we have about your health, health status, and the health care and service you were provided. We are required by law to give you this notice. It will tell you about the ways in which we may use and disclose health information about you and describes your rights and our obligations regarding the use and disclosure of that information.
How we may use and disclose health information about you:
For treatment: We may use health information about you to provide you with medical treatment or services.
We may disclose health information about you to doctors, nurses, technicians, office staff or other personnel who are involved in taking care of you and your health. For example, 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 Protected Health Information (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. Different personnel in our office may share information about you and disclose information to people who do not work in our office in order to coordinate your care. Family members and other health care providers may be part of your medical care outside this office and may require information about you that we have.
For Payment: We may use and disclose health information about you so that treatment and services you receive at this office may be billed to and payment may be collected from you, an insurance company or third party. For example, we may need to give your health plan information about a service you received here so your health plan will pay us or reimburse you for the service.
For health care operations: We may use and disclose health information about you in order to run the office and make sure that you and our other patients receive quality care. For example, we may use your health information to evaluate the performance of our staff in caring for you. We may also use health information about all or many of our patients to help us decide what additional services we should offer, how we can become more efficient, or whether certain new treatments are effective.
SPECIAL SITUATIONS: We may use or disclose health information about you without your permission for the following purposes, subject to all applicable legal requirements and limitations:
To avert a serious threat to health or safety: We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
Required by law: We will disclose health information about you when required to do so by federal, state, or local law
Research: We may use and disclose health information about you for research projects that are subject to a special approval process.
Organ and tissue donation: 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 such donation and transplantation.
Military, Veterans, National Security and Intelligence: If you are or were a member of the armed forces, or part of the national security or intelligence communities, we may be required by military command or other government authorities to release health information about you. We may also release information about foreign military personnel to the appropriate foreign military authority.
Worker’ Compensation: We may release health information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
Public Health Risks: We may disclose health information about you for public health reasons in order to prevent or control disease, injury, or disability; or report births, deaths, suspected abuse or neglect, non-accidental physical injuries, reactions to medications or problems with products.
Health Oversight Activities: We may disclose health information to a health oversight agency for audits, investigations, inspections, or licensing purposes. These disclosures may be necessary for certain state and federal agencies to monitor the health care system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order. Subject to all applicable legal requirements, we may also disclose health information about you in response to a subpoena.
Law Enforcement: We may release health information if asked to do so by a law enforcement official in response to a court order, subpoena, warrant, summons or similar process, subject to all applicable legal requirements.
Coroners, Medical Examiners, and Funeral Directors: We may release health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death.
Information not personally identifiable: We may use or disclose health information about you in a way that does not personally identify you or reveal who you are.
Family and friends: We may disclose health information about you to your family members or friends 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. In situations where you are not capable of giving consent (because you are not present or due to your incapacity or medical emergency), we may, using our professional judgment, determine that a disclosure to your family member or friends is in your best interest.
OTHER USES AND DISCLOSURES OF HEALTH INFORMATION
We will not use or disclose your health information for any purpose other than those identified in the previous sections without your specific, written Authorization. We must obtain your Authorization separate from any Consent we may have obtained from you. If you give us Authorization to use or disclose health information about you, you may revoke that Authorization, in writing, at any time. If you revoke your Authorization, we will no longer use or disclose information about you for the reasons covered by your written Authorization, but we cannot take back any uses or disclosures already made with your permission.
YOU’RE RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
You have the following right regarding health information we maintain about you:
Right to inspect and copy: You have the right inspect and copy your health information, such as medical and billing records, that we use to make decisions about your care. You must submit a written request to our Privacy Officer in order to inspect and/or copy your health information. If you request a copy of the information, we may charge a fee for the cost of copying, mailing, or other associated supplies. We may deny your request to inspect and/or copy in certain limited circumstances. If you are denied access to your health information, you may ask that the denial be reviewed. The person conducting the review will not be the person who denied your request, and we will comply with the outcome of the review.
Right to amend: If you believe health information we have about you is incorrect or incomplete; you may ask us to amend the information. You have the right to request an amendment as long as this office keeps the information.
To request an amendment, complete and submit a Medical Record Amendment/Correction Form to Privacy Officer. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
a) We did not create, unless the person or entity that created the information is no longer available to make the
b) Is not part of the health information that we keep.
c) You would not be permitted to inspect and copy.
d) Is accurate and complete.
Right to an accounting of disclosures: You have the right to request an “accounting of disclosures.” This is a list of the disclosures we make of medical information about you for the purposes other than treatment, payment, and health care operations. To obtain this list, you must submit your request in writing to our Privacy Officer.
It must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example on paper or electronically). We may charge you for the cost of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Right to request restrictions: You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for it, like a family member or friend.
We are not required to agree to your request: If we do agree; we will comply with your request unless the information is needed to provide you emergency treatment.
To request restrictions, you may complete and submit the Request for Restriction on Use/Disclosure of Medical Information to our Privacy Officer.
Right to request confidential communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. To request confidential communications, you may complete and submit the Request For Restriction on Use/Disclosure of Medical Information and/or Confidential Communication to our Privacy Officer. We will not ask you the reason for you request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to a paper copy of this notice: You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. To obtain such a copy contact our Privacy Officer.
CHANGES TO THIS NOTICE
We reserve the right to change this notice, and to make revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. You are entitled to a copy of the notice currently in effect.
If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. To file a complaint with our office, contact our
Privacy Officer at 847-605-8400, 1520 Industrial Drive, Unit C, Lake in the Hills, IL, 60156 you will not
be penalized for filing a complaint.
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