NOTICE OF PRIVACY PRACTICES OF GENTLE RIDE AMBULANCE

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. If you have any questions about this notice, please contact our Privacy Officer. As an essential part of our commitment to our clients, GENTLE RIDE Ambulance Services, Inc., ensures the privacy of confidential health care information about you, known as Protected Health Information("PHI"). We are mandated by law to protect your health information and to provide you with this Notice of Privacy Practices.

This Notice outlines our legal duties and privacy practices with respect to your Protected Health Information. It not only describes our privacy practices and legal rights, but lets you, as our client, know, among other things, how GENTLE RIDE Ambulance is permitted by law to use and disclose Protected Health Information about you, how you can obtain access and copy the information that we maintain on you, how you may request amendments to that information, and how you may request restrictions on our use and disclosure of your Protected Health Information.

GENTLE RIDE Ambulance is required to abide by the terms of the version of this Privacy Notice currently in effect. In most situations, we may use the information as described in this Privacy Notice without your permission, but there are some situations where we may use it only after we obtain your written authorization, if required by law to do so. GENTLE RIDE Ambulance vows to respect your privacy, and treat all health care information about our clients under strict policies of confidentiality that all of our staff members are committed to following at all times.

Our Obligations under Law

  • Maintain the privacy of protected health information;
  • Give you this notice of our legal duties and privacy practices regarding health information about you; and
  • Follow the terms of our notice that is currently in effect;

How We May Use & Disclose Health Information

The following describes ways that we are allowed to use and disclose Protected Health Information. Some of the categories include examples, but every type of use or disclosure of your Protected Health Information in a category is not listed. Except for the purposes described below, we will use and disclose your Protected Health Information only with your written permission. If you give us permission to use or disclose Protected Health Information for a purpose not discussed in this notice, you may revoke that permission in writing, at any time addressed to our Privacy Officer.

  • For Treatment. We may use Protected Health Information to provide you with medical treatment and/or transportation services. We may disclose Protected Health Information to other health care providers that are involved with your medical treatment, including people outside our facility. For example, we may tell your primary physician about the care we provided you or give Protected Health Information to a specialty care provider to provide you with additional medical treatment or services.
  • For Payment. We may use and disclose Protected Health Information so that we may bill or receive payment from you, an insurance company or third party for the treatment and services we provided to you. For example, we may provide your health plan information about your treatment/transport so that they will pay for such treatment. We also may tell your health plan about a treatment you are going to receive in order to obtain prior authorization or to determine whether your plan will cover the services and/or treatment.
  • For Health Care Operations. We may use and disclose Protected Health Information for health care operations purposes. These uses and disclosures are necessary to make sure that all of our clients receive the highest quality care and for our operational and management purposes. For example, we may use Protected Health Information in order to conduct Quality Assurance Review of the services/transportation that was provided to you.
  • Individuals Involved in Your Care or Payment for Your Care. We may release Protected Health Information to a person who is involved in your medical care or helps pay for your care, such as a family member or friend. We also may notify your family about your location or general condition and/or disclose such information to an authorized entity assisting in a disaster relief effort.

