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Ridgway Ambulance Corporation - Privacy Notice

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 CAREFULLY

As an essential part of our commitment to you, Ridgway Ambulance 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 provide you with the attached Notice of Privacy Practices. The Notice out- lines our legal duties and privacy practices respect to your PHI. It not only describes our privacy practices and your legal rights, but lets you know, among other things, How Ridgway Ambulance is permitted to use and disclose PHI about you, how you can access and copy that infor mation, and how you may request restrictions on our use and disclosure of you PHI. Ridgway Ambulance is also required to abide by the terms of the version of this Notice currently in effect. In 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 written Authorization, if we are required by law to do so. We respect you 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: Sean M. Papa, our Privacy Officer at 814-773-3633

Purpose of this Notice: Ridgway Ambulance 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 notice of our legal duties and privacy practices, and lets you know how Ridgway Ambulance is permitted to use and disclose PHI about you. Ridgway Ambulance is also required at 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 of Disclosure of PHI: Ridgway Ambulance may use PHI for the purpose of treatment, payment and health care operations, in most cases without your written permission.

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. It also includes information we give to other health care personnel to whom we transfer your care and treatment, and includes transfer 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, manage- ment 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, arid 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 Ridgway 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 to other health related benefits and services that may be of interest to you.

Uses and Disclosure of PHI Without Your Authorization: Ridgway Ambulance is permitted to use PHI without your written authorization, or opportunity to object in certain situations including: * For Ridgway Ambulance’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 for the health care operations activities of the entity that receives the information as long as the entity receiving the information has or 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 the other individual involved in your care if we obtain your verbal agreement to do so or if we get the 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. In situations where you are not able capable of objecting, 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 persons involvement in your care. * To a public health authority in certain situations (births, deaths, abuse etc) * For health oversight activities including audits, inspections, investigations, and other administrative or judicial actions undertaken by the government 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 slap a crime. * For military, national defense and security and other special government functions. * To advert a serious threat to the health and safety of a person or the public at large. * For worker’s compensation purposes, and in compliance with worker’s 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 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 whom 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 the protection of your PHI, including: 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 Disclosure 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 the 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. Ridgway Ambulance is not required to agree to but any restrictions agreed to by Ridgway Ambulance are binding on Ridgway 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 by electronic mail instead of paper, you may always request a paper copy.

Revisions to the Notice: Ridgway Ambulance reserves the right to change the terms of this Notice at any time, and the changes will be effective immediately and apply to all PHI that we maintain. All changes will be posted.

Your Legal Rights and Complaints: You also have right to complain to us or the Secretary of the US Dept of Health and Human Services if you believe you privacy has been violated. Individuals that file a complaint will not be retaliated against for filing a complaint.

If you have any questions or wish to file a complaint please contact our Privacy Officer: Sean M. Papa NREMT-P Operations Manager - Ridgway Ambulance Corporation - PO Box 297 - Ridgway, PA 15853 814-773-3633

Effective date of Notice 1-31-03