HEALTH INSURANCE PORTABILITY
AND ACCOUNTABILITY ACT – PROVIDER NOTICE OF PRIVACY PRACTICES
This notice describes how medical information
about you may be used and disclosed by American Ambulance Service
and how you can get access to this information.
Effective April 14, 2003 Please review
Uses and disclosures of health information:
We use health information about you for treatment
(diagnostic testing, prescription, referral, etc.) to obtain payment
(submit claims and/or encounters to billing services and/or clearinghouses,
and/or collection agencies, etc.) for administrative purposes (reporting
utilization management, quality improvement and surveys, etc) and
to evaluate the quality of care that you receive. We may contact
you to provide appointment reminders or information about treatment
alternatives or other health-related benefits and services that
may be of interest to you.
We may use or disclose identifiable health information
about you without your authorization for several other reasons.
Subject to certain requirements, we may give out health information
without your authorization for public health purposes, for auditing
purposes, for research studies, and for emergencies. We provide
information when otherwise required by law, such as for law enforcement
in specific circumstances. In any other situation, we will ask for
your written authorization before using or disclosing any identifiable
health information about you. If you choose to sign an authorization
to disclose information, you can later revoke that authorization
to stop any future uses and disclosures.
We may apply a change to our policies at any time.
Before we make a significant change in our policies, we will change
our notice and post the new notice in the waiting area and in each
ambulance. You may also request a copy of our notice at any time.
For more information about our privacy practices, contact the Privacy
Officer listed below.
You have the right, following a written request
and agreed upon date and time, to look at, get a copy of or receive
electronically protected health information about you that we use
to make decisions about you. If you request copies, we will charge
you at our cost for each page. You also have the right to receive
a list of instances where we have disclosed protected health information
about you for reason other than treatment, payment or related administrative
purposes. If you believe that information in your record is incorrect
or if important information is missing, you have the right to request
in writing that we amend the existing information.
You may request in writing that we restrict and/or
not use or disclose your information for treatment, payment and
administrative purposes except when specifically authorized by you,
when required by law, or in emergency circumstances. We will consider
your request but are not legally required to agree to it.
If you are concerned that we have violated your
privacy rights, or you disagree with a decision we made about access
or amendment to your records, you may contact the Privacy Officer
listed below. You may send a written complaint to the U.S. Department
of Health and Human Services, Office of Civil Rights. The Privacy
Officer listed below can provide you with the appropriate address
Our legal duty:
We are required by law to protect the privacy of
your information, provide this notice about our information practices,
and follow the information practices that are described in this
Questions or complaints may be address