Special Circumstances

  • As Required By Law. We will disclose Protected Health Information when required to do so by federal, state or local law. To Avert a Serious Threat to Health or Safety. We may use and disclose Protected Health Information when necessary to prevent or lessen a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, will be to limited someone who is authorized by law to receive such information, such as law enforcement officers.
  • Business Associates. We may disclose Protected Health Information to our business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions of services. For example, we may use another company to perform billing services on our behalf. All of our business associates are obligated, under contract with us, to protect the privacy of your information to the same extent as us and are expressly prohibited from using or disclosing any information other than as specified in our contract.
  • Organ and Tissue Donation. If you are an organ donor, we may release Protected 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 or tissue donation and transplantation.
  • Military and Veterans. If you are a member of the armed forces, we may release Protected Health Information as required by military command authorities.
  • Worker's Compensation. We may release Protected Health Information for worker's compensation or similar programs. These programs provide benefits for work related injuries or illness.
  • Public Health Risks. We may disclose Protected Health Information for public health activities. These activities generally include disclosures to prevent or control disease, injury or disability; report births and deaths; notify people of recalls of products they may be using; track certain products and monitor their use and effectiveness; notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and conduct medical surveillance of the office in certain limited circumstances concerning work place illness or injury. We also may release Protected Health Information to an appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence; however, we will only release this information if you agree or when we are required or authorized by law.
  • Health Oversight Activities. We may disclose Protected Health Information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government 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 Protected Health Information in response to a court or administrative order. We also may disclose Protected Health Information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
  • Law Enforcement.We may release Protected Health Information if asked by a law enforcement official for the following reasons:
    1. in response to a court order, subpoena, warrant, summons or similar process;
    2. limited information to identify or locate a suspect, fugitive, material witness, or missing person;
    3. about the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement;
    4. about a death we believe may be the result of criminal conduct;
    5. about criminal conduct on our premises; and
    6. in emergency circumstances to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime.
  • Coroners, Medical Examiners and Funeral Directors. We may release Protected 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.
  • National Security and Intelligence Activities. We may release Protected Health Information to authorized federal officials for intelligence, counter-intelligence, and other national security activities authorized by law, or pursuant to a valid court order or subpoena.
  • Inmates or Individuals in Custody.If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release Protected Health Information to the appropriate correctional institution or law enforcement official. This release would be made only if necessary
    1. for the institution to provide you with health care;
    2. to protect your health and safety or the health and safety of others; or
    3. for the safety and security of the correctional institution.

Any other use or disclosure of Protected Health Information, other than those listed above will only be made with your express written authorization, (the authorization must specifically identify the information we seek to use or disclose, as well as when and how we seek to use or disclose it). 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.

Your Rights

You have the following rights regarding Protected Health Information we maintain about you:

  • Right to Inspect and Copy. You have the right to inspect and copy Protected Health Information that may be used to make decisions about your care or payment for your care. To inspect and copy this Protected Health Information, you must make your request, in writing, to our Privacy Officer.
  • Right to Amend. If you feel that Protected Health Information we have is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for us. To request an amendment, you must make your request, in writing, to our Privacy Officer.
  • Right to an Accounting of Disclosures. You have the right to get a list of instances in which we have disclosed your Protected Health Information. The list will not include disclosures we have made for our treatment, payment and health care operations purposes, those made directly to you or your family or friends or through our facility directory, or for disaster relief purposes. Neither will the list include disclosures we have made for national security purposes or to law enforcement personnel, or disclosures made before April 14, 2003.
  • Right to Request Restrictions. You have the right to request a restriction or limitation on the Protected Health Information we use or disclose for treatment, payment, or health care operations. In addition, you have the right to request a limit on Protected Health Information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not share information about your surgery with your spouse. To request a restriction, you must make your request, in writing, to our Privacy Officer. We are not required to agree to your request. If we agree, we will comply with your request unless we need to use the information in certain emergency treatment situations.
  • 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. For example, you can ask that we contact you only by mail or at work. To request confidential communications, you must make your request, in writing, to our Privacy Officer. Your request must specify how or where you wish to be contacted. We will accommodate reasonable requests.
  • 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 a paper copy of this notice, contact our Privacy Officer.

Changes to this Notice

We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for Protected Health Information we already have as well as any information we receive in the future. We will post a copy of the current notice at our office. The notice will contain the effective date on the first page, in the top right-hand corner.

Complaints

If if you believe your privacy rights have been violated; you may file a complaint with Gentle Ride Ambulance Services, Inc., or the Secretary of Department of Health and Human Services. To file a complaint with Gentle Ride Ambulance, please contact 800-688-8030, and request to speak to the on-duty manager and/or the Privacy Officer.