Privacy

Notice of Privacy Practices

I. 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.

II. We have a legal duty to safeguard your protected health information.

We are legally required to protect the privacy of your health information. This information is called "protected health information" or "PHI." This includes information that we have created or received about your past, present, or future health or condition. This also included the provision of health care to you, or the payment of this health care. We must provide you with the notice about out privacy practices that explain how, when and why we use and disclose your PHI. We may not use or disclose any more of your PHI than is necessary to achieve the purpose of the use or disclosure, with some exceptions. We are legally required to follow the privacy practices that are described in this notice.

We reserve the right to change the terms of this notice and our privacy policies at any time. Any changes will apply to the current PHI. This notice and any subsequent revisions will be posted in the reception area. You can also requests a copy of this notice from the contact person listed in Section VI below at any time.

III. How we may use and disclose your protected health information (PHI)

We use and disclose health information for many reasons. For some of these uses or disclosures, we need your prior consent or a specific authorization. Below, we describe the different categories of your uses and disclosures.

A. Certain Uses and Disclosers Do Not Require Your Consent

1. For treatment. We may disclose your PHI to physicians and nurses who give orders to allow us to provide treatment to you. we many 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.

3. To obtain payment for treatment. We may use and disclose your PHI in order to bill and collect payment for services provided to you. For example, we may disclose your PHI to our billing service to verify that correct procedure codes are being recorded for claim processing.

5. For Health Care operations. We may disclose your PHI for 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. We may also provide you PHI to our accountants, attorneys, consultants, an others in order to make sure we are complying with the laws that affect us. For example, we may disclose your PHI to our attorney concerning a legal issue associated with your care.

7. When a discloser is required by federal, state, or local law, judicial or administrative proceedings or law enforcement. For example, we make disclosures when ordered in a judicial or administrative proceeding.

9. For public health activities. For example, reporting information about various diseases to government officials in charge of collection that information

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11. In suspected cases of abuse. We have the right t disclose PHI to an appropriate government agency where we reasonably suspect that an individual is a victim of abuse, neglect, or domestic violence.

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13. For health oversight activities. For example, we will provide the information to assist the government when it conducts an investigation of a health care provider or organization.

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15. Decedents. We have the authority to disclose PHI to a coroner, medical examiner, or funeral director following an individuals death.

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17. To avoid harm. In order to avoid a serious threat to the health or safety of a person or the public, we may provide PHI to law enforcement personnel or persons to prevent or lessen such harm.

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19. For purposes of organ 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 organ donation or transplantation.

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21. For research purposes. In certain circumstances, we may provide PHI in order to conduct medical research, but this will be subject to strict oversight and approvals.

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23. For specific government functions. We may disclose PHI of military personnel and veterans in certain situations. We may disclose PHI for national security purposes, such as protecting the President of the United States or conducting intelligence operations.

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25. For workers' compensation purposes. We may provide PHI in order to comply with workers' compensation laws.

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27. Fundraising activities. We may use PHI to raise funds for our organization. The money raised is used to expand and support the health care services we provide to the community. If you do not wish to be contacted as part of our fundraising efforts, please contact the person listed in Section VI below.

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B. Two Uses and Disclosures Require You to Have the Opportunity to Object.

1. Patient directories. We may include your name, general condition, and religious affiliation in our patient directory unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

3. Disclosures to family, friends, and others. We may provide your PHI to a family member, friend or other person that you indicate is involved in your care or the payment for your healthcare, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

C. All Other Uses and Disclosures Require Your Prior Written Authorization.

In any other situation not described in sections IIIA and B above, we will ask for your written authorization before using or disclosing any of your PHI. Note: A sample authorization form is attached to this notice for you to view. If you choose to sign an authorization to disclose your PHI, you can later revoke that authorization in writing to stop any future uses and disclosures provided we haven't taken any action relying on the authorization.

IV. WHAT RIGHTS YOU HAVE REGARDING YOUR PHI.

A. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to request limits on how we use and disclose your PHI. We will consider your request but are not legally required to accept it. If we accept your request, we will put any limits in writing and abide by them except in emergency situations. You may not limit the uses and disclosures that we are legally required or allowed to make.

C. The Right to Choose How We Send PHI to You. You have the right to request that we send information to you to an alternate address such as sending information to your work address rather than your home address. You may also request that we send information to you by alternate means such as sending the information through email instead or regular mail. We must agree with your request as long as we can easily provide it in the format you request.

E. The Right to See and Get Copies of Your PHI. Provided you make the request in writing, you generally have the right to look at or get copies of your PHI that we have. If we don't have your PHI but we know who does, we will tell you how to obtain it. We will respond to you in 30 days after receiving your written request. Under certain circumstances we reserve the right to deny your request. If we do, we will notify you in writing, the reasons for the denial, and explain your right to have the denial reviewed. If you request copies of your PHI, we will charge $.50 for each page. We have the responsibility to provide you with a summary or explanation of your PHI you requested as long as you agree to that and to the cost in advance.

G. The Right to Obtain a List of the Disclosures We Have Made. You have the right to get a list of occasions when we have disclosed your PHI. This list will not include uses or disclosure that you have already consented to, such as those made for treatment, payment, or health care operations, directly to you, to your family, or our facility director. This list also wont include uses and disclosure made for national security purposes, to corrections or law enforcement personnel, or before April 16, 2003. We will respond within 60 days of receiving your request. The list we will provide to you will include disclosures made in the last six (6) years unless you specify a shorter period of time. This list will include the date of the disclosure, to whom PHI was disclosed, a description of the information disclosed, and the reason for the disclosure. The list will be provided to you at no charge. However, if more than one list is requested in the same year, we will charge you $5.00 for each additional request.

I. The Right to Correct or Update Your PHI. If you believe there is a mistake in your PHI or that any important information is missing, you have the right to request that we correct the current information or add the missing information. You must provide the request and your reason for the request in writing. We will respond within 60 days of receiving your request. We may deny your request in writing for any of the following reasons: (i) the PHI is correct and complete, (ii) the PHI was not created by us, (iii) the PHI is not allowed to be disclosed, (iv) the PHI is not a part of our records. Our written denial will state the reasons for the denial and explain your right to file a written statement of disagreement with the denial. If you decide not to file a written statement or disagreement, you have the right to ask that your request and our denial be attached to all future disclosures of your PHI. If we approve your request, we will make the change to your PHI, inform you of the change, and let others know the need to change your PHI.

V. HOW TO COMMENT ABOUT OUR PRIVACY PRACTICES

If you feel we may have violated your privacy rights, or you disagree with a decision we made concerning access to your PHI, you may file a complaint with the person listed in Section VI below. You may also send a written complaint to the Secretary of the Department of Health and Human Services at 200 Independence Avenue, SW, Washington DC 20201. We will not take any retaliatory action against you if you file a complaint about our privacy practices.

VI. PERSON TO CONTACT FOR INFORMATION ABOUT THIS NOTICE OR TO COMMENT ABOUT OUR PRIVACY PRACTICES

If you have any questions about this notice, have any comments about our privacy practices, or would like to know how to file a complaint with the Secretary of the Department of Health and Human Services, please contact The Greater Weatherly Ambulance Association Inc. PRIVACY OFFICER, 400 Carbon Street, Weatherly PA, 18255; 570-427-8772; weathamb@hazleton.net

VII. EFFECTIVE DATE OF THIS NOTICE

THIS NOTICE IS AFFECTIVE APRIL 14, 2003