HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)
About the Notice of Privacy Practice
THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN
GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY!
We are legally required to maintain the privacy of certain confidential information about your health (referred to in this notice as
"protected health information") and to provide you with this Notice of our legal duties and privacy practices with respect to
protected health information. We are required to abide by the terms of this Notice as long as it is in effect. We reserve the right to
amend this Notice and to make the amended provisions effective for all protected health information we maintain. Any changes to
this Notice will be posted at our facility. You may obtain a copy of the latest version of this Notice from the Privacy Officer
identified below.
Your Privacy Rights
The law gives you the right to:
" You may request limitations of the information we use or disclose for health care treatment, payment, or operations, but we are
not required to agree to your request. If we agree, we will comply with your request unless the information is needed to provide
you with emergency treatment.
" You may request that we communicate with you in a certain manner or at a certain location, but you must specify how or where
you wish to be contacted.
" You have a right to inspect and copy most of the information we will maintain about you. We will normally provide access to
information within 30 days and charge a reasonable fee for copying it. Under limited circumstances, we can deny your request for
information. You may appeal certain denials.
" If you believe that the information we have about you is incorrect or incomplete, you may request an amendment. Most of the
time we cannot change or delete information, even if it is incorrect. However, Falls Co. EMS, Inc decides it should make a change;
it will add the correct information to the record and noted that the new information takes the place of the old information. The old
information will remain in the record. We will generally amend your information within 60 days of receiving a written request
specifying the specific amendment you request. We can deny your request only in certain situations, for example if we believe the
information you have asked us to amend is correct and therefore should not be amended.
" You may request an accounting of certain disclosures of your protected health information we have made in the six years prior to
the date of the request, but not prior to April 14, 2003. We are not required to provide an accounting of disclosures or uses that
occurred for treatment, payment, or health care operations or our sharing of information with our business associates.
" You may request a paper copy of this Notice from our Privacy Officer at any time. If we maintain a web site, we will post a copy
of our current Notice on our site.
How Falls Co. EMS, Inc. Uses and Discloses Health Information that Identifies You
Falls Co. EMS, Inc. maintains your protected health information in a confidential manner in accordance with legal requirements.
However, we may use protected health information as necessary, without your consent, for the purposes of treatment, payment,
and health care operations, Some examples are:
1. Treatment. This involves oral and written information we will obtain and share among health care providers involved in your care
and transportation.
2. Payment. This involves obtaining payment for the transportation and care provided to you. For example, we will provide
information about your transportation and care to insurance companies and entities and agencies involved in reimbursement and
medical necessity or utilization review.
3. Health care operations. This involves the use of information about you to improve the quality of care. For example, we will use
information about you for training, quality control, and licensure purposes.
In addition, Falls Co. EMS, Inc. is permitted to use and disclose protected health care information as authorized or required by
Federal, state, or local law, without your written authorization in these ways:
" To your parent or guardian, if you are a minor;
" To your legal guardian or attorney ad litem if one is appointed for you;
" Any use or disclosure related to public health activities;
" Use or disclosure in connection with judicial or administrative proceedings, lawsuits, subpoenas and disputes;
" For law enforcement purposes;
" In health care fraud and abuse detection activities;
" For health oversight activities, investigations by a governmental entity or its contractor, and disciplinary or licensure proceedings;
" For military, national defense and security, or law enforcement purposes;
" To coroners, medical examiners, and funeral directors;
" To avert threats to health and safety; and,
" Uses and disclosures that do not identify you;
Other Uses and Disclosures
We will use protected health information for other purposes, unless you ask for restrictions on a specific use or disclosure, for the
following other purposes:
" To provide you reminders of scheduled transportation.
" To provide you information about the services we provide and the benefits that may be available to you.
" To contact you to raise funds for our activities.
Any other use or disclosure of protected health information (besides those described in this Notice) will occur only with your
written authorization. If you give us such an authorization, you may revoke it in writing at any time. Once you revoke such
authorization, no further use or disclosure by virtue of that revoked authorization will occur.
Exercising your rights
To exercise any of the rights described in this Notice, contact our Privacy Officer listed below.
Complaints
If you believe that your privacy rights have been violated, you may file a complaint with Falls Co. EMS, Inc. or with the Secretary
of the United States Department of Health and Human Services. You will not be penalized or retaliated against in any way for
making a complaint to Falls Co. EMS, Inc. or the Department of Health and Human Services.
Contacting Falls Co. EMS, Inc.
You may contact Falls Co. EMS, Inc.'s Privacy Officer, Lori Adams at 254-883-5445, 403 Bridge St. Marlin, Texas 76661 to file a
complaint, if you have questions about this Notice, if you wish to request restrictions on uses and disclosures for health care
treatment, payment, or operations, or if you wish to exercise your rights described above.
